الفهرس 
Introduction and review of literatureOnly 14 pages are availabe for public view
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Abstract
In the past decades, the traditional protocol of dental implants has been based on a two-stage submerged surgical protocol allowing 3-6 months of bone healing period before any loading. By time, studies have been proved that implants could be immediately loaded and give excellent results and improve esthetics.
When maxillary anterior teeth are lost, resorption of the labial wall of the alveolar socket typically follows, often leaving only the previous palatal wall intact. In such cases, implant placement utilizing routine techniques is very difficult.Implant placement at the area with facial bone defects frequently results in soft tissue recession and interproximal papilla loss, potentially leading to the loss of a harmonious soft tissue profile.
There are many reconstructive and regenerative methods for augmentation of the alveolar ridge. One of these methods is the use of bone spreader technique(BST) instead of conventional surgical protocol in which drills of increasing diameter used, calls for the removal of the existing bone and does not enhance cancellous bone. It was found that BST enhance bone density and increase width of alveolar ridge. The use of flapless technique prevents bone resorption and gingival recession that appear after flap reflection in the conventional surgical protocols. Also the use of PRF accelerates bone formation and soft tissue healing after the surgical procedures. In this study, we compared between BST and standard drilling as two different techniques in preparing the osteotomy site, and evaluate their effect on hard and soft tissues surrounding 16 immediately loaded dental implants in a split mouth design. Follow up for the subjects was done both clinically and radiographically (CBCT & Digora) for 6 months. The clinical results after 6 months showed that, 2 implants out of 16 have failed, and the 2 implants were from group I (BST). There was no statistical significant difference between the two groups regarding post-operative pain and patients’ satisfaction scores. Regarding gingival index(GI), there was no statistical significant difference between the two groups after 6 months. Regarding gingival thickness(GT), group I showed a mean of (0.2 mm) decrease in GT, while group II showed a mean of (0.3 mm) increase in GT after 6 months. Regarding width of keratinized mucosa(WKM), group I showed a mean of (0.06 mm) increase in WKM, while group II showed a mean of (0.08 mm) increase in WKM after 6 months. In the present study, radiographic parameters were assessed as bone density (BD), width of alveolar ridge (WAR) and gingival thickness (GT) measured by CBCT, while crestal bone loss (CBL) measured by Digora. Regarding bone density, group I showed a statistical significant increase in mean BD after 6 months by (257.4 HU), while group II showed a non-statistical significant increase in mean BD after 6 months by (102 HU). Regarding width of alveolar ridge, group I showed a statistical significant increase in mean WAR after 6 months by (0.3 mm),while group II showed anon-statistical significant decrease in mean WAR by (0.2 mm) after 6 months. Regarding gingival thickness measured by CBCT, group I showed a non-statistical significant decrease in mean GT by (0.1 mm), while group II showed a non-statistical significant increase in mean GT by (0.3 mm) after 6 months, so these results confirmed the clinical measurements of GT. Regarding crestal bone loss, both groups showed a non-statistical significant increase in mean of CBL after 6 months by (0.5 mm) for group I and (0.03 mm) for group II.