Direct Implantation in the Anterior Maxilla: A Clinical Case

Background. Immediate implantation in the aesthetically important area of the maxilla is a predictable treatment method. However, in the presence of periapical pathology and soft tissue deficiency, it requires particularly careful planning and adherence to the surgical protocol. Key factors in ensuring long-term stability of results include preserving soft tissue volume and preventing recession. Case Report. This paper presents a clinical case of a 55-year-old female patient with decayed crowns of teeth Nos. 1.1 and 2.1 and chronic apical periodontitis. Atraumatic tooth extraction was performed, followed by immediate placement of dental implants and simultaneous soft tissue augmentation with a free connective tissue graft. Results. The clinical case demonstrates the use of immediate implantation in post-extraction sockets with deep subgingival defects in the aesthetic zone of the upper jaw. The choice of this treatment protocol is based on current scientific evidence. According to a systematic review of the literature, immediate implantation in post-extraction sockets demonstrates survival rates of 98–99 %, which is comparable to implantation in intact sockets. The key factors for success are thorough socket sanitation, curettage, and debridement. Proper positioning of implants in the aesthetic zone should take into account not only the anatomy of the bone tissue, but also the individual characteristics of the morphology of the dental arches and the angulation of the incisors. No complications were observed in the postoperative period. The implants were placed in the orthopedically correct position, achieving sufficient primary stability. In the long-term follow-up, satisfactory soft tissue condition, no signs of inflammation, and implant stability were noted. Conclusion. Direct implantation in sockets of extracted teeth with periapical pathology, provided thorough debridement and simultaneous soft tissue augmentation, is an effective and predictable treatment method in the aesthetic zone. The use of a connective tissue graft helps stabilize the gingival level and optimize aesthetic results.