After tooth extraction,resorption of the alveolar walls has been observed. Since the buccal bone wall is predominantly composed of bundle bone, resorption is greater in this area, whereas less resorption of the lingual walls has been found, since they are thicker and composed of substantial proportions of lamellar bone.^1,2

    On average, a loss of about 50% of the buccal bone contour has to be expected within 3 months after extraction.^2,3Various strategies like socket preservation techniques and immediate implants have been tested to minimize the resorption and maintain the ridge dimensions after extraction.²

The placement of the implant into the fresh extraction socket is called as   Immediate implant. The advantages of the immediate implant includes reduced number of visits and surgical procedures, diminishing patient morbidity, and in some cases, enable immediate restoration.^4,5,6

Despite these advantages, however, immediate implant placement has always been a challenge for clinicians because of its unpredictable outcome associated with implant position and soft tissue stability.⁷

Studies have demonstrated that buccolingual hard tissue resorption occurs irrespective of implant insertion.^8,9Several approaches have been suggested in order to minimize the resorption process and/or promote better healingwith immediate implants. This includes implants with different geometries, collagen membranes, use of various graft or filler materials between the implant and the buccal bone wall.¹⁰

Commercially, bioactive glasses are available in different morphologic forms. A putty form (Novabone Dental Putty)of premixed composite of bioactive calcium silicophosphate has been made available.¹¹

It is composed of elements naturally occurring in the body, which signals genetic pathways to accelerate natural bone growth. This process is defined as Osteostimulation. Osteostimulation leads to a catalytic response that accelerates the natural healing process and bone regeneration.NovaBone Dental Putty is available in multiple delivery mechanisms: clamshells, syringes and ‘Cartridge Delivery System’.It is dispensed in a pre-mixed state and can be placed directly into the defect site from the package.

It has found its multiple clinical applications in dentistry in the treatment of bone defects, ridge and socket preservations, and periodontal osseous defects including furcation defects.¹¹

Aim:

To evaluate radiographic (CBCT) outcomes of the alveolar ridge following palatal flapless Immediate implant placement associated with the use of a synthetic bone graft placed between the implant and inner surface of the buccal alveolar plate.

Objectives:

 1. To evaluate and compare the horizontal alveolar ridge changes on facial and palatal cortical plates after placement of immediate implant associated with synthetic bone graft.

2.  To evaluate and compare totalbucco-lingual dimensional changes after   placement of immediate implant associated with synthetic bone graft.

 3. To evaluate and compare the verticalbuccal alveolar ridge changes after the placement of immediate implant associated with synthetic bone graft.