The present analysis, using a simple and reproducible method for GT assessment, confirmed the existence of gingival biotypes. A clear thin gingiva was found in about one-third of the sample in mainly female subjects with slender teeth, a narrow zone of keratinized tissue and a highly scalloped gingival margin corresponding to the features of the previously introduced "thin-scalloped biotype" (cluster A1). A clear thick gingiva was found in about two-thirds of the sample in mainly male subjects. About half of them showed quadratic teeth, a broad zone of keratinized tissue and a flat gingival margin corresponding to the features of the previously introduced "thick-flat biotype" (cluster B). The other half could not be classified as such. These subjects showed a clear thick gingiva with slender teeth, a narrow zone of keratinized tissue and a high gingival scallop (cluster A2).

If the primary implant stability permits it, immediate single-tooth implants should be instantly provisionalized in the interest of optimal midfacial esthetics.

The authors declare that they have no conflict of interests. The study was supported by the dental department of the Free University of Brussels (VUB). The authors wish to express their gratitude to Nobel Biocare Belgium for their support in providing dental implants. ABSTRACT Purpose:The objective of this prospective study was to assess the overall outcome of immediate single implant treatment in the anterior maxilla after a 3-year observation period. Material and methods: Conclusions:The proposed strategy seems a valuable and predictable treatment option for well-selected patients in the mid-long term as shown by almost full papillary re-growth and a low risk for advanced midfacial recession.

Immediate implants demonstrated fairly stable midfacial soft tissue levels with only a minority of cases showing advanced recession. Irrespective of the timing of implant placement, aesthetic failures seem to be rather common and only a strict minority may show perfection.

Single immediate implants showed high implant survival and limited marginal bone loss in the long term. However, mid-facial recession, mid-facial contour and alveolar process deficiency deteriorated after 1 year. With an aesthetic complication rate of 8/17 in well-selected patients who had been treated by experienced clinicians, type I placement may not be recommended for daily practice.

The preliminary results suggest that the proposed strategy can be considered to be a valuable treatment option in well-selected patients.

Preservation of pink aesthetics is possible following IIT. However, to achieve that, CTG may be necessary in about one-third of the patients. Major alveolar process remodeling is the main reason for additional treatment.

When perfect implant positioning is required, FG surgery should be considered the gold standard approach.