Implant soft tissue dehiscences compromise not only the aesthetics of the supported restorations but implant survival in the long run. The aim of this narrative review was to briefly present the causative factors of buccal peri-implant soft tissue dehiscences (PSTDs), how these are classified, and the current therapeutic approaches. Implant malposition and the thin peri-implant phenotype are the two major determinants for the occurrence of PSTDs, but other risk factors have also been identified. The most common surgical procedure for treating PSTDs is the split-thickness coronally advanced flap combined with either a connective tissue graft or acellular dermal matrix materials. However, depending on the class and subtype of the dehiscence, the combination of surgical techniques with modifications in the restoration may further ameliorate the final result. In general, within a five-year follow-up period, most techniques lead to a satisfactory aesthetic result, although full coverage of the implant/abutment surface is not always achievable, especially in more extended lesions.

Objectives: CAD-CAM technology has enabled clinicians to provide accurate and predictable restorations. Chairside time has been reduced and patient’s comfort has been improved. A fully digital workflow can be now predictably adopted in implant surgery and implant restorations. Methods: A male patient, 55 years old, was referred for the restoration of his edentulous mandible. Radiographs and clinical evaluation were assembled to plan implant placement. The flapless approach is preferred to provide for a mucosa-supported surgical guide and lessen the patient’s post-operative complications. In flapless cases, the operator does not have any direct overview of the surrounding soft tissues and underlying bone. In this case, a new, minimally invasive H-shaped incision technique was performed. A fully digital protocol is presented with a two-piece stackable surgical guide to confirm accurate implant placement. Results: A high-performance polymer framework (PEEK) combined with zirconia crowns completes the digitally designed edentulous restoration. Conclusions: Adopting this technique offers the clinician benefits in both the surgical and the restorative part.