Reconstruction of a Complex Anterior Maxillary Defect Using the Bone-to-Soft Tissue Technique: A Case Report.

Background: Reconstruction of alveolar defects in the esthetic zone remains challenging, particularly when both hard- and soft-tissue deficiencies coexist or when implant placement is contraindicated due to age-related or anatomical factors. Biologically driven approaches aiming to simultaneously restore the dentoalveolar unit have gained increasing interest. Case Presentation: This case report describes the clinical application of a Bone-to-Soft Tissue (B2S) protocol involving transplantation of a combined tooth-bone-soft-tissue complex in a 17-year-old patient presenting with traumatic loss of a maxillary central incisor and severe alveolar ridge deficiency. The surgical procedure included harvesting of the dentoalveolar complex, adaptation to the recipient site, stabilization, and staged restorative management. Results: Stable integration of the transplanted complex was achieved, with preservation of soft-tissue architecture and restoration of alveolar contour. Radiographic follow-up confirmed maintenance of bone volume, whereas clinical outcomes demonstrated satisfactory esthetic and functional rehabilitation. Conclusions: Composite tooth-bone-soft-tissue transplantation within the B2S technique may represent a biologically oriented alternative for selected cases of esthetic zone reconstruction, particularly when conventional implant or regenerative approaches are limited. Further controlled studies are required to validate long-term outcomes and define clinical indications.