Introduction: Replacing single rooted teeth with immediate implant is quit challenging in the anterior region where the buccal bone is usually deficient, moreover the bone loss increases with the extraction of tooth and the cutting of the blood supply from the periodontal ligament. With the normal bone loss around successful implant about 0.2 mm per year, its essential to start with enough buccal bone bulk to ensure long survival of the implant. The main disadvantage of guided bone regeneration is the inability of the membrane to protect the graft from the forces exerted during suturing of the flap at the end of the procedure and the forces exerted by the patient's muscles during mastication, leading to displacement of the bone graft. Tent pole technique suggest the use of monocortical screws to support the membrane preventing displacement of the bone graft. Bone ring technique suggest surrounding the implant by ring of bone which is fixed in place by the implant itself. Aim: The aim of the study is to evaluate the effect of Bone Ring technique, and Tent-Pole technique on buccal/Labial bone with immediate implant placement. Methodology: Clinical study will be done in 24 cases of single rooted teeth with deficient buccal bone and require replacement with immediate implant. The 24 cases will be divided into three groups ,8 cases each. In group A, immediate implant will be placed with traditional guided bone regeneration, in which the buccal bone will be enhanced by autogenous bone chips obtained from the symphysis area and then covered by resorbable membrane. In group B, immediate implant will be placed with bone ring technique, in which autogenous bone ring obtained from the symphysis will be placed around the implant and fixed in place by the implant itself. In group C, immediate implant will be placed with tent pole technique, in which monocortical screws will be placed to support the membrane covering the autogenous bone chips obtained from the symphysis area. the implant stability will be measured immediate after implant placement and after six months from the surgery using osstel system. The buccal bone volume changes will be measured by cone beam ct.
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Implant Stability
Timeframe: Initial stability will be measured immediately after implant insertion before placement of cover screw and final stability will be measured after 6 months from the surgery
Bone density
Timeframe: To compare the changes in bone density in each group, the bone density around each implant was measured in two main CBCTs, which are the immediate post-operative CBCT and the final CBC taken 6 months postoperatively.
Buccal bone height
Timeframe: A) Initial change The buccal bone height in preoperative CBCT will be compared to that in the immediate postoperative CBCT B) Final change The buccal bone height in preoperative CBCT will be compared to that in 6 months postoperative CBCT
Buccal bone width
Timeframe: A) Initial change The buccal bone width in preoperative CBCT will be compared to that in the immediate postoperative CBCT B) Final change The buccal bone width in preoperative CBCT will be compared to that in 6 months postoperative CBCT
Full ridge width
Timeframe: A) Initial change The maximum ridge thickness in preoperative CBCT will be compared to that in the immediate postoperative CBCT B) Final change The maximum ridge thickness in preoperative CBCT will be compared to that in 6 months postoperative CBCT