Abstract: Peri-implant mid-facial recession, characterized by gingival recession, abutment exposure, and "black triangle" formation, critically compromises esthetic outcomes. Specific predisposing and precipitating factors are as follows: buccal bone dehiscence or fenestration, a thin periodontal phenotype, and insufficient or absent keratinized mucosa; improper case selection for immediate implant placement, overly buccal implant positioning, excessively large implant or abutment diameters, and over-contoured restorations; as well as aggressive tooth brushing and inflammatory stimuli from peri-implant diseases. Preventive strategies for mid-facial recession must be integrated throughout the entire implant treatment cycle. Preoperatively, CBCT is utilized for precise planning of implant placement, and digitally guided surgery may be selected for accurate implantation. In immediate implant cases, it is recommended to combine jump gap bone grafting and connective tissue graft (CTG) intraoperatively to thicken the soft tissue. For early or delayed implantation, the focus shifts to preserving existing tissue and reconstructing lost tissue. This involves using standardized guided bone regeneration (GBR) techniques and tension-free suturing during bone augmentation to rebuild lost support. During the prosthetic phase, provisional and final prostheses with appropriate emergence profiles and biocompatible materials are used to effectively shape and support the soft tissue. For managing the existing recession, a graded treatment protocol is proposed as follows. Mild recession (<2 mm): Tunnel technique + CTG. Severe recession (≥2 mm): coronally advanced flap (CAF) + CTG. Cases with loss of interdental papilla: connective tissue platform technique. In summary, achieving long-term stable aesthetics requires strict adherence to clinical protocols, control of iatrogenic factors, and a combination of evidence-based decision-making with precise surgical execution.

Key words: Esthetic zone, Peri-implant soft tissue dehiscence/deficiency, Mid-facial recession, Connective tissue graft