The "B.U.M.P." Concept: Combined Prosthetic and Surgical Approach in Esthetic Immediate Implant Placement. A Case...

Background/Objectives: Immediate implant placement in the esthetic zone is increasingly preferred due to its advantages for patient comfort and reduced treatment time. However, maintaining peri-implant soft tissue volume and preserving or reconstructing the interdental papilla remain significant clinical challenges. This report aims to describe a clinical protocol designed to enhance peri-implant soft tissue stability and promote papilla regeneration following immediate implant placement. Methods: This article presents a clinical case managed through a combined mucogingival and prosthetic approach. The protocol included digital planning for implant positioning, immediate implant placement, and a connective tissue graft to support peri-implant soft tissues. Particular attention was given to the design and progressive modification of the provisional restoration. Targeted additions of composite material were applied in the under-proximal areas of the provisional crown to create controlled pressure at the base of the papilla, aiming to stimulate soft tissue adaptation and growth. Results: The progressive "bumping" technique applied to the provisional crown promoted the gradual growth of the interdental papilla and complete closure of the interproximal spaces. Clinical and radiographic follow-up showed stable peri-implant soft tissues, adequate tissue volume, and highly satisfactory esthetic outcomes. Conclusions: This report represents an initial proof of concept that highlights the importance of integrating precise surgical techniques, customized prosthetic contouring, and digital workflows to achieve predictable soft tissue management in immediate implant placement. This combined approach may contribute to improved papilla formation and enhanced esthetic outcomes. Further prospective studies are needed to confirm the reproducibility and clinical advantages of this protocol.