A 50-year-old female patient with no relevant medical history came to the consultation of the Oral and Maxillofacial Surgery Service of the Virgen del Rocío de Sevilla University Hospital for a left maxillary extraction by her dentist.
The patient reported that 6 months ago he had spontaneously exfoliated the upper canine.
After performing a panoramic radiograph and a lateral radiograph, the situation of the canine included in the upper left quadrant, impacted between the lateral and central incisor, with the development of the apical foramen was verified.
Intraoral examination revealed the absence of the right upper second premolar and the left lower first molar, with a long evolution time.
The patient presented diastemas in the anterior sector and the same position as the implant placement after 5 mm. After assessing the different therapeutic options, the patient was asked to perform in the first place an orthodontic treatment with restored space.
1.
In the first phase, orthodontic treatment was performed to achieve a 7 mm mesiodistal space and diastema closure.
Once this was completed, the extraction of the included canine and the insertion of an implant were planned.
Median local anesthesia, a mucoperitic palatal flap was raised to access the canine.
After carrying out the minimum osteotomy, the teeth were subjected to odontosection, extraction and curettage of the bed.
A mucoperitic vestibular crest flap was then raised to expose the buccal cortical and the crest.
A cydrical implant of hydroxyapatite measuring 3.25 mm in diameter and 15 mm in length was placed, looking for an anchorage to the floor of the nasal crest, with this fixation being very good.
A resorbable collagen membrane was placed and guided bone regeneration of the defect was performed with demineralized bank bone.
In the same session, conventional implants were inserted in the position of the right upper second premolar and left lower first molar.
The postoperative course was uneventful.
After a period of osteosynthesis of 6 months, the second surgery was performed and the transepithelial pillar was placed without incidents.
Prosthetic reconstruction was performed with a cemented implant-supported crown.
From this moment on, the patient was referred to the orthodontist to complete the orthodontic treatment.
After seven years of evolution, the evolution is favorable without having presented peri-implant bone loss and with maintenance of aesthetics and functionality.
