How to prevent thread exposure associated with immediate implant?  Buccal (Fig.8 red dashed line) and lingual (brown dashed line) crests are uneven in this case.  When the tissue-level implant is placed according to the higher crest, there is thread exposure (between arrowheads) on the lower side.  It is safe to place an implant (e.g., bone-level) according to the lower crestal level (Fig.9 green area).  When the implant is placed between the uneven crests, the exposed coronal threads should be covered by bone graft (red area).  Therefore an incision is to be made for visibility.  It does not compromise cosmetics in the posterior region.

Bone Graft to Cover Exposed Threads

Xin Wei, DDS, PhD, MS 1st edition 03/19/2015, last revision 03/20/2015