Defects in the maxillary anterior teeth are delicate and difficult to solve because of the esthetic, functional, and psychological impairment that may arise if the rehabilitation treatment does not return the damaged tissues to the naturalness. Esthetic predictability and reduced surgical interventions are some great reasons to simplify dental treatments. During the presurgical evaluation, the clinician should review the implant esthetic risk profile, considering the patient's smile line, the esthetic demands, the hard and soft tissue thickness and width, and the gingival biotype. Thus, achieving long-term esthetic results initiates with a detailed case planning before surgical intervention.

The present report described a complex esthetic clinical case involving teeth and dental implant related to a high smile line. The clinical case was solved through immediate implant placement and immediate loading using a personalized prosthetic abutment and finalized with the installation of metal-free prosthetic restorations.

The use of a personalized prosthetic abutment helped to achieve a better emergence of the prosthesis under the periodontal tissues. Although it was a challenging esthetic case, especially because of the high smile line, the result was a natural smile while the adjacent soft tissues maintained their esthetics and health.