Immediate implant placement in infected sites using the “Roll BMP” technique: a 3-year case report with bioinformatic analysis

Immediate implant placement (IIP) in sites with infection and buccal bone wall deficiency remains a clinical challenge. This case report introduces the “ROLL BMP” technique, a flapless regenerative approach combining absorbable collagen sponge (ACS), biphasic calcium phosphate (BCP), and recombinant human Bone Morphogenetic Protein-2 (rhBMP2) to achieve simultaneous buccal bone reconstruction and soft-tissue preservation in type 2 post-extraction sockets. A healthy 56-year-old female presented with a root fracture and chronic infection at tooth 2.1. After atraumatic extraction and debridement, a 3.5 × 12 mm INNO sub implant (Cowellmedi, Busan, South Korea) was immediately placed. The biomaterial roll was created by layering BCP granules onto hydrated ACS, rolling it, and inserting it between the implant and soft tissue, followed by a 0.1 mL (1.5 mg/mL) rhBMP-2 injection (CowellBMP, Busan, South Korea). No flaps or membranes were required. Follow-ups at months (M) 3, 5, 12, 18, 24, and 36 demonstrated excellent peri-implant soft-tissue stability (Pink Esthetic Score 13 out of 14 at M36) and progressive trabecular bone maturation, accompanied by buccal cortical reconstruction on CBCT. In silico bioinformatic analysis identified BMP2, RUNX2, SPP1, and BGLAP as key osteogenic hub genes underlying bone repair and osseointegration, supporting the biological rationale for this approach. In conclusion, the “ROLL BMP” technique enables predictable, flapless IIP in compromised sockets while preserving both hard and soft tissues.