Early Implant Placement of the Maxillary Central Incisor to Overcome a Thin Biotype

Dr. Yongsoo Kim (Korea)

Case Presentation

0️⃣ Patient Overview & Treatment Planning

Introduction

There are four timing options for implant placement after tooth extraction, each with specific advantages and limitations. In the anterior region, esthetic complications are more frequent—particularly in patients with a thin gingival biotype. Immediate implant placement is generally contraindicated when anatomical conditions are not favorable. To reduce esthetic risk and ensure optimal soft tissue outcomes, early implant placement was selected in this case.

Patient Information

• 48-year-old female

• Presented for implant restoration in the maxillary anterior and mandibular posterior regions

• Medical History: Non-contributory

• Drug Allergies: None

Dental History

• Crowns on #21, 26, 44

• Endodontic treatment on #21, 26

• Missing teeth: #37, 45, 46, 47

Treatment Plan

1. Full-mouth scaling and root planing

2. Extraction of teeth #24, 25, 26, 27, 37, 38

3. Root canal therapy and crown on #36

4. Implant placement at #24, 25, 26 after 2 months of healing, with simultaneous guided bone regeneration (GBR)

5. Uncovering at 4 months post-placement

6. Final prosthetic restoration

   
   

1️⃣ Pre-Op

• Pre-operative examination revealed gingival recession and super-eruption of tooth #21. A thin gingival biotype was also noted.

2️⃣ Extraction & Healing

• Extraction of tooth #21

• 1.5 months of soft tissue healing post-extraction

• CBCT scan taken to assess ridge contour and bone quality

• #21 implant placement

• An IS-II Active 4.0×10 mm implant was placed at site #21 under local anesthesia, achieving good primary stability. A buccal dehiscence was observed after placement, requiring guided bone regeneration to ensure proper support and esthetic outcome.

• Allograft (ICB cortical bone) placed, covered with resorbable collagen membrane.

• Flaps were sutured using 5-0 Nylon.

4️⃣ Soft Tissue Management & Uncovering

• 4 months post-op: facial bone regeneration confirmed

• Connective tissue graft (CTG) placed on the facial aspect for soft tissue thickening.

• Healing abutment connected, followed by suturing.

• 3-week follow-up showed healthy soft tissue profile.

5️⃣ Prosthetics

• During healing abutment connection, Periacryl tissue adhesive was applied, eliminating the need for sutures. A provisional restoration was then placed to guide soft tissue healing and shape the emergence profile.

• The definitive abutment was connected, followed by delivery of the final prosthesis. Facial gingival recession was successfully managed, resulting in a stable and esthetic final outcome.

• Panoramic radiograph confirmed implant integration and prosthetic fit.

6️⃣ Follow-Up

• At the 7-year follow-up, the implants remained functionally and esthetically stable, with no signs of inflammation, soft tissue collapse, or gingival recession. The overall long-term prognosis was favorable.