Application of the 10 Keys Checklist and Partial Extraction Techniques to Optimize Esthetic Outcomes for Adjacent Implants in the Esthetic Zone.

Placing immediate implants in the esthetic zone poses significant challenges. Implants should be placed with consideration to hard and soft tissues to optimize long-term implant and cosmetic success. In this case report, two maxillary central incisors were extracted at two different time points 5 years apart due to horizontal root fractures. Implants were placed according to immediate single-tooth guidelines using two different surgical and loading approaches, as risk assessment factors changed in the time between the first implant placement (right central incisor) and second implant placement (left central incisor). For the first implant placement, the treatment technique included the 10 Keys approach, a checklist of diagnostic, surgical, and restorative guidelines used to pursue long-term success for single-tooth treatment with immediate implant placement and provisionaliza- tion, socket management, and connective tissue grafting. The second implant placement included partial extraction therapy (PET) and conventional healing, as well as immediate implant placement after root shield preparation, an allograft, growth factors, platelet-rich fibrin, and contour management. At the 7-year and 2-year follow-ups, radiographic and clinical results were satisfactory.