Tooth loss in the anterior maxilla is followed by significant bone loss. This bone loss is even more extensive when trauma or infection was the reason for tooth loss. The overlying soft tissue follows the contour of the underlying bone and an aesthetic deficit is the result. For patients with a high smile line the bone and soft tissue loss results in an aesthetic nightmare. In some cases papilla loss and root exposure around adjacent teeth are also a consequence. When tooth replacement is planned for such a patient care must be given to try and re-establish the tissue that was lost.
This case presentation shows how an attempt was made to graft bone back in a horizontal direction due to destruction of the buccal plate of the patient. At the same time root coverage of the adjacent teeth to create a harmonious gingival contour and the utilization of a pedicle soft tissue graft for papilla re-creation next to the missing tooth is illustrated.