Study of the Month – September 2026: Immediate Implant Placement of a Maxillary Central Incisor with a Ceramic Implant in the Aesthetic Zone
25.9.2026 · 10 min
In this month's featured case, we review a clinical case report by Dr. Fabian Schick (Biohealth Munich), published in the Implantology Journal. It describes the treatment of an aesthetically compromised maxillary central incisor using immediate implant placement, soft tissue grafting, and a triangular tissue-level ceramic implant.
Of particular interest is the implant design itself. According to the author, the triangular geometry was chosen with the intention of limiting pressure on the surrounding tissues and leaving space for the papillae and soft tissues.
Why Is Implant Treatment in the Anterior Maxilla Especially Challenging?
Implant placement in the aesthetic zone differs significantly from treatment in posterior regions of the mouth.
While implant survival and functional loading remain important, aesthetic success depends on numerous additional factors, including:
- gingival symmetry
- papilla height
- facial bone stability
- implant positioning
- emergence profile
- harmony with neighboring teeth
The challenge becomes even greater when patients present with:
- a high smile line
- a scalloped gingival biotype
- thin soft tissues
- demanding aesthetic expectations
- a natural contralateral tooth serving as the reference standard
In these situations, even minor alterations in the gingival margin or papilla contours can become clearly visible during smiling and speaking.
For this reason, current treatment concepts in the aesthetic zone place strong emphasis on managing hard and soft tissues from the very beginning of treatment.
Immediate Implant Placement with a Ceramic Implant After Extraction of a Maxillary Central Incisor
The patient presented with a compromised maxillary central incisor requiring extraction.
Beyond simply replacing the failing tooth, the clinician faced several aesthetic challenges that significantly increased treatment complexity.
These included:
- a high smile line
- a pronounced scalloped gingival architecture
- highly visible soft tissues during smiling
- the presence of a natural contralateral incisor as an aesthetic benchmark
To address these challenges, the author selected a tissue-oriented treatment approach consisting of:
- atraumatic tooth extraction
- soft tissue grafting
- guided palatal implant positioning
- immediate provisionalization
- delayed delivery of the definitive restoration following osseointegration
The stated objective was not only implant integration but also the careful management of the peri-implant soft tissues.
What Is the Design Rationale of the Triangular Tissue-Level Ceramic Implant?
The triangular tissue-level ceramic implant was a central element of the treatment concept described in this case.
In contrast to a round cross-section, the triangular geometry leaves spaces between the implant and the surrounding tissues.
According to the design rationale described by the author, these spaces are intended to:
- leave room for blood supply to the surrounding tissues
- limit compression of the adjacent tissues
- allow augmentation procedures to be performed at the same time
- accommodate soft tissue maturation
- leave space for papilla development
Whether these design considerations translate into improved long-term aesthetic outcomes needs to be confirmed in clinical studies.
How Does the Implant Geometry Relate to the Facial Bone Wall?
One distinctive design feature is the flattened facial surface of the implant.
The design rationale is to reduce contact with the thin facial bone wall, which is known to be prone to remodeling after tooth extraction.
The considerations behind this feature, as described in the case, include:
- the facial bone contour after extraction
- contact between the implant and the buccal plate
- the vascular supply of the facial bone wall
- space for augmentation procedures
- support of the overlying soft tissues
Because facial bone and gingival contours are closely related, the facial bone wall is regarded as an important factor in aesthetic treatment planning.
How Does the Implant Design Relate to the Interproximal Space?
Preserving the interdental papillae remains one of the most important goals in aesthetic implant dentistry.
The triangular implant design has reduced interproximal dimensions, which leaves additional room between the implant and the adjacent teeth.
The rationale is to leave space for:
- vascularization of the interproximal tissues
- papilla development
- soft tissue maturation
- the formation of gingival contours
In single-tooth implant restorations, the presence of papillae is important for avoiding dark triangles and achieving a natural appearance.
What Role Did Immediate Provisionalization Play in This Case?
Immediately after implant placement, a non-functional provisional crown was delivered.
In this case, the provisional restoration served several purposes beyond immediate aesthetics.
It was used for:
- shaping the soft tissues
- maintaining the gingival contours
- guiding papilla maturation
- protecting the surgical site
- providing aesthetics during healing
Special attention was paid to the design of the contact points to allow adequate space for papilla development.
The case illustrates the role that careful planning of the provisional restoration can play in immediate implant protocols.
What Outcome Was Reported in This Case?
After four months of healing, the author reported osseointegration of the implant.
At clinical evaluation, the peri-implant soft tissues were described as:
- healthy in appearance
- free of clinical signs of inflammation
- showing stable gingival contours
- aesthetically well integrated
Following complete healing, the definitive crown was delivered.
According to the author, the final restoration harmonized with the adjacent dentition and closely matched the natural contralateral central incisor.
Reported outcomes included:
- papilla formation
- a natural-appearing emergence profile
- harmonious gingival architecture
- integration into the smile
This outcome in a single patient illustrates how implant selection, soft tissue management, and provisionalization were combined in a demanding aesthetic case. It does not allow conclusions about the contribution of any individual factor.
Why Are Treatment Planning and Soft Tissue Management Important in the Aesthetic Zone?
The aesthetic result depends on the interaction of multiple factors, including:
- atraumatic extraction techniques
- implant geometry
- three-dimensional implant positioning
- soft tissue grafting
- provisional restoration design
- prosthetic execution
Current treatment concepts in the aesthetic zone increasingly emphasize approaches focused on hard and soft tissue management.
In this case, the implant design was one element of a combined treatment concept; its specific contribution cannot be isolated from a single case.
This case presents a favorable clinical outcome, but it remains a single-patient case report and its findings cannot be generalized.
Additional scientific evidence is needed through:
- prospective clinical studies
- larger patient cohorts
- long-term follow-up investigations
- direct comparisons of implant designs
- soft tissue stability evaluations
- papilla regeneration studies
Future research may clarify whether implant geometry influences long-term aesthetic outcomes around ceramic implants.
Conclusion: What Can Be Learned from This Case?
This clinical case describes the combination of immediate implant placement, soft tissue grafting, immediate provisionalization, and a triangular tissue-level ceramic implant in the treatment of a compromised maxillary central incisor, with a favorable aesthetic outcome reported by the author.
Of particular interest is the design rationale of the implant, which aims to limit compression of the surrounding tissues and to leave space for papilla and soft tissue development. Whether this translates into a clinical benefit needs to be confirmed in clinical studies.
As a single case report, it does not allow conclusions on efficacy or superiority. Further clinical studies are needed to determine whether this implant design offers advantages in demanding aesthetic cases in the anterior maxilla.
*Note for U.S. clinicians: Certain implant designs discussed in this educational series may not currently be available in the United States. Product availability and indications vary by market and regulatory approval status.
FAQ – Ceramic Implants, Immediate Implant Placement, and Aesthetic Implant Dentistry
1. Why is immediate implant placement in the anterior maxilla considered highly challenging?
2. Why are ceramic implants used to replace a maxillary central incisor?
3. Why is papilla preservation important around ceramic implants in the aesthetic zone?
4. What is the design rationale of a triangular tissue-level ceramic implant?
5. Can a ceramic implant be placed immediately after tooth extraction?
6. What is the purpose of immediate provisionalization after ceramic implant placement?
7. How long did the implant heal before final crown placement in this case?
8. Why is implant positioning so important for aesthetic ceramic implant restorations?
9. Can natural gingival contours and papillae be achieved around ceramic implants?
10. Why are tissue-level ceramic implants used in aesthetic implant dentistry?
Note: The information provided is intended for educational purposes only and does not replace clinical judgment. Treatment decisions should be based on individual patient assessment and applicable clinical guidelines.
