الفهرس 
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Abstract
Purpose: To evaluate the bone healing of horizontal gap (HG) > 2mm around immediate dental implant in the upper premolar area with and without primary closure. Patients and Methods: A total of 21 cases were enrolled in this prospective study. Cases were randomly assigned to one of three groups. Cases in group I (n =7) received immediate implant with bone graft, membrane and primary closure, Cases in group II (n=7) received immediate implant with primary closure only. Cases in group III (n=7) received immediate implant without graft, membrane or primary closure. Cone Beam Computed Tomography (CBCT) was taken preoperatively and immediately after implant placement and then after 6 months to evaluate the bone healing, buccal bone remodeling and relative bone density (RBD). Clinical parameters; pocket depth (PD) and pain intensity were recorded. Results: A total of 21 implants were inserted. During 6 months of follow-up, the implants showed good osseointegration. The CBCT examinations revealed that the bone completely filled the horizontal critical sized gap (HCZG) in the three groups. The mean buccal bone remodeling in group II was comparatively higher than in the group I and group III at 6 months with significant difference, however no significant differences between three groups in respect to the RBD. The mean PD in groups (I, II) was more than group III with significant difference. At three days postoperatively in the group I II showed significantly higher pain when compared to group III. Conclusion: The HCZG around the immediate implant completely filled with newly formed bone in the three groups. In the flap group the immediate implant had statically significant higher buccal bone remodeling, PD and pain than the flapless group.