CLINICAL MANAGEMENT OF IMMEDIATE IMPLANT PLACEMENT AND LOADING IN THE ESTHETIC ZONE WITH FINAL PROSTHETIC RESTORATION.

Immediate implant placement with immediate loading in the esthetic zone is a predictable treatment option when strict surgical and prosthetic protocols are followed. This case report describes the clinical management of a 50-year-old systemically healthy, non-smoking male treated with two immediately placed implants in the maxillary central incisor region (teeth 11 and 21). Following atraumatic flapless extraction due to extensive root caries (tooth 11) and a chronic periapical granulomatous lesion with insufficient residual root length (tooth 21), two tapered implants (3.5×13 mm; Hiossen) were placed. Primary stability was achieved with insertion torque values of 40 Ncm (D.11) and 45 Ncm (D.21) fulfilling accepted criteria for immediate loading. Guided bone regeneration was performed using a 50:50 mixture of autogenous bone harvested from the mandibular retromolar area and xenograft material, without the use of a barrier membrane. Immediate screw-retained provisional restorations were placed out of occlusion. Clinical and radiographic evaluation at six months after final prosthesis delivery demonstrated stable peri-implant bone levels, preserved interdental papillae, and satisfactory esthetic integration. The limited follow-up duration represents a limitation for long-term esthetic evaluation.