Immediate definitive implant restoration in an early extraction socket with severe buccal resorption

Immediate implant placement with immediate loading offers reduced treatment time and improved esthetic outcomes, but becomes challenging in sites with severe buccal bone deficiency. This report describes the management of a 45-year-old male who presented 3 weeks after the extraction of the maxillary second premolar. Clinical evaluation showed complete soft-tissue closure, while cone-beam computed tomography demonstrated extensive buccal plate loss reaching the root apex. A digitally guided surgical protocol was used to place a 4.5 mm × 13 mm implant with 50 Ncm torque by engaging the palatal and proximal bone. The buccal defect was reconstructed with particulate bone graft mixed with 0.2% hyaluronic acid gel and covered with a resorbable collagen membrane. A definitive screw-retained zirconia crown was delivered within 24 h. One-year clinical and radiographic follow-up revealed stable crestal bone and healthy peri-implant tissues, indicating that immediate definitive restoration is feasible even in compromised early extraction sockets when supported by precise digital planning and enhanced regeneration.