Background. In the early years of modern implantology, the chief concern was tissue health and implant survival. Over the last decade, there has been an increasing appreciation that esthetics is just as important to the success of the final restoration as health. The World Health Organization has defined health as a state of ‘ ‘ complete physical, mental, and social well-being, and not merely the absence of disease. ” Patients increasingly demand restorations that are as esthetic as they are functional. Consequently, many recent studies have concentrated on treatment outcomes of implant Therapy performed in the esthetic zone. In a review of the recent literature “ Belser and colleagues “ reported that, dental implants in the anterior maxilla have an overall survival and success rate similar to those reported for other segments of the jaw. In an 11-year retrospective study, “ Eckert “ and “ Wollen” evaluated 1170 implants placed in partially edentulous patients and found no differences in survival rates of the implants with regard to their anatomical location. However, they also reported an esthetic failure rate of about 9% for implant placement in this area. SO, Placement of a dental implant in the esthetic zone is a technique sensitive. A subtle mistake in the positioning of the implant or the mishandling of soft or hard tissue can lead to esthetic failure and patient dissatisfaction. Methods. The Search was limited to English language articles published between 2005-2019 with key words, implant placemet in Anterior of Maxilla, Implant in the Esthetic Zone Results. Implant placement in the Esthetic zone should be planned meticulous, there is Tischler’ s guidelines for implant placement in this area that is included:-Employ a conservation flap design-Evaluate the existing bone and soft tissue-Time the placement correctly-Visualize the 3-dimensional position of the implant-Consider the determinants of emergence profile-Consider healing time-Select a proper abutment and final restoration Conclusions. Implant placement in the Esthetic zone has successful result thorough proper preoperative treatment planning and choosing correct technique combined with appropriate surgical skills and knowing Esthetic parameters. Correct positioning of the implant in this zone is an important topic that periodontists face it and can make a significant contribution to applicant patients.

Background. There is no standard protocol for immediate implant placement and subsequent loading in the smile zone. We aimed to evaluate the long-term outcomes of simultaneous implant placement, soft tissue grafting, and immediate prosthetic loading in the esthetic zone. Methods. Thirty-five implants were placed in the maxillary aesthetic zone. Twenty-two patients were evaluated using the Pink Esthetic Score (PES) and White Esthetic Score (WES). Also, the degree of peri-implant bone resorption and patient survey were applied for the esthetic and functional outcomes. Results. The esthetic and harmonizing outcomes were achieved according to the mean total PES/WES value (17. 9±2. 0). The mean overall PES was 8. 5±1. 66. The papilla level had the highest mean score (1. 8±0. 36). Furthermore, the combination of root convexity/color and soft tissue color and texture was one of the key values in evaluating the effectiveness of this method (the mean value was 1. 5±0. 5). The mesial and distal papillae were 1. 6±0. 5 and 1. 8±0. 4, respectively. None of the 35 implants reached below 6 points (which is considered an esthetically unsatisfactory result). The mean WES score was 9. 5±0. 57. The average degree of total peri-implant bone resorption was 1. 05±0. 3 mm after 12 months. According to the questionnaire, all the patients smiled without hesitation and were satisfied with the treatment (100%). Conclusion. This study showed that restoring one or more teeth in the smile zone using the concept of one-stage implant placement, soft tissue flap augmentation, and loading with provisional crowns was an esthetically successful and predictable method.

The peripheral giant cell granuloma(PGCG) or the so-called "giant cell epulis" is one of the most common oral giant cell lesions. It occurs in response to chronic local irritation, and originates from mucoperiosteum or the periodontal ligament. This article presents the clinical and histopathological findings of PGCG in the esthetic zone in a 26 years old female patient. The treatment plan consisted of an excisional biopsy with immediate soft tissue grafting by placement of a free gingival graft in order to prevent esthetic complications. The six-month clinical follow-up showed no recurrence of the lesion and soft issue healing. Proper management of a PGCG lesion requires eliminating other pathologies prior to planning for surgery. Correct diagnosis of such lesions is essential to optimize the treatment and prevent recurrence. Clinical examination alone may not give a correct picture, thereby requiring histopathological confirmation. Immediate soft tissue augmentation using free gingival graft has been suggested as a surgical solution after removal of PGCG when soft tissues and the whole attached gingiva is lost.