Maxillary canines are the second most impacted teeth (20 % of all impacted teeth); the prevalence in general population is approximately 2 %. Most impacted cuspids are located palatally, with a palatal/buccal ratio of 8:1.

There are several known treatment options for impacted canines to align them into the dental arch. The most widely used option is orthodontic traction after surgical exposure. An alternative is autotransplantation of the impacted canine optionally combined with orthodontic treatment, e.g., when only orthodontic repositioning is not possible or unsuccessful. In general, these treatment options use the patient’s own teeth to encounter the clinical problem. The advantages of this aspect are functioning as normal teeth, normal dentofacial development, and maintenance of the alveolar bone. Prognosis of autotransplantation is significantly dependent on the stage of root development, with lower risk of failure in teeth with open apex. Success rates for autotransplantation, mentioned in the literature, lie between 82 and 99 %. Disadvantages of both treatment options for alignment of impacted canines into the dental arch are a long treatment time and high costs, not to mention the unpredictable final outcome. Surgical exposure followed by orthodontic traction is associated with damage to supporting structures such as bone loss, root resorption, and gingival recession. The most frequently reported complications in autotransplantation are root resorption or ankylosis, pulp necrosis, and reduction of final root length. Replacement of a failing single tooth, such as a failing primary canine with an impacted secondary canine, through a single implant is another reasonable treatment option. Single implant treatment in this respect is not widely applied yet, but should be considered, if orthodontic treatment and autotransplantation are not feasible because of factors such as canine location, severity of impaction and age of the patient, or when the patient is not willing to encounter conventional treatment options because of treatment duration, morbidity, and costs. With regard to prosthodontic rehabilitation of a single implant, the concept of immediate single implant placement and provisionalization is not yet a standard treatment, but there is a growing interest in immediate tooth replacement, particularly in the esthetic region.

Applying an immediate protocol means shortening of the treatment duration as only one surgical intervention is needed and no need for a temporary prosthesis. Thus morbidity and costs of the treatment are reduced.

According to the literature, immediate implant placement is accompanied by survival rates comparable to conventionally placed implants. With regard to immediate provisionalization, it is not yet set that the esthetic outcome is more favorable. However, immediate provisionalization of the immediately placed implant is presumed to give better support to the surrounding peri-implant tissue for preservation of the original architecture, conditions which are in favor for an optimal esthetic result.

The objective of the present report was to describe a surgical approach for removal of an impacted secondary canine, either located buccally or palatally, combined with extraction of the primary canine and immediate placement and provisionalization of an implant.