Prosthetic Soft Tissue Management in Esthetic Implant Restorations, Part I: Presurgical Planning, Implant Placement, and Restoration Timing. A Narrative Review

Objectives

This two-part review article delineates various techniques to enhance esthetic outcomes in anterior implant treatments. Part I concentrates on presurgical measures, case selection, implant placement, and restoration timing. Part II discusses post-surgical steps, the temporary restoration phase, the emergence profile contour, abutment types, and impression techniques.

Material and Methods

A comprehensive search was conducted using Medline/PubMed, Embase, Scopus, and the Cochrane Library. The primary keywords included were “Dental Implants,” “Dental Prosthesis, Implant-Supported,” “Esthetics, Dental,” “Dental Impression Techniques,” and “Tissue Management.”

Results

Initially, 1472 studies were identified, from which 187 were selected based on publication year and title relevance. After removing duplicates, 84 abstracts were reviewed in full text, culminating in 59 studies being thoroughly analyzed.

Conclusions

Optimal esthetics in implant restorations are attainable through meticulous treatment planning, precise surgical execution, and systematic restorative steps, ensuring predictable outcomes. Factors such as a thick gingival biotype, an intact facial bone wall, and atraumatic extraction significantly contribute to superior esthetic results. Immediate implant placement combined with immediate provisionalization provides the most predictable outcomes by supporting and maintaining soft tissue architecture. Conversely, delayed implant placement and provisionalization often require extensive manipulation of collapsed soft tissues to achieve desired esthetics.