Management of Soft Tissue Deficiency Around an Anterior Implant Placed During the Adolescent Period: A Case Report of 30 Months Follow-Up

This clinical report describes the interdisciplinary rehabilitation of a 21-year-old male patient who presented with esthetic concerns due to an anterior implant placed during adolescence following traumatic tooth loss. Clinical and radiographic examination revealed the presence of an implant in infraposition at tooth #21, along with vertical and horizontal peri-implant soft tissue deficiencies. The patient underwent two sequential soft tissue augmentation procedures using de-epithelialized gingival grafts to improve the volume and stability of the mucosa. A customized abutment was digitally designed and fabricated, considering the buccal malposition of the implant, and provisionalized to allow soft tissue conditioning. Anodization techniques were employed to minimize the grayish shine-through effect of the titanium abutment. Final restoration was completed using a monolithic zirconia crown, shade-matched using Matisse.AI (LabMatisse, Veenendaal, the Netherlands). This case underscores the challenges associated with implant placement during adolescence and highlights the importance of soft tissue management, abutment customization, and the integration of digital prosthetic workflows to achieve mid-term esthetic and functional success.