Esthetic management of anterior implants in advanced periodontal defects

Achieving optimal implant prosthodontic outcomes in the esthetically demanding anterior region requires sufficient hard and soft tissue volume to provide adequate support and coverage to ensure that the implant restorations are functional and yield predictable, long-lasting treatment results. A comprehensive biologic understanding of the 3D relationships between hard and soft tissue is crucial when treating esthetically demanding areas. Various techniques, notably guided bone regeneration, have been developed and are well documented as being reliable methods for larger 3D bone augmentation procedures. Additionally, dental modification and tooth repositioning in proximity to prospective implant placement sites has been extensively discussed. Recently, orthodontic extrusion with deferred extraction has emerged as a predictable treatment strategy for gaining additional vertical hard and soft tissue. Implementing treatment sequences and the timing of combined treatment methodologies have also been subjects of discussion. Combining orthodontic treatment with staged or delayed tooth extractions has been shown to be beneficial in providing the necessary osseous foundation for implant sites that may not be as amenable to more conventional augmentation techniques. These augmentation techniques and treatment methods require adequately stable and predictable periodontal health since uncontrolled periodontal disease poses a significant challenge and is detrimental to successful outcomes. The purpose of the present clinical report is to demonstrate the staging and sequencing of vertical hard and soft tissue management techniques for a severe anterior periodontal defect to achieve an esthetically functional implant treatment result.