Managing Anterior Implant Esthetics: Technique for Immediate Placement

Fig 1. Preoperative photograph showing tooth No. 9 fractured at the gingival line with recurrent decay. Tooth No. 10 did not have any restorations.

Fig 2. Preoperative radiograph showing an old defective crown that had fractured on tooth No. 9. The remaining walls on the tooth appeared to be thin with a compromised prognosis.

Fig 3. Final extraction site. Endodontic files were used to remove a piece of root that fractured during the extraction process. Note minimal trauma to the area and preservation of buccal bone and papillae.

Fig 4. A 3D surgical guide was fabricated utilizing a previously taken scan (Trios), planning software (Blue Sky Plan®, Blue Sky Bio), and 3D printing.

Fig 5. An implant (4.2 mm x 12 mm Tapered Pro, BioHorizons®) was placed at least 1 mm below the crestal bone and 5 mm away from the contact of the adjacent teeth.

Fig 6. In this step, a temporary cylinder (BioHorizons) was cut at the gingival level. The socket was filled with DuoLink cement, and the cylinder was relined with composite and polished thoroughly.

Fig 7. A ribbon fiber was utilized. Z-Prime Plus was used on tooth No. 9, and 37% phosphoric acid with All-Bond Universal was used on tooth No. 10.

Fig 8. Temporary crown on No. 9, which the patient wore for 4 months during the healing process of the implant.

Fig 9. The emergence profile, which was obtained using a well-polished composite and temporary cylinder.

Fig 10. A zirconia abutment was used to circumvent potential issues related to show-through of metal color beneath the crown and graying of the gingival tissue.

Fig 11. Because zirconia can be susceptible to contamination from saliva, ZirClean® (BISCO) was used to clean the crown before cementation with TheraCem.

Fig 12. Postoperative radiograph, captured at crown delivery, showcasing a successful implant integration. The radiograph demonstrates appropriate bone levels, affirming the implant’s stability and long-term potential.

Fig 13. Final outcome. Gingival tissues exhibited a healthy appearance, underscoring successful treatment. Adjustments were made to eliminate occlusal contacts during excursive movements.