esthetic implant management

53 Rating(s).

Posted on By sameh barsoum In Implants

case presented 21 years old with high lip line, implant supported crown #10 with unsightly root portion. Narrow diameter implant, zero probing depth

initial presentation
existing crown removed\short, narrow temp

already some vertical gain
coronally and palataly advanced flap with CT graft

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i would have removed the implant and grafted. Lots of scarring and most likely dehiscence present on labial of implant. Dr. S


Yes lots of scarring and pink color and texture mismatch however when treatment planning I recalled multiple cases presented by prof Zuchelli where he treated cases with complete B bone loss and no probing depth i.e- an otherwise healthy implant, he did not strip the connective tissue from the exposed fixture surface and grafted on top with only a deepithelized graft and he showed long term stability.
Removing a non ailing nor failing implant and bone grafting didn't sound attractive to me I would've been left with very little bone then a block graft would've been the only solution with the morbidity, time frame and expenses it entailed.
Did I make the right decision? I don't know. Managing the color mismatch and scarring perhaps I could do with a second soft tissue surgery.


The straightforward, advanced, and complex (SAC) classification system was developed to aid clinicians in the treatment planning of dental implant cases. Treatment of a single-tooth replacement in the esthetic zone is considered a complex procedure requiring a team approach.This is because once an esthetic complication occurs, restoring the lost hard and soft tissues to their original presurgical levels is extremely difficult.3-6 According to Levine et al, immediate placement in the esthetic zone requires the clinician to be experienced and knowledgeable about esthetic diagnosis, minimally invasive extraction techniques, oral plastic-surgical procedures (eg, hard- and soft-tissue grafting, “gummy smile” correction/crown lengthening), and accurate 3-dimensional (3D) implant placement and restoratively driven planning/placement based on cone-beam computed tomography (CBCT) analysis. Tissue-contour management requires prosthetic knowledge of provisionalization techniques to sculpt peri-implant tissue for developing submergence contour from the implant shoulder to the mucosal zenith to adequately support the tissue. Final impression techniques must capture and transfer this submergence contour, or “transitional zone,” to be duplicated in the final crown. In a 2009 systematic review, Chen et al suggested potential risk for facial gingival recession of was up to 30% of cases if inclusion criteria were not used for immediate implant placement. They identified pre existing defects of the facial bone, thin facial bone, thin soft-tissue biotype, and facial malposition of the implant as potential risk factors for gingival recession following immediate single-tooth implant placement.

Esthetic-Zone Single Immediate Implants


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