A Clinical Diagram to Guide Optimal Coronoapical Positioning of Bone-Level Implant Relative to Orofacial Placement in the Esthetic Zone

Abstract

Objective This article introduces a visual diagram designed to assist clinicians in determining the optimal apical depth for bone-level (BL) implant placement in the esthetic zone. The diagram references the midfacial gingival zenith point. It aims to ensure biologically sound, esthetic, and restoratively driven outcomes, an approach recently described in the literature as the "Bio-Restorative" concept, particularly when orofacial positioning is altered due to anatomical or restorative limitations.Clinical Applications A healthy 45-year-old female patient required extraction of a fractured maxillary right central incisor. Immediate BL implant placement was planned using static computer-assisted implant surgery (S-CAIS). A virtual prosthetic setup was created, and the proposed diagram, featuring a set of circular depth guides, was superimposed onto the cross-sectional cone-beam computed tomography (CBCT) image. This visual aid helped verify that the implant platform (implant-abutment junction) fell within the clinically acceptable range of the abutment's emergence angle (EA). S-CAIS was conducted according to the digital plan, and the definitive restoration demonstrated favorable esthetic integration.Conclusions The visual diagram supplements digital workflows by providing a practical, geometry-based reference for implant depth relative to the prosthetic implant platform. It is particularly valuable in esthetically demanding cases, enabling clinicians to make objective decisions that integrate prosthetic and biologic considerations, in line with the bio-restorative concept.