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I case report _ single tooth replacement for the apex resection had resulted in scar tissue at the junction of the keratinised and non-keratinised gingiva. Tooth #21 had been filled withafour-sidecompositefillingat the mesial side. Since the expectations of the patient regarding the aesthetic out- come were very high, we decided on immediate implant placement with a CAMLOG SCREW-LINE Implant after extraction of tooth #11. The soft- and hard-tissue structures were preserved as far as pos- sible.Boneaugmentationwasperformedatthetime of implantation to treat the bone defect. The pros- thetictreatmentwastotakeplacethreetosixmonths post-operatively, depending on the size of defect. _Conclusion Implant-borne reconstruction of missing ante- rior teeth is challenging, especially in fresh extrac- tion sockets. For a functionally and aesthetically stable outcome, sufficient hard and soft tissue is needed. Care has to be taken to preserve the exist- ing tissue structures. Vertical and horizontal bone loss after insertion of the implant due to remodel- ling processes has to be taken into account. In the present case, the patient had high ex- pectations regarding the aesthetic outcome. An alternative treatment of this case would have been a bridge solution combined with augmentation of the pontic area. Such a solution would have held fewer risks and allowed achievement of a more predictable soft-tissue situation. The patient was informed of the risks and alternatives. However, she decided on implant reconstruction. We aimed to preserve the soft- and hard-tissue structures to achieve an adequate level of marginal gingivatogetherwithanadequateinterdentalbone peak. Therefore, we decided on immediate implant placement after extraction of tooth #11, creating optimalsoft-andhard-tissuestructuresaroundthe implant at the time of implant placement. The soft tissue around coronal part remained untouched and the coronal aperture was closed with a trans- mucosal abutment. The flap preparation was per- formed in the apical region only. This technique was chosen to provide the best possible interface between crown and gingiva. Wewereabletoachieveanideal3-Dpositioning of the implant and an optimal aesthetic result that was still stable after three years._ 32 I cosmeticdentistry 4_2012 DrPeterRandelzhofer studieddentistryinMunich, Germany,andreceivedhis traininginprostheticsand implantdentistryattheUniversity ofFreiburg,Germany.In2001, hewasappointedAssistant DirectoroftheCentrefor ImplantologyandPeriodontology,aprivatepractice inAmstelveen,Netherlands.In2002,hereceived hiscertificationasanimplantologistfromtheNvOI (theDutchoralimplantologyassociation).From2005 to2009,heworkedattheCentreforImplantology andPeriodontology.In2009,hefoundedthegroup practiceforimplantologyandperiodontologyin Munich,Germany,togetherwithDrClaudioCacaci. DrRandelzhoferisauthorofnumerouspublications andheisaninternationallyrenownedspeaker.He isactiveasatrainerandteacheratvariousinstitutions intheNetherlandsandGermany,andheisamember ofseveralnationalandinternationalstudygroups. Implantat Competence Centrum in München Weinstraße 4 80333 Munich Germany cosmeticdentistry _about the author Impression taking and prosthetic reconstruction: Fig. 21_Clinical situation before impression taking. Fig. 22_The ideal emergence profile of the temporary crown was copied with an individual impression post and reproduced on the master model. Fig. 23_Individual impression post. Fig. 24_Individual impression post placed on the implant and the open- ing of the sulcular structures. Fig. 25_Lateral view of the implant with impression post. Fig. 26_Impression tray capturing the crown-gingiva interface. Fig. 27_Master model with temporary abutment and silicone index showing the preservation of the backward-planning information. Fig. 28_IPS e-max crown (Ivoclar Vivadent) immediately after definitive placement on the individualised ceramic abutment with PANAVIA cement (Kuraray). The apical scar tissue was shaped with a diamond drill for a smoother gingival outcome. Result after one year: Fig. 29_Final result one year after implant placement. The soft tissue shows a stable and near-perfect interface with the implant crown. Fig. 30_Optimal tissue contour. Results after three years: Fig. 31_Stable soft tissue showing no resorption at the implant-crown interface or gingival sulcus. Conclusion: Fig. 32_Initial situation before extraction. Fig. 33_Initial situation with non-preservable tooth #11. Fig. 34_Clinical situation three years after implantation. Fig. 35_Final X-ray after one and three years. Fig. 34 Fig. 35 Fig. 32Fig. 31 Fig. 33