Early Implant Placement with Contour Augmentation - Biologic Rationale, Surgical Technique & Long-Term Results
Today, the timing of implant placement post-extraction in the esthetic zone is considered an important factor which influences the esthetic treatment outcome. One of these options is early implant placement after 4 to 8 weeks of soft-tissue healing. The purpose of this presentation is to present data and to analyze the stability of esthetic treatment outcomes in patients following single-tooth replacement in the anterior maxilla using the concept of early implant placement with simultaneous contour augmentation. Special emphasis will be placed on assessing the stability of the facial mucosa, since it directly depends on the stability of successful contour augmentation by GBR and to compare it to currently utilized immediate techniques like Dual Zone Therapy (Chu & Tarnow) and Partial Extraction Therapies (Salama & Gluckman).

The "Dual-Zone" Approach in Immediate Implant Placement
Improvements in implant designs have helped advance successful immediate anterior implant placement into fresh extraction sockets. Clinical techniques described have enabled practitioners to achieve predictable esthetic success using a method that limits the amount of buccal contour change of the extraction site ridge and potentially enhances the thickness of the peri-implant soft tissues coronal to the implant-abutment interface. This approach involves atraumatic tooth removal without flap elevation, and placing a bone graft into the residual gap around an immediate fresh-socket anterior implant with a screw-retained provisional restoration acting as a prosthetic socket seal device. This protocol allows for efficient management of the patient and an attempt to maintain all original contours of the extraction site. Multiple case and retrospective case studies will be cited to support this concept.

Partial Extraction Therapy (PET) The Final Frontier
Buccopalatal collapse of the postextraction ridge is a significant challenge in restorative and implant dentistry. A variety of different approaches as well as ridge preservation techniques using tissue and augmentative materials have been proposed in the literature. A slightly different approach, "PET" is to use the tooth itself by purposely maintaining all or a portion of the root in the remaining socket. Root submergence has been reported in the literature for more than 4 decades, and it has been demonstrated that the submerged tooth root retains the periodontal tissues and preserves the bone in pontic sites or below dentures to retain the ridge. The socket-shield technique entails preparing a tooth root section to remain behind on the labial aspect simultaneous to immediate implant placement and has demonstrated histologic and clinical results that are highly promising to esthetic implant treatment.

Combination Therapies in the Esthetic Zone: Steps for Success
This presentation will cover the critical aspects to consider for deciding the sequence and implementation of combination therapies. Successful esthetic zone treatment must begin with a well thought-out space management plan. This plan involves a three dimensional adjustment of the periodontal attachment, with a possibility of root submergence and partial extraction technique. Following this, a decision is made concerning the timing and position of implant placement, and an adequate hard tissue foundation can be restored using GBR with titanium mesh and collagen membrane. On top of this base a more efficient soft tissue augmentation and adjustment completes the requirements for success in the esthetic zone.

Immediate Implant Provisionalization: A Critical Aspect in Tissue Care and Esthetics-Part 2
The management of the hopeless tooth or an edentulous span in the Estheitc Zone is amongst the most clinically demanding procedures in tooth replacement do to the demands of tissue preservation and patient management during the healing phase. As important as the implant surgical process in these areas is the role of the immediate provisional restoration. Tissue support, emergence profile and The provisional restoration phase of implant therapy has become one of the most critical steps in immediate or delayed placement for several reasons including the following...

Hard and Soft Tissue Augmentation: Optimizing Esthetic Results for the Restorative Dentist
Contemporary patient expectations have made esthetics a major requisite of all treatment plans, especially in situations where there is a high smile line. Although new restorative materials have highly improved predictability and esthetic outcomes, soft and hard tissue management play a fundamental role when working in esthetic areas. To achieve ideal esthetics, preservation of the natural soft and hard tissue architecture is a primary clinical objective. These new proposed techniques illustrate the importance of pre-prosthetic soft and hard tissue management when working in highly esthetic compromised areas.

Labial Bone Thickness in Area of Anterior Maxillary Implants Associated with Crestal Labial Soft Tissue Thickness
Soft tissue problems (ie, gingival recessions) are common in implantology and are often associated with thin soft tissue biotypes or buccally placed implants. Goaslind described 2 types of biotypes commonly found in the natural dentition: thick and thin. It has been suggested that thicker soft tissue biotypes are associated with less tissue recession, higher crestal bone levels, and better aesthetics. A thin tissue biotype has been shown to be more prone to tissue recession. Gingival recession is always associated with alveolar bone dehiscences. Furthermore, there is evidence that thick soft tissue may be protective against crestal bone loss (ie, tissue thickness of ,2.5 mm resulted in crestal bone loss of 1.45 mm vs. thicker tissues had 0.26 mm). This protective effect occurred, despite the supracrestal position of the implant-abutment interface.

A Decision Tree for Soft Tissue Grafting
The decision tree proposed serves as a guide for clinicians to select the most appropriate and predictable soft tissue grafting procedure to minimize unnecessary mistakes while providing the ultimate desired treatment outcome.

Achieving Predictable Connective Tissue Root Coverage
Gingival recession creates esthetic issues. These issues may be corrected from a restomtive perspective by the placement of composite resin or ceramic over the exposed root. But this approach often results in a gingival-incisal length that does not blend esthetically with tire adjacent teeth. Often accompanying the gingival recession is a decrease in the band of attached gingiva. The wider the band of attached gingiva, the more stabIe the long-term result Therefore, surgical correction of the recession…