Vestibular Socket Therapy Using Acellular Dermal Matrix Versus Connective Tissue Graft in Immediate Implants of Aesthetic Zone
Phase: PHASE2
Conditions: Immediate Implant
Sponsor: Tanta University

Vestibular Socket Therapy Using Acellular 
Dermal Matrix versus Connective Tissue Graft 
in Immediate Implants of Aesthetic Zone 
 
 
Protocol of Thesis Submitted in Partial Fulfillment of The 
Requirements for Doctor Degree  
in 
 Oral Medicine, Periodontology,  
Oral Diagnosis and Radiology 
 
 
By 
Amr Anwar Mohammed Ellithy 
B.D.S (2012) 
M.S.C (2021) 
 
 
Oral Medicine, Periodontology,  
Oral Diagnosis and Radiology 
Faculty of Dentistry 
Tanta University 
2021 

Supervisors 
 
Dr. Maher Mohamed Mahmoud El-Tonsy 
Professor of Oral medicine, Periodontology, 
Oral Diagnosis & Radiology 
Faculty of Dentistry 
Tanta University 
(Main supervisor) 
 
 
 
Dr. Sahar Fawzy Ghoraba  
Professor of Oral medicine, Periodontology, 
Oral Diagnosis & Radiology 
Faculty of Dentistry 
Tanta University 
 
 
Dr. Bassem Nabil Mohammed El Fahl 
Lecturer of oral, Periodontology, 
Oral Diagnosis & Radiology 
Faculty of Dentistry 
Tanta University 
 
 

1 
Introduction 
Tooth extraction is one of the most widely performed procedures in 
dentistry and it may lead to significant dimensional changes of the alveolar 
ridge. However, loss of alveolar bone may occur prior to tooth extraction 
because of periapical pathology, trauma and\or advanced periodontal 
disease.(1) 
Patients have been seeking for the optimum treatment outcomes 
following the replacement of missing teeth which could be achieved this by 
using different treatment protocols, including conventional removable 
prostheses, overdentures, fixed prostheses and dental implants.(2) 
Dental implants have been in use for over 50 years and according to 
the literature are a highly successful treatment option for the long-term (10-
years plus) replacement of missing teeth.(3) Considering replacing a tooth 
with an implant, clinician is faced to choose either delayed or immediate 
approach. Delayed Approach, where the hopeless tooth is extracted, and the 
implant is placed after completion of partial ridge healing occurs. The 
resultant osseous sites are often accompanied by significant vertical and   
horizontal changes in both hard and soft tissue dimension. These changes 
may subsequently require additional procedures to reconstruct the collapsed 
ridge and further prolong treatment duration.(4, 5) 
The other approach which is immediate implant placement in the 
extraction socket is an attractive treatment modality that facilitates 
immediate tooth replacement and reduces treatment time, cost and surgical 
trauma as compared to delayed approaches.(6) 

2 
Elian et al.,(7) proposed a classification for the extraction sockets and 
the rendered treatment approach, in which sockets were divided into three 
types (Type I, type II and type III). Figure (1)  
 
Figure (1) Illustration of the three types of extraction sockets, as defined by the facial soft 
tissue and buccal plate of bone present. 
Type I socket, facial or buccal plate of bone and soft tissue level is 
normal related to the cemento-enamel junction of the extracted tooth and still 
intact post extraction. Type II socket, the facial soft and hard tissues are 
normal, but the buccal plate is partially missed after tooth extraction. Type 
III socket, the buccal bone plate and facial soft tissue are reduced after tooth 
extraction.(7) 
Type II sockets are usually the most difficult to diagnose. They are 
very deceptive, as the inexperienced dentist may treat it as a Type I socket. 
This leads to less aesthetic outcomes. The major aesthetic problems arise 
from compromised treatment of Type II sockets because of post treatment 
soft tissue recession.(7) 
A modification to Elian’s classification(7) was proposed by El Askary  
2019,  Each class was divided into several subdivisions based upon; buccal 

3 
bone thickness, soft tissue thickness, keratinized tissue width, palatal bone 
level and the degree of vertical buccal bone and soft tissue loss. This 
modification aimed at facilitating precise diagnosis of extraction sockets and 
increasing the versatility of customized treatment options for various case 
scenarios.(8) However, this treatment concept has been controversial in terms 
of implant survival , aesthetic outcomes and possible  post-operative  
resorption of bone plates in particular, when anterior maxilla is involved.(6, 9) 
Multiple approaches have been developed to overcome such 
drawbacks such as dual zone grafting(10) , socket shield technique(11) and 
more recently vestibular socket therapy. (12) 
Sanz et al.,(13)studied adding bone grafts in the gap between the 
implant and facial bone surface in immediate implants (dual zone) and stated 
that the horizontal crest dimension underwent changes during healing at the 
facial side of the alveolar crest where this reduction estimated to 
1.1mm(29%) in the cases with graft and 1.6 mm (38%) in the non-grafted 
case.  
Another technique  introduced by Hürzeler et al ., (11) which is socket 
shield technique that involves partial tooth extraction and intentional 
retention of a section of a small labio-coronal fragment at the time of 
immediate implant placement. This aimed at tricking the bone that the tooth 
is still present and preserving the blood supply reaching the facial cortical 
plate from the periodontal ligaments and thus reduces resorption in both 
buccal/proximal bone. (14) 
Disadvantages of socket shield technique were reported in a systematic 
review by Gharpure and Bhatavadekar (15) where clinical studies showed 
complications as, buccal/crestal bone loss and shield exposure/failure which 

4 
were the most common. Other complications such as formation of cementum 
and periodontal fibers on implant surfaces, pockets , mucositis, and peri-
implantitis.(15, 16) However, some clinical reports recorded stable results at 
one year follow up interval. It is still difficult to predict the long-term 
success of this technique.(17) 
Most recently, a novel technique for immediate implant placement, 
the vestibular socket therapy (VST) was described by Elaskry et al., 
(18)for treating wide variety of fresh extraction  sockets , intact , thin, lost 
labial plate of bone and infected sockets, where a facial bone membrane 
shield is applied from a horizontal incision in the vestibule to cover 
particulate bone graft that is added in the socket in addition to placing a 
custom made healing abutment to seal the socket rim. It was 
hypothesized that this technique restore the lost osseous architecture, 
stabilize soft tissue margins, and allowed immediate placement compared 
to immediate implant placement using other techniques reported in the 
literature.(19, 20) 
Various materials can be used to augment bone deficiency in fresh 
extraction socket including bone grafts and barrier membranes. One of 
innovative materials is the allogenic bone membranes made from 
demineralized cortical bone fibers that are entangled and shaped into 
sizes engineered to complement specific surgical applications. This 
unique process creates an interconnected graft material that contains 
BMPs and other growth factors necessary for the promotion of new bone 
formation. Bone membranes are flexible upon hydration and each 
allograft has a sterility assurance level of 10 -6 via low-dose gamma 
sterilization(21, 22).  

5 
The anatomy of soft tissues around dental implants is extremely 
important to prevent inflammatory peri-implant diseases and ensure 
healthy, stable and long-term survival of a dental implant. Various 
methods and materials for increasing the physiological thickness of 
tissues 
have 
been 
described 
including 
connective tissue 
graft (CTG) which is considered the gold standard material for 
augmenting soft tissue around implant(23) . 
Another type of membrane is freeze dried Acellular dermal matrix 
(Alloderm) which is a biocompatible tissue composed a structurally 
integrated basement membrane complex and extracellular matrix with 
collagen bundles and elastic fibers. The alloderm was used as an 
alternative to autogenous free gingival graft to increase amount of 
keratinized tissue around natural teeth or dental implants(24).  
Given that to date, there is very little information about soft tissue 
around implants with vestibular socket therapy. Therefore, our study will be 
directed towards clinical and radiographical evaluation and comparing the 
Vestibular Socket Therapy (VST) technique using Alloderm versus 
connective tissue graft both with xenogenic bone membrane in immediate 
implants of anterior aesthetic zone. 
 
 

6 
Aim of The Work 
The aim of this study is to evaluate and compare the Vestibular Socket 
Therapy (VST) technique using alloderm versus connective tissue graft both 
with xenogenic bone membrane in immediate implants of anterior aesthetic 
zone. 
 
 
 
 

7 
Materials and Methods 
Study design: 
A randomized controlled clinical and radiographic trial. 
Study setting: 
The research will be carried out in the outdoor clinic of Oral 
Medicine, Periodontology, Oral Diagnosis and Radiology Department, in 
accordance with the guidelines of human research by the Research 
Ethical Committee of the Faculty of Dentistry, Tanta University. 
Sample size: 
Sample size was estimated assuming 5% alpha error and 80% study 
power. After one year, the mean thickness of labial plate was 2.18±0.73 
mm using VST with bone membrane shield (18). By assuming that VST 
with alloderm membrane will have similar effect as collagen membrane, 
according to Sarnachiaro et al., (25), the mean thickness of labial plate was 
estimated after 12 months to be 3.3 mm. Based on difference between 
two independent means using SD of 0.73, the minimum sample size was 
calculated to be 8 sockets per group. This was increased to 10 sockets to 
make up for lost to follow up cases. Total sample size = Number per 
group x Number of groups = 10 x 2 =20 sockets. 
Software: 
Sample size was based on Rosner’s method (26) calculated by G-
power 3.0.10. (4) 
Patient and site selection: 
Twenty surgical sites with remaining roots or non-restorable teeth in 
the maxillary anterior region from canine to canine with sockets type II 

8 
confirmed with CBCT will be selected from the Periodontology Clinic, 
Faculty of Dentistry, Tanta University who fulfill the inclusion criteria. 
The purpose of the present study will be explained to patients and 
informed consents will be obtained according to guidelines adopted by 
Research Ethics Committee, Faculty of Dentistry, Tanta University. 
Inclusion criteria: 
1) Adults (20-50) years old. 
2) Class II socket according to Elian et al, (7)described as facial soft tissue is 
present but the buccal plate is partially missing following extraction of the 
tooth in the maxillary anterior region. 
3) Thin gingival phenotype. 
4) Bone quality ranges from D2-D3 as gained from preoperative cone beam 
computed tomography. 
5) Presence of at least 3 mm of keratinized gingiva. 
6) Optimal compliance as evidenced by no missing treatment appointments 
and positive attitude towards oral hygiene. 
Exclusion criteria: 
1. Medically compromised patients and systemic conditions precluding 
implant and periodontal surgery. 
2. Smokers, diabetics, pregnant or lactating women. 
4. History of chemotherapy, radiotherapy in head and/or neck region. 
5. Bisphosphonate therapy. 
Materials: 
1) Implant* 
2) Computer assisted surgical guide for implant† 
 
* biohorizons implant, the pro,platform switching design,USA 

9 
3) Xenogenic bone membrane shield‡ 
4) Alloderm§ 
5) Xenograft ** 
6) Connective tissue graft  
The clinical study design: 
1- Phase I therapy 
All patients will receive a comprehensive periodontal examination, oral 
hygiene instructions and they will be subjected to full mouth scaling and root 
planning (SRP) and polishing. 
2- Patient grouping: 
Twenty surgical sites will be divided into two groups; each of 
which has 10 surgical sites. Grouping will be done randomly sequentially 
numbered, opaque, sealed envelopes (SNOSE) 
The groups will be treated as follow: 
• Group I:  Ten sites will be treated by immediate implant and VST with 
Alloderm + allogenic bone membrane and xenograft.  
• Group II: Ten sites will be treated by immediate implant and VST with 
connective tissue graft + allogenic bone membrane and xenograft.  
3- Surgical protocol: 
− Sulcular incision will be made under local anesthesia, and then hopeless 
teeth will be extracted atraumatically. Socket lavage and curettage, the 
socket type will be assessed and confirm the presence of adequate 
interproximal bone level. 
 
† Specially designed for every case according to biohorizons guided surgical kit 
‡ Osteobiol ,flexible xenograft cortical sheet from Technoss,USA 
§ AlloDerm SELECT™ RTM,biohorizons 
** Deproteinized bovine bone minerals (DBBM), Min Oss X from biohorizons,USA 

10 
− A vestibular access horizontal incision will be made at the socket site, 3 
to 4 mm apical to the mucogingival junction and extending 5 to 10 
mm horizontally. 
− A sub mucoperiosteal tunnel will be created starting from the facial 
aspect of the socket orifice and extending apically until the vestibular 
access incision. 
− A computer guided surgical template will be used to deliver the implant 
(Biohorizons implant) in the optimum prosthetically guided position 
with the implant shoulder placed 3 to 4 mm apical to the labial 
gingival margin. 
− Connective tissue graft of sufficient size will be harvested from the 
patient palate opposite to the area from canine region to first molar 
region and then trimmed to fit the facial wall  
Group I:  Implant will be placed through the surgical guide in the extraction 
socket then xenogenic bone membrane will be trimmed to fit the facial 
wall of the socket and introduced through the tunnel lying over the 
facial bone plate and stabilized by bone tacks then Alloderm 
membrane will be trimmed to be placed through the tunnel lying over 
allogenic bone membrane. The facial gap will be filled with 
xengogenic bone graft. 
Group II: Implant will be placed through the surgical guide in the 
extraction socket then xenogenic bone membrane will be trimmed to 
fit the facial wall of the socket and introduced through the tunnel 
lying over the facial bone plate and stabilized by bone tacks then 
connective tissue graft will be placed through the tunnel lying over 
allogenic bone membrane. The facial gap will be filled with 
xengogenic bone graft. 

11 
The socket orifice will be sealed using a customized healing 
abutment screwed to the implant, adequately finished, and polished to 
ensure a proper soft tissue emergence profile, while the vestibular access 
horizontal incision will be sutured. 
4-Postoperative Phase 
-All subjects will receive postoperative instructions including (27) 
a) Rinsing with 0.1% Chlorhexidine mouth rinse twice daily for two weeks. 
b) Antibiotics combination of 500 mg Metronidazole along with Amoxicillin 
Clavulanate (Augmentin 100 mg) every 12 hours one day preoperatively 
and continuing for 5 days after extraction.(18) 
c) Non-steroidal anti-inflammatory (NSAID) medication of Ibuprofen 400 
mg twice daily for one week. 
5-Clinical Assessment: 
Each group will be subjected to intraoral scanning at baseline, 6 
months and 12 months. The changes in peri-implant mucosal level will be 
assessed by superimposition of scanning files of different intervals to 
monitor the changes in surface area calculated by software. 
The changes in gingival phenotype could be assessed at 6 months and 
12 months intervals by superimposition of DICOM files on CBCT software. 
 
 

12 
6-Radiographic Assessment: 
Each group will be subjected to: Cone Beam Computed Tomography 
(CBCT) at baseline, 6 months and 12months to asses both thickness and 
height of labial (facial) plate of bone and implant survival. 
7-Statistical analysis: 
Results will be collected, tabulated and analyzed using computer 
software. Data will be presented as mean and standard deviation (SD) values 
and the significance level will be set at p < 0.05. The differences of the 
clinical parameters within the time intervals in each group will be 
determined. Statistical analysis will be carried out blindly such that the 
assigned groups should not be revealed during the analysis. 
Rules and Responsibilities: 
Study chair: Dr. Abd El-Salam El-Askary is the inventor of the 
technique will be overlooking the whole procedures to ensure the accurate 
delivery of the procedure as it was described.  
 
 
 
 
 

13 
 
References 
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contour changes following single-tooth extraction: a clinical and radiographic 
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Howe M-S, Keys W, Richards D. Long-term (10-year) dental implant survival: A 
systematic review and sensitivity meta-analysis. Journal of dentistry. 
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4. 
Hansson S, Halldin A. Alveolar ridge resorption after tooth extraction: A 
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biomechanics. 2012;3. 
5. 
Tan WL, Wong TL, Wong MC, Lang NP. A systematic review of post‐
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Clinical oral implants research. 2012;23:1-21. 
6. 
Jiang X, Di P, Ren S, Zhang Y, Lin Y. Hard and soft tissue alterations during the 
healing stage of immediate implant placement and provisionalization with or 
without connective tissue graft: A randomized clinical trial. Journal of Clinical 
Periodontology. 2020;47(8):1006-15. 
7. 
Elian N, Cho S, Froum S, Smith RB, Tarnow DP. A simplified socket 
classification and repair technique. Practical Procedures and Aesthetic 
Dentistry. 2007;19(2):99. 
8. 
Elaskary A. Advances in Esthetic Implant Dentistry: John Wiley & Sons; 2019. 
9. 
Araújo MG, Sukekava F, Wennström JL, Lindhe J. Ridge alterations following 
implant placement in fresh extraction sockets: an experimental study in the 
dog. Journal of clinical periodontology. 2005;32(6):645-52. 
10. Tan-Chu J, Tuminelli FJ, Kurtz KS, Tarnow DP. Analysis of buccolingual 
dimensional changes of the extraction socket using the “ice cream cone” 
flapless grafting technique. Int J Periodontics Restorative Dent. 
2014;34(3):399-403. 
11. Hürzeler MB, Zuhr O, Schupbach P, Rebele SF, Emmanouilidis N, Fickl S. The 
socket‐shield technique: a proof‐of‐principle report. Journal of clinical 
periodontology. 2010;37(9):855-62. 
12. Th Elaskary A, Gaweesh YY, El Tantawi M, Maebed MA. Vestibular Socket 
Therapy: A Novel Approach for Implant Placement in Defective Fresh 
Extraction Sockets With or Without Active Socket Infection (One-Arm Cohort 
Study). International Journal of Oral & Maxillofacial Implants. 2021;36(1). 
13. Sanz M, Lindhe J, Alcaraz J, Sanz‐Sanchez I, Cecchinato D. The effect of placing 
a bone replacement graft in the gap at immediately placed implants: a 
randomized clinical trial. Clinical Oral Implants Research. 2017;28(8):902-10. 

14 
14. Cornelini R, Cangini F, Martuscelli G, Wennström J. Deproteinized bovine 
bone and biodegradable barrier membranes to support healing following 
immediate placement of transmucosal implants: a short-term controlled 
clinical trial. International Journal of Periodontics & Restorative Dentistry. 
2004;24(6). 
15. Gharpure AS, Bhatavadekar NB. Current evidence on the socket-shield 
technique: a systematic review. Journal of Oral Implantology. 2017;43(5):395-
403. 
16. Nevins ML, Langer L, Schupbach P. Late Dental Implant Failures Associated 
with Retained Root Fragments: Case Reports with Histologic and SEM 
Analysis. International Journal of Periodontics & Restorative Dentistry. 
2018;38(1). 
17. Saeidi Pour R, Zuhr O, Hürzeler M, Prandtner O, Rafael CF, Edelhoff D, et al. 
Clinical benefits of the immediate implant socket shield technique. Journal of 
Esthetic and Restorative Dentistry. 2017;29(2):93-101. 
18. Elaskary AT, Gaweesh YY, Maebed MA, Cho S-C, El Tantawi M. A Novel 
Method for Immediate Implant Placement in Defective Fresh Extraction Sites. 
International Journal of Oral & Maxillofacial Implants. 2020;35(4). 
19. Spray JR, Black CG, Morris HF, Ochi S. The influence of bone thickness on 
facial marginal bone response: stage 1 placement through stage 2 uncovering. 
Annals of periodontology. 2000;5(1):119-28. 
20. Grunder U, Gracis S, Capelli M. Influence of the 3-D bone-to-implant 
relationship on esthetics. International Journal of Periodontics & Restorative 
Dentistry. 2005;25(2). 
21. Dias FJ, Arias A, Borie E, Lezcano MF, Arellano-Villalón M, Fuentes R. 
Comparison of morphological quantitative characteristics of the newly 
formed alveolar bone after the application of demineralized bone matrix and 
cortical bone allografts. 2019. 
22. Charde P, Thakare KS, Bhongade ML, Markovic A, Deshpande AM. 
Reconstruction of Interimplant Papilla by Demineralized Freeze-dried Bone 
Allograft Block Fixed by Titanium Screw in Maxillary Esthetic Zone. J Contemp 
Dent Pract. 2020;21:1205-9. 
23. Puzio M, Hadzik J, Błaszczyszyn A, Gedrange T, Dominiak M. Soft tissue 
augmentation around dental implants with connective tissue graft (CTG) and 
xenogenic collagen matrix (XCM). 1-year randomized control trail. Annals of 
Anatomy-Anatomischer Anzeiger. 2020;230:151484. 
24. Yan J-J, Tsai AY-M, Wong M-Y, Hou L-T. Comparison of acellular dermal graft 
and palatal autograft in the reconstruction of keratinized gingiva around 
dental implants: a case report. International Journal of Periodontics & 
Restorative Dentistry. 2006;26(3). 
25. Sarnachiaro GO, Chu SJ, Sarnachiaro E, Gotta SL, Tarnow DP. Immediate 
implant placement into extraction sockets with labial plate dehiscence 

15 
defects: a clinical case series. Clinical implant dentistry and related research. 
2016;18(4):821-9. 
26. Rosner B. Fundamentals of biostatistics: Nelson Education. 2015. 
27. Resnik RR, Misch C. Prophylactic antibiotic regimens in oral implantology: 
rationale and protocol. Implant dentistry. 2008;17(2):142-50. 
 

 
دراسة مقارنة لتقييم لا ةينقت
جالع نم ا ا ههجلا
يزيلهدلة 
لتجاويف الخلع 
  
بإستخدام كلا من هيولخلا همدألا 
وطعم النسيج الضام في 
اهيلامجلا هيمامألا قطانملا ف هيروفلا هعارزل 
 
 
 
لا ةجرد يلع لوصحلل يئزجلا ءافيتسإلل ثحب ةطخ
هاروتكد 
 في 
 
 
طب الفم وأمراض اللثه وطرق التشخيص والأشعه 
 
 
مقدمه من الطبيب 
 
عمرو أنور محمد الليثي 
 
بك( سويرولا2012
) 
ما( ريتسيج2021
)
 
 
 قسم طب الفم وأمراض اللثه 
  
وطرق التشخيص والأشعه  كلية طب الاسنان 
  
جامعة طنطا  
2021
 
 
 
 

 
 
 
 
نيفرشملا 
 
 
ا.د. 
ميسنوتلا دومحم دمحم رها 
و مفلا بط ذاتسا
ضارما ةثللا ،، ةعشالا و صيخشتلا قرطو 
نانسألا بط ةيلك - 
جاطنط ةعما 
(يسيئرلا فرشملا)
 
 
 
أ.د. 
سحر فوزي غرابه 
 
و مفلا بط ذاتسا
ضارما ةثللا ،، ةعشالا و صيخشتلا قرطو 
نانسألا بط ةيلك - 
جاطنط ةعما 
 
 
د. 
بلحفلا دمحم ليبن مسا 
سردم و مفلا بط
ضارما ةثللا ،، ةعشالا و صيخشتلا قرطو 
نانسألا بط ةيلك - 
جاطنط ةعما 
 

1 
الملخص العربي 
 
ةمدقملا 
ل جالعلا جئاتن لضفأ ىلع لوصحلل ىضرملاو نانسألا ءابطأ ىعسيتضيوع 
الأ .ةدوقفملا نانس
قام 
أنانسألا ءابط 
بالعمل علي 
تحقيق 
ذلك  
بةفلتخملا جالعلا تالوكوتورب مادختسا والتي من احدث 
 
اهتلثمأ تاسرغلا
ضيوعت يف همدختسملا الأسنان لعدة عقود. 
تتنوع  
 تارايخ ت تيقوت 
غرس الاسنان باحدي طريقتين احدهما التقليدية  والاخري الفورية 
حيث في الطريقة التقليدية ، يتم خلع السن ، وتوضع الغرسة بعد أن تلتئم علخلا فيواجت 
وفي هذه 
لاحلا
ة افش نوكي
اهئ 
مداعبأ نم لك يف ةريبك ةيقفأو ةيسأر تارييغتب اًبوحص 
الأنسجه اللينه والعظام. 
الأسلوب الآخر هو وضع الزرع الفوري ، حيث يمكن للطبيب أن يضع الغرسة فورًا بعد 
خلع السن 
وتتميز هذة الطريقه  
 ب
لاب ةص اخلا كلتل ة لثا مم حاج ن تالدع م راه ظإ عم ج العلا تقو لي لقت
سرغ 
يديلقتلا. 
من اجل 
تح، يجالع رايخ لضفأ ديدأنم ي 
وضع الزرع الفوري أو المتأخر ، مع أو بدون 
ي عط تم عظمي ، يجب أن نفهم كيفية تقييم شكل تجويف الخلع بعد  
خ
لع الأسنان ، ووجود ودرجة تراجع 
 هثللا على السن الذي يتم خلعه ، ووجود أو عدم وجود صفيحة 
 لاعمظ قدشلاية. 
ثالث ي لا علخل ا فيوا جت م سقنته انواع  : الالا عونل ا ن م فيوج تلاول تكون الأنسجة الرخوة 
المقابله 
للوجه وصفيحة العظم الشدقية في المستويات الطبيعية 
بعد الخلع اما  
تجويف من النوع الثاني 
،نوكت 
الأنسجة الرخوة 
المقابله 
للوجه موجودة ولكن الصفيحة نسلا علق دعب اًيئزج ةدوقفم ةيقدشلا اما 
 
تجويف من النوع الثالث ، يتم دقف كل من الأنسجة الرخوة للوجه ولوحة العظم بشكل ملحوظ بعد قلع 
 الأسنان.
. 
اثبتت التجارب ان 
تجاويف النوع الأول هي الأسهل امنيب حاجنلا بسن يف يلعالاو 
يصعب علاج تجاويف النوع الثالث 
 في خطوة واحدة 
 
وتتطلب تطعيم الأنسجة الرخوة 
والعظام ةيفاضإ موعطب. 
في حين أنه  
غالبًا ما تكون تجاويف النوع الثاني هي الأكثر صعوبة في التشخيص. يمكن أن تكون 
خادعة للغاية ، حيث قد يتم  التعامل معها على أنها من النوع الأول. هذا غالبا ما يؤدي إلى نتيجة 
جمالية أقل من مثالية. 

2 
من ينقت ثدحأ
تا عضو رزلا
اعه يروفلا يتلاو 
تثيح يزيلهدلا فيوجتلا جالعوه اهفصو م 
متي ةمعاد هحيرش عضو 
من خلال شق دهليزي أفقي وتطعيم عظمي يُضاف إلى التجويف بالإضافة إلى وضع دعامة 
 
التئام مخصصة. 
في 
هةديدجلا ةساردلا هذ 
سوف يتم مقارنه و 
تقييم لا ةينقت
جالع 
من ا ا ههجلا
يزيلهدلة 
لتجاويف 
الخلع  
بإستخدام كلا من هيولخلا همدألا 
وطعم النسيج الضام في الزراعه الفوريه ف المناطق الأماميه 
هيلامجلا. 
ةساردلا نم فدهلا:
 
تقييم ومقارنه  لا ةين قت
جالع نم ا ا ههجل اليزيلهد
ة 
لتجاويف الخلع  
 
بإستخدام كلا من  
الأدمه 
اهيولخل وطعم النسيج الضام في 
 هيلامجلا هيمامألا قطانملا ف هيروفلا هعارزلا. 
بيلاسألاو داوملا:
 
ميمصت ةساردلا:
 
ةبرجت ةيريرس 
وةيعاعش. 
دادعإ ةساردلا:
 
متيس ءارجإ 
اثحبل 
في 
عةداي بط 
امفل 
ومسق 
أضارم 
اةثلل 
وصيخشت مفلا مسقو ةعشألا ، اًقفو 
تاداشرإل ثحبلا يرشبلا نم لبق ةنجل تايقالخأ ثحبلا ةيلكب بط نانسألا ةعماج اطنط.
 
• سوف يتم شرح كل خطوات المتبعة في الدراسة قبل البدء فيها مع اخذ موافقتهم كتابيا. 
مجح ةنيعلا:
 
مت 
تريدق 
حمج 
اةنيعل 
بناءًً ىلع ضارتفا 5
٪ أطخ افلأ و 
80
٪ ةوق 
دةسار 
 
إيلامج مجح ةنيعلا 
20
 
مريض مقسمين عشوائيا علي مجموعتين . 
كل  :ةيتآلا تافصلا مهيف رفاوتت نأ دبال نيراتخملا ىضرملا 
1. بالغين في السن من 
 
20
 : 
50
 
عما 
2. 
يتم تضمين المرضى إذا كان لديهماكثر من سن واحد غير قابل للعلاج منه بدون علامات العدوى الحادة في المنطقة الأمامية للفك العلوي من 
 
النوع الثاني لتجاويف الخلع مع وجود عظام كافية في 
الٍفاك يلوأ تابث عم حيحص لكشب ةسرغلا عضوب حامسلل كنحلاو ةمق. 

3 
3. 
سقيقر هثل كم 
• و :نم الك ةساردلا نم دعبتسي 
1. 
المرضى الذين يعانون من ظروف مرضية قد تؤثر على العملية الجراحية او الغرسات. 
2. 
الم. نونخد 
3. تاعضرملاو لماوحلا . 
الم :ةمدختسملا داو 
1. 
اتاسرغل 
2. بساحلا ةطساوب تاسرغلا عضول يحارج ليلد 
3. 
غيمظع ءاش 
4. 
اهيولخلا همدأل 
5. 
طماضلا جيسنلا مع تصميم الدراسة 
 
 
جالعلا لحارم 
الم: جالعلل ىلوالا ةلحر 
ولك: لمشت ةساردلا يف نيكرتشملا ل 
1
- 
إزالة الجير وتنعيم الجذور. 
2
- تعليمات الحفاظ على صحة الفم 
 
ونظافته. 
مىضرملا تاعومج: سوف يصنف المرضى عشوائيا إلى مجموعتين علاجيتين كل منهما سوف يتلقى إحدى طرق العلاج 
 
الآتية: 
المجموعة الاولى : عم هيروف تاسرغ لا ةينقت
جالع نم ا ا ههجلا
يزيلهدل
ة 
لتجاويف الخلع  
بإستخدام 
اهيولخلا همدأل 
ةيناثلا ةعومجملا : عم هيروف تاسرغ لا ةينقت
جالع نم ا ا ههجلا
يزيلهدل
ة 
لتجاويف الخلع  مادختسإب  
طماضلا جيسنلا مع 
 
 

4 
ال :ةيحارجلا ةلحرم 
•
 
كل . حارجلا سفن ةطساوب متت فوس تاحارجلا 
•
 
ومراعاة إعطاء كل المرضى تعليمات ما قبل و بعد الجراحة. 
•
 - 
يتم عمل شق جراحي تحت التخدير الموضعي ، ثم يتم قلع الأسنان 
والجذور المتبقية بطريقة 
هيضر ريغ. غسيل التجويف وكشطة ، سيتم تقييم نوع التجويف والتأكد من وجود مستوى عظام 
  
بسانم. 
•
 - سيتم عمل شق أفقي للوصول إلى الدهليز في موقع التجويف ، من 
 3 إلى 
 4 
مم قمي إلى الوصلة المخاطية اللثة ويمتد من 
 5 إلى 
 
10
 اًيقفأ م. 
•
 - 
سيتم إنشاء نفق تحت الغشاء المخاطي بدءاً من الجانب الوجهي من فتحة التجويف ويمتد بشكل 
يزيلهدلا لوصولا قش ىتح يمق. 
•
 - 
سلثمألا عضولا يف ةسرغلا لاصيإل رتويبمكلاب هجوم يحارج بلاق مادختسا متي 
•
 - 
سيتم وضع الغشاء المناسب في مكان جدار الوجه من التجويف وإدخاله من خلال النفق 
ماظعلا سيبابد ةطساوب هتيبثت متيو هجولا ماظع ةحول قوف دوجوملا. 
•
 - 
سيتم ملء التجويف من الجهه الوجهيه بمواد تطعيم مختلفة وسيتم إغلاق فتحة التجويف التاجيه 
بهصصخم مائتلا ةماعد مادختسا . 
1
-
 
الت: يكينيلكإلا مييق 
سوف ستم تقييم سمك اللثه في البدايه وبعد 6 اشهر وبعد 
 
12
 
شره 
2
-
 يعاعشإلا ميقتلا :
 
عاعشلا طورخم يعطقملا ريوصتلا اهذخأ متي فوس 
في لبدايه وبعد 6
 
اشهر وبعد 
12
 
شهر لتحديد 
سمك. تاسرغلا حاجن كلذكو تاسرغلا لوح نوكتملا مظعلا عافتراو  التحليل الإحصائي:
:
 
كل . رتويبمكلا ةطساوب ايئاصحإ للحتو اهتلودج متيو مظنت فوس ةعمجملا تانايبلا