Immediate Implant Placement With Autologous Crown Provisionalization: A Digitally Guided Workflow

Immediate implant placement in the esthetic zone is a predictable treatment approach when precise planning and appropriate soft tissue management are achieved. However, preserving the natural gingival contour remains challenging.

A 53-year-old male patient presented with a vertical root fracture of the maxillary left central incisor confirmed by CBCT. Given the favorable socket morphology and the need to preserve soft tissue architecture, immediate implant placement with provisionalization was planned. After atraumatic extraction, a digitally guided workflow was used, integrating CBCT and intraoral scan data for prosthetically driven implant positioning. A tooth-supported surgical guide was fabricated to guide the osteotomy, and a GM 4.2 × 11.3 mm implant was placed with an insertion torque of 45 Ncm. The extracted clinical crown was adapted onto a temporary abutment and relined with flowable composite resin. A 3D-printed positioning guide was used to ensure accurate seating of the provisional restoration without occlusal contact.

The digitally guided workflow enabled accurate implant placement and immediate provisionalization using the autologous crown, preserving peri-implant soft tissue contours. Favorable early healing and stable esthetic outcomes were observed at 1 week.

The integration of digital planning with anatomical provisionalization using the extracted clinical crown enabled predictable immediate rehabilitation in the esthetic zone. This hybrid workflow represents a simplified and patient-centered approach for achieving favorable esthetic and functional outcomes.