## 4 Discussion  
The immediate tooth replacement and the provisional restoration procedures provide a physiologic and esthetic advantage over the traditional delayed implant placement and prosthetic restoration [28]. From a clinical point of view, the post-extraction healing and osseointegration occur simultaneously, which is advantageous in terms of time. The current study suggests that the immediate post-extraction implant placement and provisional restoration in the esthetic zone yield acceptable changes in the soft tissue [8; 9; 10; 11; 12; 13]. The immediate provisional restoration after an implant placement in the maxillary anterior dentition produces predictable results by maintaining the gingival papilla and facial gingival heights [29]. The gingival mucosa around the implant can heal along the contour of the interim restoration [30]. Maintaining the anatomic architecture of the existing extraction socket is an important factor in achieving esthetic results with the immediate placement and immediate restoration in the esthetic zone. A variety of immediate provisionalization methods have been attempted to obtain desirable emergence profiles [31; 32; 33; 34]. With the developments in digital implant dentistry, a CAD/CAM system can be used to make the stereolithographic guides and customized abutments, as well as the final prostheses [35]. The stereolithographic guides used in this study (Oneguide, Ossem, Korea) were designed by superimposing the scanned data of the cast and by CBCT imaging using a CAD/CAM software (Implant Studio, 3 Shape, Copenhagen, Denmark). The implant-supported prosthesis was planned from the scanned cast data, and the location and size of the fixture to be placed were chosen with the consideration of the alveolar bone and its adjacent anatomical structures on the CBCT data. A titanium customized abutment was designed by the CAD/CAM software (Dental System, 3 Shape, Copenhagen, Denmark) duplicating the anatomical contours of the pre-existing tooth. A guided surgery in combination with a pre-fabricated customized abutment can preserve the anatomic gingival architecture, minimizing the change in soft tissue. Current studies report that a peri-implanted soft tissue can heal according to the contours of the provisional restoration [36; 37]. In this study, a titanium abutment replicating the original gingival shape before the extraction was pre-fabricated using a CAD/CAM system. On the day of surgery, the titanium anatomic abutments were connected to allow soft tissue healing and contouring along the original gingival shape. The customized anatomic abutment provides a reconstruction of the emergence profile and a gingival architecture to optimize the esthetic appearance. It also provides a custom seal to allow the graft material applied between the fixture and the bone gap to remain stable, without an exposure to the oral cavity (Figures 5 and 6). An additional advantage includes fewer complications from food retention and plaque \begin{table}
\begin{tabular}{c c c c} \hline \hline
**PES Parameter** & **Pre-Operative** & **Follow-Up** & **\(p\)-Value** \\ \hline Mesial papilla & \(1.33\pm 0.49\) & \(1.25\pm 0.45\) & 0.586 \\ Distal papilla & \(1.42\pm 0.51\) & \(1.58\pm 0.51\) & 0.438 \\ Midfacial mucosa level & \(1.67\pm 0.65\) & \(1.42\pm 0.51\) & 0.117 \\ Midfacial contour & \(1.58\pm 0.51\) & \(1.33\pm 0.49\) & 0.191 \\ Alveolar process deficiency & \(1.33\pm 0.78\) & \(1.16\pm 0.72\) & 0.504 \\ Soft tissue color & \(1.58\pm 0.51\) & \(1.42\pm 0.51\) & 0.339 \\ Soft tissue texture & \(1.50\pm 0.52\) & \(1.42\pm 0.51\) & 0.586 \\ Total score & \(10.58\pm 1.97\) & \(9.83\pm 1.34\) & 0.137 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: The Pink Esthetic Score. deposition between the gingiva and the abutment. In a systematic review, [PERSON] et al. reported that the surface of the abutment affects the tissue of the peri-implant. From an histological point of view, machined titanium abutments provide a low risk of inflammatory reactions that interfere with the healing of soft tissue [38].