[Clinical dilemmas concerning immediate implants in the esthetic zone]

Teeth replacement in the esthetic zone is a considerable challenge. Dental implants are usually the preferred treatment alternative for tooth replacement. The present review discusses several clinical issues concerning implant placement in the esthetic area. It is still unclear whether raising a flap at the time of implant placement enhances alveolar crest remodeling. However, a flapless surgical procedure could avoid changes in the free gingival margin and maintain the the attached gingiva width. A submarginal approach not involving the free gingival margin can be applied to treat bone defects with the GBR technique. Implants should be placed as palatal as possible while maintaining optimal restoration emergence profile and the horizontal bone defect filled with a non resorbable material such as bovine bone mineral. Thick periodontal biotype and coronally positioned free gingival margin usually lead to better results. Immediate implant placement in presence of a periapical lesion may be performed, however, sites should be thoroughly debrided prior to implant placement.