Placing immediate implants in the esthetic zone area poses significant challenges. Implants should be

placed with consideration to hard and soft tissue management to optimize long term implant and

cosmetic success. In this case report, two maxillary central incisors were extracted in two different

time points, separated by 5 years because of horizontal root fractures. Implants were placed according

to immediate single-tooth guidelines, using two different surgical and loading approaches, as risk

assessment factors changed in the time between first immediate placement (#8) and second immediate

placement (#9). These techniques included Partial Extraction Therapy (PET), the use of allograft and

growth factors, connective tissue graft (CTG), platelet rich fibrin (PRF) and immediate and

conventional loading. These were grouped as the “10 keys”, a checklist used to pursue long term

success. After 6-year and 1-year follow-up, radiographic and clinical results were satisfactory.