Traumatic anterior tooth loss often presents both surgical and esthetic challenges. In this clinical case, oral surgeon Dr. David Ramos demonstrates immediate placement of a Dentis AXEL 4.2 × 12 mm implant in the anterior esthetic zone, combined with hard and soft tissue augmentation to support predictable healing and preservation of the natural gingival architecture.
Through careful treatment planning and immediate provisionalization, the case demonstrates an approach designed to support esthetic integration and long-term functional success
Case Background
Date: June 19, 2026
A 35-year-old healthy male patient presented following dental trauma involving teeth #8, #9, and #10. Clinical examination revealed a root fracture of tooth #9, rendering the tooth non-restorable.
Initial image shows the traumatic root fracture.
To preserve the extraction site and optimize esthetic outcomes, Dr. Ramos elected to perform immediate implant placement with simultaneous hard and soft tissue grafting.
Initial Assessment & Treatment Plan
Clinical evaluation revealed D2 bone density with a thin facial bone plate. Based on the condition of the surrounding tissues and the patient’s overall health, an immediate implant protocol was selected to minimize tissue collapse and reduce overall treatment time.
The treatment plan included:
- Atraumatic extraction of tooth #9
- Immediate placement of an AXEL implant
- Facial gap grafting with allograft
- Connective tissue grafting for facial soft tissue support
- Immediate screw-retained provisional restoration
Tooth Extraction & Site Preparation
The fractured tooth was atraumatically extracted while preserving the surrounding hard and soft tissues. The implant osteotomy was then prepared using a prosthetically driven approach, allowing ideal implant positioning while maintaining the facial plate.
Implant Placement
An AXEL 4.2 × 14 mm implant was immediately placed into the extraction socket in a palatal position, allowing the screw-access channel to emerge through the cingulum for an optimal restorative outcome.
ScanBody placement following implant insertion.
The implant achieved 40 Ncm insertion torque, providing excellent primary stability and making immediate provisionalization possible.
Hard & Soft Tissue Management
To preserve facial contour and support long-term tissue stability, the facial gap surrounding the implant was grafted with allograft.
A connective tissue graft was also placed to reinforce the facial soft tissue and help maintain volume around the implant during healing, reducing the risk of post-extraction recession.
Immediate Provisional Restoration
An individual screw-retained provisional crown was fabricated using SeedPrint Definitive Crown Resin on a 2 mm titanium T-base.
To protect the implant during healing, the provisional crown was kept completely out of occlusion. Tooth #8 was provisionally restored with composite resin while the implant site progressed through the healing phase.
Postoperative Result
Date: July 10, 2026
At the 21-day follow-up, clinical evaluation demonstrated favorable soft tissue healing with excellent preservation of the interdental papillae and peri-implant tissue contours.
3week post-op displaying excellent soft tissue healing and contour.
The implant remains in the provisional phase prior to fabrication of the definitive restoration.
Conclusion
This case demonstrates how immediate implant placement following traumatic tooth loss can successfully preserve both esthetic and functional outcomes when combined with careful surgical planning and soft tissue management.
By utilizing the AXEL Implant System, a bone graft using allograft, connective tissue augmentation, and immediate provisionalization, Dr. Ramos established excellent primary stability while maintaining the natural architecture of the surrounding tissues. The favorable early healing observed at the three-week follow-up provides a strong foundation for long-term restorative success.
