A 50-year-old female patient with no medical history of interest was referred by her dentist to the Oral and Maxillofacial Surgery Department of the Virgen del Rocío University Hospital in Seville for the extraction of an included upper left canine. The patient reported that 6 months ago the deciduous upper canine had been exfoliated spontaneously. After taking a panoramic radiograph and a lateral radiograph, the situation of the included canine was verified in the upper left quadrant, impacted between the lateral and central incisor, with complete root development and apical foramen. Intraoral examination revealed the absence of the upper right second premolar and the lower left first molar, which had been missing for a long time. There were diastemas in the anterior sector and a distance from the edentulous section of less than 5 mm. After assessing the different therapeutic options, the patient was offered orthodontic treatment in order to provide the necessary space for prosthetic replacement in the canine region, and secondly, after insertion of an osseointegrated implant in the same surgical time as the extraction of the included canine, to proceed with the prosthetic restoration.

In the first phase, orthodontic treatment was carried out to achieve a mesiodistal space of 7 mm and closure of diastemas. Once this was completed, the extraction of the impacted canine and the insertion of an implant were planned. Under local anaesthesia, a mucoperiosteal flap was raised palatally to gain access to the impacted canine. After performing the minimal osteotomy, the tooth was odontosected, extracted and curetted. A vestibular mucoperiosteal flap was then raised to expose the vestibular cortex and ridge. A cylindrical hydroxyapatite implant 3.25 mm in diameter and 15 mm in length was placed, ensuring crestal anchorage to the floor of the nostrils, achieving very good fixation of the implant. A resorbable collagen membrane was placed and guided bone regeneration of the defect was carried out with demineralised bank bone. Also at the same session, implants were conventionally inserted in the position of the upper right second premolar and lower left first molar. The postoperative course was uneventful.
After an osseointegration period of 6 months, the second surgery and placement of the transepithelial abutment was carried out without incident. The prosthetic reconstruction was performed with a cemented implant-supported crown. The patient was then referred to the orthodontist to complete the orthodontic treatment. After seven years of evolution, the evolution is favourable with no peri-implant bone loss and maintenance of aesthetics and functionality.

