A multidisciplinary approach to soft tissue preservation and digital prosthetic rehabilitation following delayed implant placement in the aesthetic zone: A case report

A 33-year-old systemically healthy male patient presented to the Department of Periodontology, Faculty of Dentistry, Istanbul University, with a chief complaint of mobility in teeth 21 and 22. Clinical and radiographic examination revealed advanced loss of supporting bone, and the prognosis of the involved teeth was considered hopeless, leading to extraction. Following extraction, leukocyte- and platelet-rich fibrin (L-PRF) was applied to the extraction sockets, and the esthetic requirement was managed with an immediate removable provisional prosthesis. After a three-month healing period, the edentulous site was evaluated for implant surgery. With prosthetic consultation, an implant was placed at site 22, and a de-epithelialized connective tissue graft was applied simultaneously to compensate for potential soft tissue deficiency. Immediately after surgery, a digital impression was taken, and a new immediate provisional prosthesis was fabricated to avoid pressure on the surgical site. After completion of osseointegration, a gingiva former was placed to establish an appropriate emergence profile, and due to the presence of buccal soft tissue volume loss, an additional de-epithelialized connective tissue graft was performed in the same session. Following soft tissue healing, a screw-retained definitive prosthesis was delivered to the patient. At the threemonth follow-up, a maxillary frenectomy and an additional connective tissue graft were performed to further optimize the peri-implant soft tissue profile. Thereafter, the patient was enrolled in supportive periodontal therapy