Periimplant tissue management: optimal timing for an aesthetic result.

When implants are utilized to restore the dentition in an aesthetically prominent region, there are four different time points when the periimplant tissue can be influenced-prior to implant placement, simultaneously with implant placement or during the healing phase of the implant, at second-stage surgery, and during the maintenance phase. There is no single optimal point in time for managing the periimplant tissues; the patients present for treatment at various stages, and each case has to be individually evaluated and an appropriate treatment plan designed. The earlier periimplant tissue management is initiated, the greater are the opportunities for a successful result. The learning objective of this article is to review these options by means of case presentations. The different surgical procedures are explained and their advantages or disadvantages discussed. Four case reports are used to demonstrate the rationale and the clinical procedures. An improvement in the aesthetic harmony was attained in all four cases.