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Peri-implant marginal mucosa defects (PMMDs) are alterations of the periimplant soft tissue architecture characterized by an apical discrepancy of the mucosal margin respective to its ideal position with or without exposure of transmucosal prosthetic components or the implant fixture surface. PMMDs may not only represent an esthetic concern but also predispose to biofilm accumulation and subsequent initiation and progression of peri-implant inflammatory diseases. A treatment-driven classification for tooth-bound, facial PMMDs in nonmolar sites, consisting of three different levels of complexity, is proposed. Clinical recommendations pertaining to the prosthetic and surgical management of each type of PMMD, illustrated with practical examples, are provided with the purpose of facilitating decision-making processes in daily practice. K E Y W O R D Sclinical decision-making, dental implant, oral mucosa, plastic surgery PERI-IMPLANT SOFT TISSUE DEFORMITIESDeformity is a congenital or acquired alteration of the normal shape, size or alignment of a biological structure. Deficiencies and defects are specific types of deformities. Deficiency is an insufficient or inadequate amount of a necessary constituent. Defects are dysmorphic abnormalities associated with structural alterations.Thus, peri-implant soft tissue deficiencies and defects can be categorized into three distinct groups: A. Keratinized mucosa width deficienciesPeri-implant keratinized mucosa width

This article describes a comprehensive step‐by‐step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long‐term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence.