Impact of the Buccal Dehiscence Morphotype on the Regenerative Strategy in Immediate Implant Placement

OBJECTIVE: To propose buccal dehiscence morphotypes and discuss their impact on the regenerative potential and strategy in immediate implant placement (IIP). CLINICAL CONSIDERATIONS: Eleven buccal dehiscence morphotypes could be identified based on vertical and lateral extent, and facial soft tissue support. Two morphotypes should not be treated with IIP given a high risk of esthetic failure. These include a buccal dehiscence combined with facial recession and extended defects. Nine morphotypes may be amenable to IIP and appropriate regenerative strategy. Sockets with a relatively high regenerative potential can be treated by slightly modifying the trimodal approach for intact sockets. Sockets with a moderate regenerative potential require the additional use of a non-supportive barrier, whereas those with a low regenerative potential require a supportive barrier and composite bone graft. Comprehensive diagnosis, expertise, and surgical skills are key to identify the correct morphotype, to select the appropriate regenerative strategy and to put it into practice. CONCLUSIONS: The identification of two morphotypes that contraindicate IIP is the first and most crucial step in the clinical decision-making process. Other morphotypes may be amenable to IIP, yet require comprehensive diagnosis, expertise, and surgical skills. Clinical studies are needed to validate the concepts presented in this article.