Tabriz University of Medical Sciences Journal of Dental Research, Dental Clinics, Dental Prospects 2008-210X 17 3 2023 11 11 Long-term evaluation of combined prosthetic-surgical approach and soft tissue augmentation in the esthetic zone 170 176 10.34172/joddd.2023.40593 EN David Nazarian https://orcid.org/0000-0001-9423-2221 Viktoriia Olegovna Dzhuganova https://orcid.org/0000-0002-5957-1364 Anastasia Nefedkina https://orcid.org/0000-0002-1788-1292 Georgy Zakharov https://orcid.org/0000-0002-3406-2088 Aleksander Fedosov https://orcid.org/0000-0002-4372-7723 Grigoriy Kyalov https://orcid.org/0000-0002-1813-8775 Arbak Khachatryan https://orcid.org/0000-0002-3066-8373 Journal Article 10.34172/joddd.2023.40593 2023 08 15 2023 10 01 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.