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Treatment Algorithm · Module
Esthetic zone management
Stratifying esthetic risk and selecting a placement and provisionalization strategy in the anterior maxilla. Anchored to the ITI SAC classification and Esthetic Risk Assessment, with a restoration-driven, biotype-aware approach.
Use: Anterior planning reference
Gatekeeper: Esthetic risk level
Framework: ITI SAC / ERA
01 — Risk Factors
Esthetic risk assessment & provisionalization
The ERA aggregates patient and site factors into an overall risk level. Higher risk shifts the plan toward staged, augmentation-supported, restoration-driven approaches.
Patient / smile
Phenotype & smile line
- Gingival phenotype — thick/flat is forgiving; thin/scalloped is high-risk
- Smile line — high lip line exposes margins
- Esthetic expectations and tooth shape (triangular = papilla-sensitive)
- Medical status & smoking
Site
Gap, defect & papillae
- Width of edentulous span — single vs. multiple
- Bone defect & facial bone-wall phenotype
- Adjacent papillae / bone level on neighboring teeth
- Soft-tissue anatomy & infection at the site
Restorative
Provisionalization
- Provisional shapes the emergence profile and papillae
- Screw-retained provisional preferred where access allows
- Develops a tissue-supportive subgingival contour over time
- Serves as a blueprint for the definitive restoration
02 — Decision Pathway
Interactive esthetic-risk selector
Aggregate the ERA factors into an overall risk level, then read the recommended placement and contour strategy. Tap the level that matches the case.
Tap the overall esthetic risk level (per ERA).
Step 1 — What is the aggregated esthetic risk?
LOW
Low risk
Thick biotype, low smile, intact walls, healthy.
MODERATE
Moderate risk
Average biotype, some contour deficit, medium lip line.
HIGH
High risk
Thin/scalloped biotype, high smile, bone defect.
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03 — Quick Reference
Risk factor → planning modifier
Each unfavorable factor pushes the plan toward a more cautious, staged approach. Treat multiple modifiers as additive.
| Risk factor | Favorable | Unfavorable → modifier |
|---|
| Gingival phenotype | Thick / flat | Thin / scalloped → soft-tissue graft; consider connective tissue |
| Smile (lip) line | Low | High → maximize tissue management; manage margin position |
| Facial bone wall | Intact, thick | Thin / dehiscent → contour grafting, avoid immediate placement |
| Edentulous span | Single tooth, intact neighbors | Multiple adjacent → papilla loss risk; stage carefully |
| Infection at site | None | Acute → defer; favor early (delayed) placement |
Reference
Sources & clinical disclaimer
For licensed clinicians — educational use only. This algorithm summarizes published classifications and is not a substitute for individual clinical judgment, examination, or the standard of care in your jurisdiction. Esthetic zone implant therapy is an advanced/complex procedure requiring appropriate training.
- Dawson A, Chen S, eds. The SAC Classification in Implant Dentistry. Berlin: Quintessence; 2009.
- Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants. 2004;19(Suppl):43–61.
- Kan JYK, Rungcharassaeng K, Umezu K, Kois JC. Dimensions of peri-implant mucosa: an evaluation of maxillary anterior single implants in humans. J Periodontol. 2003;74(4):557–562.
Last reviewed: June 2026 · Next review due: June 2027 · Version 1.0