Long-term implant success depends on prosthetically driven three-dimensional positioning and the stability of peri-implant and adjacent periodontal tissues. In partially edentulous patients—especially those with a history of periodontitis—an untreated vertical intrabony defect next to the planned implant site can impair plaque control and jeopardize peri-implant hard-tissue stability.

This case report presents a 54-year-old, systemically healthy patient with a history of periodontitis, missing the mandibular right first molar (46) and exhibiting a combined mesial intrabony defect at the adjacent second molar (47). Management combined implant placement at site 46 with minimally invasive regenerative surgery at 47 and soft-tissue phenotype modification using a connective tissue graft. Healing was uneventful, and 6-year follow-up demonstrated stable crestal bone at the implant, sustained radiographic fill of the mesial defect, and favorable, well-contoured peri-implant soft tissues.

Results: The results suggest that simultaneous guided implant placement with adjacent defect regeneration and connective tissue grafting may achieve durable hard- and soft-tissue stability over years.