## 4 Discussion
Although this approach appears to improve the stability of the soft tissue, it is a common clinical observation that the addition of the connective tissue graft (CTG) can potentially affect the color and volume of the tissue, making it look different than that of the adjacent sites. The color changes observed are strongly related with the origin of the CTG and the time that has lapsed from the time of surgery [51; 52]. The MMC protocol does not induce any such problems, since no CTG or any other material is introduced into the pouch, but instead the generated blood clot is the foundation behind the changes that occur [42]. The ideal position of an immediately placed implant in the esthetic zone has been well documented and is generally described as the \"palatal position\" [18]. However, the term \"palatally-placed implant\", generates some misconceptions. It is important to note that the sockets in the esthetic zone present different anatomies [26]. A fundamental goal that the clinician needs to fulfil in order to be able to immediately load the implant is to achieve high primary stability by engaging anadequate amount of native bone [53]. Thus, based on the socket's anatomy and the implant's size and macro-geometry, the position of the implant body can be located palatally, centered, or even bucally, in order to achieve high primary stability (Scheme 1B). As long as the platform and the neck of the implant (3-4 mm of the coronal part of the implant body) are located a minimum distance of 2 mm from the buccal wall of the socket, the needed conditions for a positive esthetic outcome are met, since this coronal area of the socket is the one mostly affected by the physiologic changes/remodeling that occurs during and after the initial healing period of the socket [5; 19]. Thus, we believe that a term such as \"palatally-positioned implant neck\" is more suitable when describing ideal implant positioning in immediate extraction cases. As far as the depth of the implant is concerned, again several factors can affect the final decision for ideal depth. The size and the horizontal location of the implant platform along with the size of the cervical margin of the prosthesis, in combination, dictate the necessary room for proper emergence angle of the prosthesis and thus need to be accounted for when deciding the ideal depth position for the implant [54]. This depth in reality will be anywhere between 3 to 5 mm from the zenith point of the final prosthesis for the majority of the clinical cases. At the stage of provisionalization, the first provisional restoration is designed with two factors in mind. The first refers to the esthetic appearance of the patient and it is related to the design, texture, and color of its supra-gingival portion. The second factor refers to the healing process of the socket and, in particular, its soft tissue zone. More specifically, the abutment shoulder with its tulip shape and restricted lateral dimensions provides a surface to contain the membrane and the BRG within the soft tissue zone of the socket, while at the same time providing space for the soft issue adaptation and integration [21]. The cervical margin of the prosthesis being located at least 1 mm supra-gingivally and comprising a 90\({}^{\circ}\) emergence angle, provides necessary room vertically for the soft tissue to migrate coronally. It is understood that in the case of type II sockets where a gingival recession is present, the margin of the prosthesis should be located 1 mm coronal to the future zenith point of the final prosthesis. Thus, in these cases, the cervical margin of the temporary prosthesis can be located 2, 3, or even more millimeters supra-gingivally at the mid-buccal portion. Other published protocols install a temporary prosthesis with a submergence profile that is identical to the emergence profile of the socket. These protocols aim for the prosthesis to fully occupy and support the existing emergence profile of the soft tissue [55].