Chronic Apical Periodontitis Implant Restoration With CTG: A Case Report

Chronic apical periodontitis with bone defects elevates aesthetic risks in anterior implant rehabilitation. Flapless socket preservation preserves tissue dimensions when primary stability is unattainable, while connective tissue graft (CTG) establishes biological prerequisites for aesthetics. A 26-year-old female presented with a fractured maxillary left central incisor (#21) requiring implant restoration. Clinical findings included crown-root fracture with chronic apical periodontitis (#21), poor gingival contour, and inadequate root canal therapy (#11). Minimally invasive extraction of #21 was performed, followed by socket preservation using PRF membrane, low-resorption bone graft, and collagen sponge. At the 6-month postoperative evaluation, crown lengthening of tooth #11 was executed according to Digital Smile Design (DSD) principles to harmonize gingival contour, with simultaneous fabrication of a provisional restoration for #11 and an implant-supported interim prosthesis for #21. Once the transmucosal emergence profile of #21 was o. In localized chronic apical periodontitis, inflammatory granulation removal precedes socket preservation for bone defect rehabilitation. CTG induced predictable gingival biotype conversion, acting as a biomechanical foundation for peri-implant pink-white aesthetic. This case demonstrates that implant restoration combined with socket preservation and CTG in the esthetic zone with localized infectious lesions can achieve ideal esthetic outcomes.