Objective A scarf‐shaped connective tissue graft can be placed at the facial and proximal aspect of the peri‐implant soft tissue zone during immediate implant placement and provisionalization (IIPP) procedures in the esthetic zone to optimize implant esthetics without the need of flap reflection. This retrospective study evaluated soft tissue stability after scarf‐connective tissue graft (S‐CTG) in conjunction with IIPP procedures in the esthetic zone. Materials and Methods Patients who received IIPP with S‐CTG with a minimum 1‐year follow‐up were evaluated. Mid‐facial gingival level (MFGL) change and mid‐facial gingival thickness (MFGT) change were measured and compared at the pre‐op (T0), IIPP + S‐CTG surgery (T1), follow up appointment with MFGT measurement (T2), and latest follow‐up appointment (T3). Implant success rate and graft necrosis were also recorded. Results A total of 22 IIPP and S‐CTG procedures in 20 patients were evaluated in the study. After a mean follow‐up of 8.2 years (3.9–13.4) (T3), all implants remained osseointegrated (22/22 [100%]), with statistically insignificant mean midfacial gingival level change of −0.19 mm (−1.5 to 0.8). Statistically significant difference in midfacial gingival thickness (MFGT) was noted (2.5 mm [1.8–3.5 mm]) after a mean follow‐up time (T2) of 2.3 years (1–8.6) when compared with MFGT at baseline (1.1 mm [0.6–1.3 mm]) (T1). Necrosis of S‐CTG during initial healing phase was noted in 9% (2/22) of the sites. Conclusions Within the confines of this study, scarf‐connective tissue graft at time of immediate implant placement and provisionalization can thicken the gingiva and maintain the gingival level at the critical soft tissue zone. Clinical Significance Managing the soft tissue zone is as important as that of the hard tissue zone for peri‐implant esthetics. Connective tissue graft is one of the methods that can enhance the final esthetic outcomes. This retrospective study has demonstrated that Scarf‐CTG technique is an effective treatment modality to maintain soft tissue stability.

ObjectiveThe purpose of this cone beam computed tomography (CBCT) study was to determine the frequency percentage of screw‐retained crown using angulated screw channel (ASC) abutment for single immediate implant placement and provisionalization (IIPP) in the esthetic zone.MethodsThe CBCT images of 200 patients without disease and without metal restorations in maxillary anterior teeth were evaluated. The mid‐sagittal‐sectional CBCT images of maxillary anterior teeth (#6–#11) were created in an implant planning software, screen‐captured, and transferred to a presentation program. Template of tapered implants with diameter of 3.5 mm (for central and lateral incisors) and 4.3 mm (for central incisors and canines) and lengths of 13, 15, and 18 mm were applied to the sagittal images to identify the IIPP cases. To qualify for IIPP, the implant must engage >35% bone with at least 1 mm of surrounding bone and no perforations. The IIPP cases were further divided into straight screw channel (IIPPSSC) abutment or 25‐degree angulated screw channel abutment (IIPPASC), based upon its restorability. The frequency percentages of possible IIPP, IIPPSSC, and IIPPASC were reported and compared among all maxillary anterior teeth.ResultsA total of 1200 maxillary anterior teeth sagittal images from 200 patients (88 male and 112 female) with a mean age of 51.3 years (range 20–83 years) were evaluated in this study. The overall frequency percentages of IIPP, IIPPSSC, and IIPPASC possibility were 84% (74%–92%), 14% (10%–24%), and 75% (66%–87%), respectively.ConclusionWithin the limitations of this CBCT study, 90% of single IIPP in the esthetic zone can be restored with screw‐retained crown when utilizing ASC. In addition, the possibility of using a screw‐retained restoration following IIPP increases about five times with ASC abutment compared to the SSC abutment.