Replacing Hopeless Maxillary Incisors With Adjacent Implants via an Integrative Biologically Oriented Approach

Achieving successful immediate implant placement in periodontally compromised sites requires that current biologic insights be translated to the modern clinical workflow. The clinical challenge increases in the case of adjacent implants in the smile zone and when the immediately placed implants are to be immediately restored. This article describes and analyzes state-of-the-art concepts and clinical strategies used to maximize key influencing variables to attain success with this treatment modality. These factors that are described in detail include: precise virtual planning for accurate guided implant placement, a flapless surgical approach, bone augmentation and soft-tissue enhancement of the deficient thin biotype, a "one abutment, one time" prosthetic approach for screw-retained restorations utilizing a novel implant system, and model-based cervical design for optimal restorative integration with newly created peri-implant mucosa. The combined digital and analog workflow demonstrates the use of current tools that enable clinicians to predictably perform such treatment in a controlled manner for the right indications.