Über den Autor

Dr. Helmut G. Steveling

Fachzahnarzt für Oralchirurgie, Tätigkeitsschwerpunkt Implantologie
Kelterbergstraße 10
76593 Gernsbach
Tel.: 07224/67840


  • 1974: Abitur
  • 1974–77: Zahntechnische Lehre mit Abschluss
  • 1977–82: Studium der Zahnmedizin Universität Würzburg
  • 1982–85: Wiss. Assistent Abteilung für Zahnersatzkunde Universität Würzburg
  • 1985–92: Wiss. Assistent und OA Abteilung für MKG-Chirurgie Universität Würzburg
  • 1992–2009: OA MKG-Chirurgie Universität Heidelberg, Fachzahnarzt für Oralchirurgie
  • Seit 2010: Praxis für Implantologie in Gernsbach
  • Seit 1992: Anwender des Astra Tech Implantatsystems
  • Seit 2008: Anwender von Atlantis Abutments
  • Seit 2013: Ambassodorprogramm EV Implantate


José de San José González, Dr. Christian Mertens

Immediate implant placement combined with titanium granules - 4 years of clinical experience



The immediate implant placement in the esthetic zone is an often performed procedure (1, 2, 3, 4). The position of the implant is in direct contact to the palatal wall. There are different concepts for the management of the remaining gap between the implant and the buccal bone plate. The aim is to avoid the horizontal and vertical collapse of the alveolar crest.

Method and material:

In this study, the gap was filled up with white titanium granules (Tigran Technologies, Malmö, Sweden). 35 implants were placed in the region of the upper incisors, canines and of one bicuspid. After the placement, a healing abutment in the same diameter as the implant was connected. The granules were mixed with blood and pushed with gentle pressure into the gap. The healing abutment was removed and replaced by an abutment in a diameter corresponding to the replaced tooth. A temporary crown was fixed to the abutment and adhered to the adjacent teeth. After a healing time of 3 months, the abutments and temporary crowns were replaced by the definite reconstruction. To evaluate the stability of the alveolar process, clinical pictures were taken before extraction and after the delivery of the final crown. In addition measuring was made using the planning model and the master cast.


The healing period was uneventful in all cases. Some granules in the margin of the soft tissue were removed before the impression. The final restorations showed a healthy gingival margin and no discoloration of the soft tissue. All patients were satisfied with the clinical results. The minimal horizontal collapse of the alveolar process (0.0 to max. 1.1 mm) doesn´t compromise the clinical situation.


These early results justify further use for this indication.

Bildergalerie (33)


  • Sanz, Mariano/Denis Cecchinato/Jorge Ferrus/E. Bjarni Pjetursson/Niklaus P. Lang/Jan Lindhe. 2010. "A prospective, randomized-controlled clinical trial to evaluate bone preservation using implants with different geometry placed into extraction sockets in the maxilla." Clinical Oral Implants Research. 21 (1):13-21.
  • Daniele Botticelli/Leif G. Persson/Jan Lindhe/Tord Berglundh. 2006. "Bone tissue formation adjacent to implants placed i fresh extraction sockets: an experimental study in dogs." Clinical Oral Implants Research. 17 (4): 351-58.
  • Araujo, Mauricio G./Jan Lindhe. 2005. "Dimensional ridge alterations following tooth extraction. An experimental study in the dog." Journal of Clinical Periodontology. 32: 212–218.
  • De Kok, Ingeborg J./Sandra S. Chang/John D. Moriarty/Lyndon F. Cooper. 2006. "A retrospective analysis of peri-implant tissue responses at immediate load/provisionalized microthreaded implants." The International Journal of Oral & Maxillofacial Implants. 21 (3): 405-412.


The immediate implant placement in the esthetic zone is an often performed procedure. The position of the implant is in direct contact to the palatal wall.