Immediate Implants in Extraction Sockets with Deficient Buccal Walls in the Maxillary Aesthetic Zone

<b>Background:</b> Immediate implant placement in fresh extraction sockets has become an accepted treatment in dentistry as a predictable procedure to restore failing teeth. One prerequisite for this immediate procedure in the anterior maxillary region is an intact facial wall. Unfortunately, the presence of fenestrations and dehiscences is very common. These defects occur due to the pathology responsible for the extraction of the teeth. Traditionally, hard and soft tissue grafting is necessary to repair these large bony defects before implant placement. However, there are many defects with facial wall deficiencies. <b>Methods:</b> This report reflects procedures used to provide successful functional outcomes using grafting techniques in conjunction with immediate implant placement in defective sockets. This clinical research study followed a qualitative methodology, and the results are based on observational outcomes of four patient surgical implant procedures. Each patient received the same protocol in an attempt to reach similar results. <b>Results:</b> Proper diagnosis, treatment planning, and clinical skills are key factors in achieving predictable results. With each of these four patients, the clinical soft tissue outcomes revealed that the midfacial gingival margin had minimal or no recession at two years with minimal pocket depths less than 3 mm. <b>Conclusions:</b> Although the procedure presented in this article has yet to be clinically validated, it is an available technique that can be used in the hands of an experienced practitioner and can provide excellent results for the patient.