The proposed three-stage protocol :
The protocol used in our case report consists in deviding implant placement into 3 distinct surgeries :
The frist surgery is undoubtedly the most risky ; in fact, drilling through the dysplasic tissue generates heat which increases the risk of infection and necrosis of the surrounding tissue. Systematic antiotherapy is highly advised in this stage to prevent such risks. In case it proved unsufficient, infection must be treated with surgical curettage of the site, betadine rinsing and the prescription of an antiseptic mouthwash.
Delaying implant insertion 3 to 4 weeks comes with 2 major advantages ; First, preventing implant surface contamination in case of infection due to the drilling sequence. And second, the time lapse between the drilling sequence and implant placement matches the proliferation phase of the socket healing process caracterized by the formation of a woven immature bone surrounded by a provisional fibrous matrix (fig 14)(14). It has been hypothesized that this newly-created healthy tissue surroundig the implant would act more like normal bone and would be more compatible with implant osseointegration than the cementum-like tissue originally found in COD.
In addition, delaying the placement of the healing abutement is highly advised. In fact, exposing the implant to the oral cavity’s flora simultaniously with its insertion increases the risk on infection. A 3-month delay enables the surrounding hard tissue to reach a more mature state corresponding to the remodeling phase of the socket healing process (14).