Case presentation: Midfacial peri-implant soft tissue recession poses a significant challenge to achieving satisfactory aesthetic outcomes and requires a comprehensive, multidisciplinary approach. The present study describes two challenging cases in which implants were aesthetically compromised. A predictable technique was employed to manage these cases by using the implant itself as a tent to achieve 3D horizontal and vertical soft tissue building, which resulted in improved patient satisfaction. The first case involved a deep, severely buccally placed implant situated adjacent to compromised tooth structure. Horizontal and vertical soft tissue augmentation were carried out using a healing abutment to maintain the connective tissue coronal to the implant. The final fixed prosthesis was then delivered on top of the permanent submerged implant, with excellent soft tissue outcomes and a high level of patient satisfaction. The second case involved two compromised, deep, buccally placed implants that were managed by performing a permanent implant submergence technique on the maxillary left central incisor implant and augmenting the soft tissue vertically and horizontally. The final fixed prosthesis was delivered between the maxillary left lateral incisor implant and the previously prepared maxillary right central incisor, resulting in an acceptable aesthetic outcome. The technique presented managed the peri-implant soft tissue dehiscence effectively and restored the previously deficient peri-implant papillae.
Conclusions: The key to treating challenging aesthetic complications encountered with implants is presurgical prosthetic preparation followed by use of a comprehensive surgical technique to optimise soft tissue thickness and height and address compromised aesthetics in a single surgical step. Use of a permanent implant submergence technique with remediation of associated defects may be a viable clinical approach that is not often explored for these types of defects.