Joseph Kan: Peri-implant esthetics

Immediate tooth replacement offers the benefit that the hard and soft tissue architecture can be maintained. A change in labial contours is usually occuring, so the correct management of the facial contour is crucial in order to achieve an adequate esthetic result. Dr. Kan discusses the treatment options of not grafting at all, grafting the gap that occurs around the implant and grafting both the gap and the buccal bone plate and recommends to consider the second option (to at least graft the gap). The size of the gap depends on both the socket size and the implant diameter and should be at least 1.5 mm wide in order to allow for a sufficient tissue volume. Therefore, in light of the socket size being on average around 7-9 mm, the implant diameter usually should not exceed 4.3 mm. To avoid soft tissue clefts occurring in esthetically visible areas, Dr. Kan refers to the tunneling technique for the placement of the facial connective tissue graft. Dr. Kan concludes that immediate implant placement is a difficult procedure and that in esthetically demanding areas grafting inside and outside of the socket is very important.