Sectional Connective Tissue Technique Combined With an Emergence Profile Provisional for Gingival Margin Stabilization During Immediate Implant Placement: A Case Report With a 2-Year Follow-Up.

INTRODUCTION: Little is known regarding maintaining free gingival margin stability after immediate implant placement. Therefore, we present a sequential technique incorporating a sectional connective tissue graft with an emergence tissue provisional to stabilize the free gingival margin position during immediate implant placement in the esthetic zone. CASE PRESENTATION: A 57-year-old male was referred for assessment and treatment of a failing maxillary right central incisor. Clinical examination revealed poor retentive features, recurrent caries, and exposed endodontic material rendering a poor prognosis for the remaining tooth root system. After comprehensive evaluation, as well as understanding important patient case expectations, a decision was made to remove the existing tooth and place an immediate implant with a staged-provisional approach. To maintain the free gingival mid-facial height, a sectional-connective tissue graft technique was used concurrently with a custom emergence profile provisional to stabilize the gingiva immediately post-implant placement. CONCLUSION: Patients undergoing implant replacement of failing anterior maxillary teeth are at risk of esthetic complications. Marginal stability of the facial gingival is an important component of establishing and maintaining the final esthetic outcome. In cases where the initial hard or soft tissue thickness may put the patient at risk, combining soft and hard tissue augmentation with attention to emergence profile provisionalization appears to aid in the initial stability of the buccal free gingival margin. This report details the steps associated with a sectional connective tissue technique combined with emergence profile provisonalization and characterizes the gingival stability up to 2.5 years obtained with this approach.