Immediate Implants in Front Teeth With Bone Loss: Regeneration and Temporary Crown in a Randomized Clinical Study

This clinical trial investigates the biological and clinical outcomes of immediate implant placement in aesthetic areas presenting with buccal bone dehiscence. Traditionally, these defects are treated with a bone graft and covered using a collagen membrane; however, there is ongoing debate about whether the membrane is necessary for optimal regeneration. This study proposes the use of a connective tissue graft instead of a collagen membrane, aiming to improve soft tissue volume and aesthetics without compromising bone healing. The objective of the study is to evaluate whether the use of an autogenous connective tissue graft in combination with a deproteinized bovine bone mineral with collagen (DBBM-C) achieves results that are not inferior to the conventional protocol that uses DBBM-C and a collagen membrane. The main outcome variable is the vertical buccal bone gain measured after twelve months of healing. The study design is a randomized controlled clinical trial including twenty-four patients divided equally into two groups. Each participant will attend eight follow-up visits over twelve months. After atraumatic tooth extraction, immediate implants (BLC, Straumann) will be placed using a prosthetically guided protocol. Buccal dehiscence will be measured intraoperatively, and a partial-thickness tunnel flap will be prepared to allow soft tissue adaptation and graft placement. In the control group, the defect will be filled with DBBM-C and covered with a collagen membrane stabilized with horizontal mattress sutures. In the test group, the defect will receive DBBM-C covered by a connective tissue graft harvested from the palate and fixed in a similar manner. When primary stability is equal to or greater than 35 N/cm, an immediate screw-retained provisional crown will be delivered; if stability is lower, a customized healing abutment or Maryland-type provisional will be used instead. After three months, digital impressions will be taken to fabricate the definitiv