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Early Implant Placement Following Single-Tooth Extraction in the Esthetic

Zone: Biologic Rationale and Surgical Procedures

Article in The International journal of periodontics & restorative dentistry · November 2008
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441

Early Implant Placement Following

Single-Tooth Extraction in the
Esthetic Zone: Biologic Rationale and
Surgical Procedures

Daniel Buser, DMD, Prof Dr Med Dent* The dental rehabilitation of a patient
Stephen T. Chen, MDSC** following single-tooth extraction in the
Hans Peter Weber, DMD, Dr Med Dent*** esthetic zone is often clinically chal-
Urs C. Belser, DMD, Prof Dr Med Dent**** lenging. One treatment option is the
use of an implant-supported single
crown. This has the significant advan-
tage that adjacent teeth do not have
to be prepared, as opposed to when
Early implant placement is one treatment option for implant therapy following treating with a three-unit fixed dental
single-tooth extraction in the anterior maxilla. The surgical technique presented prosthesis.
here is characterized by tooth extraction without flap elevation, a 4- to 8-week Since the 1980s, osseointegrated
soft tissue healing period, implant placement in a correct three-dimensional posi- implants have been used increasingly
tion, simultaneous contour augmentation on the facial aspect with guided bone often in partially edentulous patients,
regeneration using a bioabsorbable collagen membrane combined with auto- and they are well documented with
genous bone chips and a low-substitution bone filler, and tension-free primary prospective long-term studies.1–5
wound closure. The surgical step-by-step procedure is presented with a case Today, single-tooth replacement with
report. In addition, the biologic rationale is discussed. (Int J Periodontics an implant-supported crown has
Restorative Dent 2008;28:441–451.) become the most frequent indication
for implant therapy.6 In posterior sites,
the primary objective of single-tooth
replacement is the reestablishment of
*Professor and Chairman, Department of Oral Surgery and Stomatology, School of Dental
masticatory function. Esthetic consid-
Medicine, University of Bern, Bern, Switzerland.
**Senior Fellow, Department of Periodontics, School of Dental Science, The University of erations in these areas are less fre-
Melbourne, Melbourne, Australia. quently of concern. In contrast, anterior
***Professor and Chairman, Department of Restorative Dentistry and Biomaterials sites are more closely linked to esthetic
Sciences, Harvard School of Dental Medicine, Boston, Massachusetts; Visiting Professor,
expectations and often represent a
School of Dental Medicine, University of Bern, Bern, Switzerland.
****Professor and Chairman, Department of Fixed Prosthodontics and Occlusion, School of considerable challenge for involved
Dental Medicine, University of Geneva, Geneva, Switzerland. clinicians and dental technicians, since
various local risk factors have the
Correspondence to: Prof Dr Daniel Buser, Department of Oral Surgery and Stomatology,
Freiburgstrasse 7, CH-3010 Bern, Switzerland; fax: 41 31 632 98 03; e-mail:
potential to compromise the pre-
daniel.buser@zmk.unibe.ch. dictability of the result.7–9

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In recent years, substantial efforts
have been made to increase the
appeal of implant therapy by shorten-
ing the overall treatment time and min-
imizing the number of surgical inter-
ventions. Therefore, late implant
placement following extraction with a
healing period of 6 to 12 months prior
to implant placement has lost its dom-
inance in daily practice, although this
approach was considered the standard
of care in the late 1980s. Over the past
18 years, alternative approaches have
been proposed, such as immediate
implant placement at the time of
extraction10–12 or early implant place-
ment following a few weeks of soft
tissue healing prior to implant inser-
tion.13–18 Common to both these
approaches is the requirement for a
simultaneous bone augmentation pro-
cedure using barrier membranes. This
so-called guided bone regeneration
(GBR) technique is used to correct peri-
implant bone defects, which are pres-
ent in most patients following tooth
extraction. The goal of implant therapy
is to provide patients with a pre-
dictable and esthetically and function-
ally satisfying treatment outcome with
a low risk of esthetic complications.
For obvious reasons, it is desirable to
achieve this goal with a minimal num-
ber of surgical procedures and in the
shortest possible treatment time from
tooth extraction to implant restoration.
When local risk factors and expected
biologic changes in the alveolar ridge
after tooth extraction are correctly
interpreted,7–9,19,20 it appears that early
implant placement can fulfill these
expectations.
The purpose of this article is to
present the concept of early implant
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placement after extraction of a single
tooth in the esthetic zone. The step-by-
step surgical procedures are demon-
strated with a case report, and the
biologic rationale is discussed, which
supports this approach as a valid alter-
native to immediate implant place-
ment in the esthetic zone.
Case report
The 23-year-old female patient was
referred to the clinic for extraction of
the maxillary left central incisor
because of a complication following
dental trauma. At the first clinical exam-
ination, it was noted that the patient
had a high smile line (Fig 1) and a thin,
highly scalloped gingival biotype (Fig
2). The central incisor showed an
increased probing depth of 8 mm on
the facial aspect and a small fistula
approximately 3 mm apical to the gin-
gival margin. Both neighboring teeth
were healthy and free of restorations.
However, there was a slight mismatch
between the crown width of both cen-
tral incisors, since the metal-ceramic
crown of the central incisor was slightly
larger than the contralateral tooth. The
periapical radiograph demonstrated a
small periapical radiolucency (Fig 3).
Vertical bone levels at adjacent roots
were not reduced. The nonsmoking
patient was healthy and did not have
any medical problems that could
potentially cause impaired wound
healing following implant surgery.
Early implant placement was the
recommended treatment. The patient
was informed about all relevant
aspects of the treatment. Based on
this comprehensive information, she
agreed to the proposed treatment and
gave written informed consent to par-
ticipate as part of a prospective case-
series study.
The first treatment step was the
careful extraction of the left central
incisor under local anesthesia. This was
carried out without flap elevation using
rotational forces with an appropriate
pair of extraction forceps. The extrac-
tion socket was carefully debrided and
filled with a collagen plug (Tissuecone,
Baxter). In addition, a removable par-
tial denture was inserted, with care
taken that it did not create pressure on
the soft tissues.
After a healing period of 8 weeks,
the clinical examination revealed
uneventful healing of the extraction
socket. The soft tissues were fully
intact, and the two papillae had short-
ened slightly. On the facial aspect, a
minor flattening of the ridge contour in
the middle of the single-tooth gap was
observed (Fig 4). Implant surgery was
performed under local anesthesia
using 4% articaine solution combined
with a vasoconstrictor (Ubistesin forte,
3M ESPE). To insert the implant, a full-
thickness flap was raised using a crestal
incision in the edentulous area. The
incision was extended through the
sulcus of both adjacent teeth to the
respective facial aspects, where diver-
gent distal line-angle releasing inci-
sions were applied. The muco-
periosteal flap was carefully elevated
from the alveolar crest and held in
place with a retraction suture.
Following careful debridement, the
intrasurgical status showed a residual
bone defect in the alveolar process
where the extraction socket had been
located. Part of the facial bone wall in
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443

Fig 1 (left) Patient at the first examination

showing a high smile line.

Fig 2 (right) The patient showed a thin

biotype and a highly scalloped gingival
margin. In addition, the crowned left central
incisor has a probing depth of 8 mm and a
fistula caused by a chronic infection at the
root. The metal-ceramic crown is slightly
oversized compared to the contralateral
incisor.

Fig 3 (left) The periapical radiograph

shows the left central incisor with the metal-
ceramic crown. A small periapical radiolu-
cency is apparent.

Fig 4 (right) After uneventful healing over

8 weeks, the clinical status demonstrates a
well-healed extraction site. There is some
flattening of the ridge contour in the mid-
facial area of the extraction socket. There is
a slight mismatch between mesiodistal gap
size and crown width of the contralateral
incisor.

the middle of this defect was missing,
forming a crater-like defect (Fig 5). The
bone crest next to both adjacent teeth
had not resorbed, and the crest width
measured more than 6 mm at both
sites.
Implant bed preparation was com-
pleted according to the standard pro-
tocol using sharp round burs and spi-
ral drills of increasing diameter and
copious cooling with chilled saline.
Special emphasis was placed on
obtaining a correct three-dimensional
position of the implant platform within
the so-called comfort zones, mesio-
distally, orofacially, and coronoapically.8
In the coronoapical direction, the plat-
form of the implant (Institut Straumann)
was positioned approximately 3 to 4
mm apical to the anticipated midfacial
mucosal margin of the future implant
crown (Fig 6). This distance corre-
sponds to about 2 to 3 mm apical to
the cementoenamel junction on the
midfacial aspect of the adjacent con-
tralateral central incisor. The implant
achieved excellent primary stability. In
the orofacial direction, the implant was
intentionally positioned about 1 mm
palatal of the prosthetic point of emer-
gence. Because the crest was more
than 6 mm wide at the implant site, the
exposed implant surface was clearly
positioned inside the alveolar process,
resulting in a craterlike defect with a
2-wall defect morphology on the facial
aspect (Fig 7).
Following incorporation of a
4-mm healing cap, small autogenous
bone chips were harvested at the nasal
spine using a flat chisel and bone
scraper. These chips were soaked in
blood and stored in a sterile glass dish.
In addition, the periosteum of the full-
thickness flap was released with an
incision at its base to allow for ten-
sion-free primary wound closure fol-
lowing completion of the procedure.

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444

Fig 5 (left) The intrasurgical status follow-

ing elevation of a full-thickness flap con-
firms that the crest width is well maintained
at adjacent teeth, but the resorption of the
facial bone wall in the middle of the extrac-
tion socket is also apparent.

Fig 6 (right) The bone-level implant is

inserted in an appropriate three-dimension-
al position, leaving a craterlike defect on
the facial aspect of the implant. The implant
platform is located 2 to 3 mm apical to the
midfacial cementoenamel junction level of
the adjacent central incisor.

Fig 7 (left) The implant is positioned

slightly to the palatal aspect, with the
exposed implant surface clearly inside the
alveolar crest.

Fig 8 (right) The endosseous portion of

the defect is filled with autogenous bone
chips, which were harvested at the nasal
spine with a flat chisel and then soaked in
blood.

Fig 9 (left) The site is overcontoured with

a second layer of DBBM granules for con-
tour augmentation.

Fig 10 (right) The augmentation material

is covered with a non-crosslinked collagen
membrane applied with a double-layer
technique. The membrane serves as a tem-
porary barrier.

This incision caused temporary bleed-
ing, which allowed the collection of
blood with a syringe. This blood was
mixed with granules of deproteinized
bovine bone mineral (DBBM; Bio-Oss,
Geistlich Biomaterials) of small particle
size. Local bone augmentation was
first performed with autogenous bone
chips, which were placed directly on
the exposed implant surface and
which filled the craterlike defect in the
crestal area (Fig 8). This was followed
by a second layer of DBBM granules
to overcontour the alveolar crest on
the facial aspect (Fig 9). The augmen-
tation material was then covered with
two strips of a non-crosslinked colla-
gen membrane (Bio-Gide, Geistlich
Biomaterials). The barrier membrane
was cut into two strips, moistened with
blood, and applied with a double-layer
technique to improve membrane sta-
bility (Fig 10). At the end of surgery,
tension-free primary wound closure
was achieved with nonresorbable
suture material. In the crestal area,
5-0 sutures were used, whereas 6-0
suture material was used for the releas-
ing incisions (Fig 11). The existing par-
tial denture was shortened over the

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445

Fig 11 (left) After an incision is made in

the periosteum, tension-free primary wound
closure is achieved with fine, nonresorbable
suture material (5-0 and 6-0).

Fig 12 (right) After 8 weeks, the surgical

site is well healed. The local anatomy shows
convexity in the alveolar crest, as intended.

Fig 13 (left) The periapical radiograph

confirms a well-integrated implant at 8
weeks of healing.

Fig 14 (right) Clinical status with the

acrylic resin provisional crown supported by
a titanium, screw-retained coping. The peri-
implant soft tissues have matured well and
are esthetically configured.

surgical sites to avoid direct contact
with the underlying tissues. The
patient received an analgesic to con-
trol postsurgical pain and periopera-
tive antibiotic prophylaxis with amox-
icillin, which was initiated 2 hours prior
to surgery and maintained for 3 days
postsurgically. In addition, the patient
was asked to avoid tooth brushing in
the surgical site, and instructed to use
0.1% chlorhexidine digluconate rinses
twice daily for plaque control.
Postsurgical healing progressed
well and without complications. By 8
weeks, the implant site had healed
favorably. The local anatomy showed
well-maintained vertical tissue height
and a convex contour of the alveolar
crest in the edentulous area (Fig 12).
The corresponding periapical radio-
graph confirmed the complication-free
tissue integration of the implant
(Fig 13). The implant was exposed with
a small circular incision using a no. 12b
blade. The short healing cap was
replaced with a longer cap. One week
later, a screw-retained provisional
acrylic resin crown, based on a tita-
nium coping, was inserted. During the
next few weeks, the peri-implant soft
tissues were observed to adapt nicely
to the shape of the crown. As required
by the study protocol, the provisional
crown remained in place for 6 months
postloading. The 6-month follow-up
examination demonstrated clinically
healthy peri-implant soft tissues (Fig
14) and a well-integrated implant, as

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446

Fig 15 (left) The esthetic treatment out-

come at 18 months postloading is pleasing.
The mucosal margin at the implant is appro-
priate, the gingival course is harmonious,
and the papillae are intact.

Fig 16 (right) The patient’s smile confirms

the pleasing esthetic outcome.

Fig 17 The 18-month periapical radio-

graph confirms the stable peri-implant bone
situation.

confirmed with a periapical radio- The 18-month follow-up exami- Discussion

graph. Subsequently, the provisional
crown was replaced by the definitive
crown, which was a cemented full-
ceramic crown supported by a screw-
retained mesostructure made of a
combination of titanium (apical por-
tion) and zirconia (coronal portion).
nation revealed clinically healthy peri-
implant soft tissues, no signs of com-
plications such as a peri-implant
infection or mucosal recession, and an
overall pleasing esthetic treatment out-
come (Figs 15 and 16). The periapical
radiograph showed stable bone crest
levels, with signs of minor bone remod-
eling at the alveolar crest (Fig 17).
The replacement of a tooth with an
implant-supported crown is the most
frequent indication for implant ther-
apy. 6 Many of these single-tooth
replacements are clinical situations in
which the tooth must be extracted first.
Consequently, the timing of implant
placement is critical for successful treat-

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Buser.qxd 9/22/08 3:28 PM Page 447
ment.18 This is especially the case for
single-tooth replacements in the
esthetic zone, where patients’ high
esthetic expectations represent a chal-
lenge for clinicians. Thus, clinicians
need a treatment concept that offers
an esthetic outcome with a high
degree of predictability and a low risk
of complications. The surgeon directly
influences esthetic soft tissue parame-
ters (or “pink” esthetics) during the
surgical phase of treatment, including
intact papillae, a harmoniously scal-
loped course of the gingival line with-
out abrupt changes in tissue height,
and a convex facial contour of the alve-
olar crest at the implant site.7
Several experimental and clinical
studies have shown that the concept of
a biologic width applies to endosseous
implants21,22 as it does to natural
teeth.23 It was noted that the mucosa
has a relatively constant dimension
around implants. The mucosa thick-
ness also depends on the gingival bio-
type.24,25 Thus, the underlying bone
structure plays a key role in the estab-
lishment of esthetic soft tissue con-
tours. Two anatomic structures are rel-
evant8: the vertical bone height of the
alveolar crest at interproximal areas
and the height and thickness of the
facial bone wall. The interproximal
crest height determines the presence
or absence of peri-implant papillae. A
clinical study around implant-sup-
ported single crowns demonstrated
that a distance of 6 mm or more from
the alveolar crest to the contact point
reduces the probability of intact peri-
implant papillae.26,27 It has also been
shown that the height of peri-implant
papillae in single-tooth gaps is inde-
pendent of the proximal bone level
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next to the implant, but mainly
depends on the interproximal bone
height at adjacent teeth.24 Therefore,
clinical situations with reduced vertical
bone at adjacent teeth are still chal-
lenging and cannot be controlled by
the surgeon, since surgical techniques
are still not available to predictably
regain lost bone. In contrast, horizon-
tal bone deficiencies on the facial
aspect of an inserted implant can usu-
ally be managed by the surgeon using
the GBR technique.
The main objective of the concept
of early implant placement presented
here is successful contour augmenta-
tion on the facial aspect of the implant.
This contour augmentation must be
combined with a correct three-dimen-
sional positioning of the implant plat-
form for the reestablishment of pleas-
ing soft tissue esthetics. Recent
experimental studies have emphasized
the importance of the facial bone wall.
These studies have provided a much
better understanding of ridge alter-
ations following extraction.19,20 They
demonstrated that a thin buccal bone
wall, mainly comprising of bundle
bone, is resorbed quickly (within 4 to 8
weeks), leading to a reduction in bone
height of approximately 2 to 3 mm on
the facial aspect regardless of whether
an implant is placed into the socket.
These observations in preclinical stud-
ies have been confirmed in a recent
clinical study using computerized
tomographic scans, where the ridges of
nongrafted extraction sockets showed
more than 20% loss of crest height.28 In
the anterior maxilla, the facial bone
wall of extraction sockets is most often
thin as a result of the facial position of
these teeth. In addition, the facial bone
447
wall can often be missing because of
chronic infections around the tooth to
be extracted. Both clinical situations
require bone augmentation at implant
placement if an esthetic outcome is to
be accomplished. When the facial
bone wall is thick, less horizontal and
vertical bone resorption will occur, as
shown in experimental and clinical
studies.29,30 However, even in patients
with an intact facial wall at implant
placement, horizontal bone resorption
still takes place and leads to a flatten-
ing of the facial contour.31 Thus, con-
tour augmentation is beneficial even in
these clinically favorable situations if the
esthetic outcome is to be optimized.
As already noted, the surgical
technique presented here is primarily
focused on the establishment of a
facial wall with a thickness of at least 3
mm using the GBR technique. Today,
bioabsorbable non-crosslinked colla-
gen membranes are preferred in daily
practice, since they are relatively easy
to apply during surgery owing to their
hydrophilic properties. When soaked
in blood, they become adhesive and
can be easily put into place without the
use of fixation pins.32 They are also
characterized by a low complication
rate in case of a soft tissue dehis-
cence.33 The most significant clinical
advantage is that collagen membranes
do not require a second surgical pro-
cedure for membrane removal, as
opposed to bioinert, nonresorbable
membranes. This eliminates a second
open-flap procedure and unnecessary
morbidity at the implant site.
However, although these non-
crosslinked collagen membranes have
demonstrated excellent biocompati-
bility in several experimental studies,
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448
they have a short barrier function and
a tendency to collapse because of their
soft characteristics.34–38 Thus, collagen
membranes need to be supported by
appropriate bone fillers to avoid
membrane collapse. For this, locally
harvested autogenous bone chips
combined with a bone substitute are
preferred and represent an important
aspect of this concept. Autogenous
bone chips are used inside the alveo-
lar crest to fill the craterlike bone defect
at the exposed implant surface, since
autografts are able to accelerate new
bone formation, as shown in several
experimental studies.39–41 This is criti-
cal close to the exposed implant sur-
face. Rapid achievement of osseoin-
tegration at the bone-implant interface
is advantageous since it helps to
reduce healing periods between
implant placement and the reopening
procedure. In most cases, the peri-
implant craterlike bone defects are
rather small in volume. Therefore, local
harvesting does not pose problems
for the surgeon or lead to additional
morbidity for the patient, since it can
be performed within the limits of the
same flap, and a second surgical site
for graft harvesting is not necessary. A
second layer of bone substitute is
applied on top of autogenous bone
chips to overcontour the alveolar ridge
to the desired local convexity. For this
contour augmentation, a bone filler
with a low substitution rate is preferred.
It is hypothesized that this helps main-
tain the created volume; however, this
must be confirmed in long-term clini-
cal studies. Several experimental stud-
ies support this hypothesis, since they
all have shown that bone fillers made
of hydroxyapatite are minimally
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resorbed over time.39–42 A well-docu-
mented bone filler with a low substi-
tution rate is DBBM, which was used in
the present case report. DBBM has
been used in implant dentistry for
more than 20 years and is character-
ized by good biocompatibility and
osteoconduction, as well as a low sub-
stitution rate.40–44 Its favorable volume
stability has also been documented in
sinus grafting studies with human
histology.45,46
Another important aspect of this
surgical concept is tension-free pri-
mary wound closure following mem-
brane application. Therefore, tech-
niques for immediate restoration of
implants are contraindicated using this
treatment concept. The primary
wound healing helps protect the bio-
materials against bacteria from the oral
cavity and reduces the risk of postsur-
gical complications. Primary wound
closure is much easier to accomplish if
the extraction site has healed for a few
weeks. This short healing period pro-
vides 4 to 6 mm of additional kera-
tinized mucosa at the extraction site,
which facilitates tension-free primary
wound closure without altering the
mucogingival line too far coronally.
In that short period of time, ridge alter-
ations are minimal and mainly limited
to the bundle bone on the midfacial
wall of the extraction socket, as already
discussed. It is argued that this bone
resorption is mainly caused by the
interruption of blood supply through
blood vessels within the periodontal
ligament.19,20 No significant bone
resorption takes place at the bone sur-
face next to adjacent teeth, since tooth
extraction is performed without flap
elevation. Thus, the periosteal blood
supply, which is important for the
superficial bone,47 is uninterrupted and
left intact. As a consequence, the crest
width at adjacent teeth is maintained
at the time of implant placement and
results in a two- or three-wall mor-
phology of the craterlike bone defect.
These conditions are optimal for suc-
cessful bone augmentation. Since the
implant is positioned slightly palatal in
the so-called comfort zone,8 the two-
wall morphology is even more pro-
nounced, thus improving the chances
for predictable bone regeneration. If
for some reason the crest width is
reduced, potentially leading to an
exposed implant surface outside the
alveolar crest with a one- or no-wall
defect morphology, a staged
approach is used to obtain a predica-
ble augmentation outcome.33
When immediate implant place-
ment is chosen by the clinician, pri-
mary wound closure is much more dif-
ficult because of the opening in the
gingiva. Clinicians have recommended
the use of rotational flaps from the
palate or simultaneous connective tis-
sue grafting.48,49 Although the con-
cept of immediate implant placement
is well documented by survival stud-
ies,50 it seems that the use of immedi-
ate implant placement in esthetic sites
increases the risk of esthetic compli-
cations such as recessions, with a fre-
quency of around 35% to 40%.29,51–53
One potential cause of gingival reces-
sion is that facial bone augmentation
is less predictable with immediate
implants, as indicated by experimen-
tal and clinical studies comparing dif-
ferent treatment modalities. 17,54
Potential risk factors identified to cause
such complications are facial malposi-
Buser.qxd 9/22/08 3:28 PM Page 449
tioning of the implant29,53 and the
shape of the facial bone defect at
implant placement.52
It can be argued that the flatten-
ing of papillae after extraction is a
potential disadvantage of early implant
placement. Thus, peri-implant papillae
have to be developed during the soft
tissue conditioning phase using provi-
sional crowns. As already pointed out,
the height of peri-implant papillae in
single-tooth gaps depends on the
bone crest level at adjacent root sur-
faces.26,27 When the bone level is sig-
nificantly reduced, esthetic treatment
outcomes will be compromised
regardless of the timing of implant
placement or the loading protocol.
When the bone level is not reduced
and the distance between the bone
crest and contact point is around 5
mm, the papillae will shape within a
few weeks following incorporation of
the implant-supported crown.55–57 A
recent randomized controlled study
comparing immediate implants with
implants placed 12 weeks after tooth
extraction reported a similar response
of the peri-implant papillae in both
groups.51 Thus, the timing of implant
placement does not appear to influ-
ence the final form of the peri-implant
papillae.
Connective tissue grafting has also
been advocated in conjunction with
immediate implant placement to facil-
itate better primary wound closure.49
It has also been argued that connective
tissue grafting will improve the facial
contour at the implant site.58,59 The
concept described in the present
report does not require the routine use
of connective tissue grafts, since the
contour is augmented at the bone
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ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER
level. Thus, the additional morbidity
caused by the harvesting procedure of
connective tissue grafts in the palate
can be avoided in routine cases.
The esthetic treatment in the pres-
ent case report, based on the concept
of early implant placement, leads to
pleasing treatment outcomes. In addi-
tion, the protocol is patient friendly,
since only one open-flap procedure
was used and the time period from
extraction to restoration with a provi-
sional crown was roughly 16 weeks.
However, a case report cannot be used
to draw conclusions about the pre-
dictability of the presented concept; it
can only present the clinical procedures
and its biologic rationale. Ongoing ret-
rospective and prospective case series
studies will soon be published,60 thus
offering scientific evidence for the pre-
dictability of this concept and its low
risk of esthetic complications.
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In the article “Molar Uprighting with
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Periodontal Environment,” published
in the previous issue of this journal (Int
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2008;28: 375–381), three errors were
not appropriately corrected by the
publisher.
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ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER
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author’s address should read: Dr
Sachiko Maeda, Team JIADS (The
Japan Institute for Advanced Dental
Studies) 4-1-46 Shin-osaka Build 6F,
Miyahara, Yodogawaku, Osaka, Japan
532-0003.
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the word “attachment” should be
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On page 380, Fig 10c should have
appeared as follows:
The publisher regrets these errors.
Volume 28, Number 5, 2008