Dental Implant in the Esthetic Zone - Case #1

Immediate Placement, Socket Gap Graft, Connective Tissue Grafting and Immediate Provisional Crown

A single missing front tooth in a high smile-line demands precision, biological respect, and esthetic vision. This case highlights how immediate implant placement with soft-tissue preservation can achieve a natural and seamless result that blends perfectly with the surrounding teeth and gums.

A patient presented with a fractured upper left central incisor and a high smile line — a situation that demands precise implant positioning and soft-tissue management to ensure a natural appearance.

For esthetic zone implant cases, Dr. Onur Cavus’s goal is to make the replacement tooth indistinguishable from the natural dentition — both in color and in the way the gum tissues frame the tooth.

Treatment included atraumatic extraction, immediate implant placement, socket gap grafting to preserve bone, and connective tissue grafting through a minimally invasive tunnel approach. A custom-designed immediate provisional crown was delivered to maintain soft tissue contours and provide an instant esthetic result.

After osseointegration and complete soft-tissue maturation, a final digital crown was fabricated to blend seamlessly with the adjacent tooth and gingival architecture — restoring both function and confidence.

Case Overview

Patient Concern:

Broken upper left central incisor after trauma (high smile-line, esthetic zone).

Treatment Goals:

Restore function and esthetics while maintaining gum contour and papilla integrity.

Main Procedures:

Atraumatic extraction, immediate implant placement, socket gap graft, connective tissue graft (tunneling approach), immediate provisionalization, digital final crown.

Clinical Challenges

  • High smile-line — full gum visibility during smiling.

  • Thin gingival biotype with risk of recession.

  • Adjacent natural tooth with intact papillae that must be preserved.

  • Need for immediate esthetics and soft-tissue stability.

Key Takeaways

  • Immediate implant placement can be predictable in esthetic areas with careful planning.

  • Soft-tissue grafting is essential for long-term stability in thin biotypes.

  • Digital provisional crowns play a critical role in shaping tissue contours.

Related Topics - Internal Links

Treatment Approach

1. Atraumatic Extraction

Preserving the alveolar bone and soft-tissue scallop to maintain the natural gingival outline.

2. Immediate Implant Placement

Implant positioned with 3D precision following extraction, ensuring ideal emergence profile and primary stability.

3. Socket Gap Grafting

Gap between implant and socket walls filled with bone substitute to prevent ridge collapse and maintain volume.

4. Connective Tissue Graft (CTG)

Minimally invasive tunneling technique performed to thicken soft tissue and prevent long-term recession in thin biotype areas.

5. Immediate Provisionalization

A custom temporary crown placed to preserve papilla and soft-tissue contour during healing.

“Following immediate placement and completion of socket grafting and CTG, a digital impression was taken, and a lab-fabricated provisional crown designed to fit the original socket anatomy was delivered within days.”

6. Final Restoration

After full osseointegration and tissue maturation, the final digital crown was fabricated and placed — matching the contralateral incisor in shape, shade, and gingival margin.

Interested in dental implants in Toronto or North York?

Schedule your consultation with Dr. Onur Cavus, BDS, PhD, to explore minimally invasive implant solutions designed for natural, long-lasting results.

📞 (437) 808-0888

📍 Dentalship, 4750 Yonge St #322, North York, Toronto

Case FAQs — Esthetic Zone Dental Implant

What is an esthetic zone dental implant?
The esthetic zone is the visible front teeth and gumline. Implants here require precise planning to match the neighbouring tooth and natural gingival contours.
Why use a connective tissue graft (CTG) in this case?
CTG thickens delicate gum tissue, supports papillae, and helps maintain a stable, natural gumline—reducing recession risk over time.
What is a socket gap graft and why was it done?
After immediate implant placement, the space between the implant and socket wall was grafted to preserve ridge volume and support an ideal emergence profile for the crown.
Will I receive a temporary tooth right away?
When stability and anatomy allow, an immediate provisional is used to shape the tissue. In this case, a lab-fabricated provisional crown—designed to the original socket anatomy—was inserted within days.
How long until the final crown?
Typically 8–12 weeks, after osseointegration and soft-tissue maturation are confirmed. Timing varies by individual healing.
Is IV sedation the same as being asleep?
No. IV sedation used here is moderate conscious sedation—you’re deeply relaxed, can respond to verbal cues, and breathe on your own.
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