Background:

Severe buccal bone destruction in the esthetic zone represents one of the most challenging reconstructive situations in implant dentistry. Traditional staged approaches involving block grafts and mesh techniques are associated with infection risk, graft resorption, prolonged treatment time, donor-site morbidity, and multiple surgeries.

 

Objective:

To evaluate whether a single-stage protocol combining immediate implant placement, simultaneous guided bone regeneration (GBR), and immediate loading can achieve mechanical stability and biological predictability.

 

Methods:

A cortical anchorage–driven concept was applied using long implants (13–18 mm) engaging cortical bone to obtain primary stability (>40 Ncm). Simultaneous GBR was performed using autogenous chips, xenograft, and a collagen membrane without fixation pins to preserve vascularization. Immediate provisionalization was used to protect the graft and guide soft tissue maturation.

 

Results:

CBCT evaluation at 6–8 months demonstrated >10 mm vertical bone gain and 2–3 mm horizontal gain, with stable crestal levels and mature soft tissue.

 

Conclusion:

This 3-in-1 protocol reduces surgical stages, morbidity, and overall treatment time while maintaining biomechanical stability and biological principles in severe buccal defects.