Preservation of Alveolar Dimensions at Molar Immediate Implant Sites Using Laser-Assisted Clot Stabilization: A Report of Four Consecutive Cases with One to Three Years of Follow

Objective: Immediate implant placement into a molar extraction socket may hasten return to masticatory function and reduce overall treatment time. Placement of a graft or biomaterial in the peri-implant gap defect (PGD) has been associated with superior treatment outcomes. The purpose of this report is to present four cases demonstrating use of laser-generated blood clots to stabilize freeze-dried bone allografts (FDBAs) at molar immediate implant sites. Methods: Four patients with non-restorable mandibular first molars presented to the Department of Periodontics, Army Postgraduate Dental School, Uniformed Services University, Fort Eisenhower, GA, USA. The hopeless teeth were extracted without flap reflection, and dental implants were installed in each socket. FDBAs were applied in the PGDs. In one case, a cover screw was utilized, and the implant was submerged under a laser-generated clot. In the remaining cases, transmucosal healing abutments were installed. Results: Favorable healing was observed in all cases, each patient reporting minimal discomfort limited to the first two postoperative days. At the submerged implant site, > 2 mm buccal bone thickness was noted at re-entry. In the remaining cases, keratinized peri-implant mucosa was in contact with the healing abutment at the one-week follow-up appointment. All implants exhibited interproximal radiographic bone levels coronal to the first implant thread at every follow-up assessment. Conclusions: Whether infrared lasers enhance healing at immediate implant sites remains an open question in implantology. However, the presented cases demonstrate that a neodymium-doped yttrium aluminum garnet laser can reliably stabilize particulate bone allografts in PGDs at immediate implant sites exhibiting large horizontal defect dimensions.