Failure of a natural tooth may not permit placement of an implant at the time of extraction due to insufficiency in available bone to house the implant. Reconstruction of the extraction socket frequently involves both hard and soft tissue augmentation to provide a site that can house the implant and ridge contours that mimic the adjacent natural anatomy. This situation becomes more problematic in the maxillary anterior due to the anatomy and the lower density of the bone of the premaxilla.

The solution is the interpositional vascularized augmentation neogenesis (IVAN), which consists of hard tissue grafts, various barrier membranes, and closure with the pediculated connective tissue graft (PCTG). The modified IVAN (mIVAN) technique achieves the necessary goals and may be used in both delayed and immediate placement situations.

We present a case showing use of the mIVAN technique with a delayed implant placement and long-term follow-up demonstrating hard and...

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