A case that demonstrates how, even in complex situations, accurate diagnosis and careful planning allow for immediate functional and aesthetic results without interfering with adjacent anatomical structures. In this clinical case, the extraction of a deciduous canine (tooth #53) was followed by the placement of an immediate implant with an immediate provisional restoration, in an anatomically delicate site due to the presence of the corresponding impacted permanent canine, which is intended to remain in that position. The main challenge was to ensure primary stability and an immediate aesthetic outcome, precisely planning implant position and axis to avoid any interference with the impacted tooth. Immediate loading, whenever conditions allow, is considered the ideal solution: reducing waiting times for the patient without compromising treatment predictability and safety is a goal that consistently guides the team’s therapeutic choices.
Fig.1
The patient wishes to improve her smile and replace her deciduous canine, which is now very mobile and discolored.
Fig.2
The X-ray clearly shows the root resorption that the deciduous tooth has undergone and the presence of the permanent canine in total bone inclusion which anatomically limits the insertion of an implant for the replacement of the same tooth.
Fig.3
Upon careful examination, it is clear that the patient does not only need the replacement of the canine, but also a more complex therapy that takes into consideration the entire mouth, solving her orthodontic and aesthetic problems.
Fig.4
An orthodontic treatment is then started to resolve the deep bite and the alignment of the patient’s teeth.
Fig.5
Surgical treatment begins with the extraction of the deciduous tooth, preserving the architecture of the soft tissues as intact as possible as they are ideal in terms of shape and position.
Fig.6
In occlusal view it is evident that the root prominence is clearly visible and therefore associated with the good availability of keratinized gingiva, it is possible to perform the intervention without planning any connective tissue graft.
Fig.7
At the end of the surgery, after having filled the gap between the implant and the bone and the entire transmucosal path with heterologous biomaterial, an immediate provisional resin prosthesis is screwed in, suitably concave in its portion inside the soft tissues.
Fig.8
From the x-ray at the end of the surgery it is clear that the apex of the implant is very close to the impacted canine without causing any problems.
Fig.9
Months later, at the end of orthodontic therapy, the case is ready to be finalized. Thanks to an adequate shape of the transmucosal path of the temporary restoration, the tissues have maintained an ideal, very natural architecture.
Fig.10
At the end of the therapy, after having screwed the definitive zirconia ceramic crown, the result is truly natural, so much so that it can be said that at a common distance of conversation it is practically impossible to be able to say that it is an artificial tooth on an implant.
Fig.11
The same can be said for all the teeth, now the patient has an absolutely natural and aesthetically pleasing appearance.
Fig.12
At the end of the treatment the patient can proudly show off her smile without any problems related to the shape, appearance or position of her teeth.
Fig.13
Final X-ray at the end of treatment.
Conclusions
This case highlights how a multidisciplinary approach and integrated planning are essential for managing complex clinical situations. Alongside the implant rehabilitation, the patient underwent orthodontic treatment aimed at aligning the dental elements and correcting a deep bite, thus completing the therapeutic picture from both a functional and aesthetic standpoint. The synergy between the different dental disciplines made it possible to achieve a harmonious and stable long-term result, confirming how collaboration between specialists and a comprehensive view of the case are key elements for therapeutic success, especially in young patients whose growth and development are still ongoing.
Bibliography
- R Saito H, Chu S, Reynolds M, Tarnow D: “Provisional Restorations Used in Immediate Implant Placement Provide a Platform to Promote Peri-implant Soft Tissue Healing: A Pilot Study “ Int J Period Rest Dent 2016;36:47-52;
- Redemagni M, Cremonesi S, Garlini G, Maiorana C: “Soft Tissue Stability with Immediate Implants and Concave Abutments.” Eur J Esthet Dent 2009;4:226-235;
- Mankoo T: “Contemporary implant concepts in aesthetic dentistry-Part 2: immediate single tooth implants.” Pract Proced Aesthet Dent 2004;16:61-68;
