Overview
One of the common questions with an anterior immediate implant case is: do we need a connective tissue graft (CTG) or not? Another challenge is how to fabricate a chairside fixed provisional on the day of surgery.
In this case, the patient presented with a non-restorable #8. Since the patient had a low lip line, intact interproximal bone, and no significant hard or soft tissue defect, this was a great candidate for an immediate implant approach.
Treatment Planning
- Immediate implant placement
- GBR (guided bone regeneration)
- Connective tissue grafting (CTG)
- Fixed provisionalization
A surgical guide was designed in BlueSkyBio and printed in-house. The patient's extracted crown was converted into a chairside fixed provisional restoration.
Clinical Steps
✓ Pre-operative evaluation
✓ Virtual wax-up and prosthetic planning, Implant position planning ,Designed & 3d Printed Surgical Guide
✓ Immediate implant placement
✓ Chairside Fixed provisionalization
Outcome
1 Week Post-Op
Healing is progressing well with healthy tissue integration at the 1-week follow-up. Since this is an ongoing case, the patient was instructed to remain on a soft diet and avoid using the front teeth during healing.
Immediate implant placement with simultaneous fixed provisionalization helps support the papilla and shape the peri-implant soft tissue from day one, minimizing the need for additional soft tissue conditioning later.
Clinical Pearls
✓ Simultaneous CT grafting and GBR generally provide a more predictable long-term esthetic outcome than GBR alone.
✓ Implant positioning should be against the palatal bone while maintaining an adequate facial jumping gap.
✓ A positioning suture can be used to stabilize the connective tissue graft at the desired location.
✓ A gradual emergence profile with no sharp transitions is critical for soft tissue development around the implant.
Detailed step-by-step protocols and surgical demonstration videos for anterior implant treatment planning, connective tissue grafting, immediate provisionalization, and complication management are covered in ECDA Module A.
Surgical guide design using BlueSkyBio is available in the ECDA Basic Module.
