Case 1

A 36-year-old woman consulted the Department of Oral and Maxillofacial Surgery of the University Medical Center Groningen, Groningen, the Netherlands, with a persisting upper right primary canine and impacted secondary canine (Fig. 1). The primary canine had to be removed because of fracture of the crown. The patient did not want to undergo orthodontic treatment, and autotransplantation was no treatment option. She asked for a fixed restoration without involvement of the adjacent teeth and chose for a single implant treatment. She was healthy and non-smoker.

Intra-oral examination revealed a healthy, well maintained dentition. Clinically, adequate bone volume was thought to be present at the future implant site as well as favorable conditions for an implant crown with an anatomical design.

Radiographic examination, consisting of a standardized digital intra-oral radiograph and a cone beam computer tomography (CBCT) image (i-CAT® 17–19; Imaging Sciences International, LLC, Hatfield, USA), was done prior to localize the impacted canine. The CBCT image revealed an impacted right maxillary canine, situated on the buccal side (Fig. 2) with sufficient bone volume on the apical part of the future implant site. Removal of the impacted canine seemed to be possible with maintenance of sufficient bone at the future implant site for immediate implant placement. Furthermore, no pathology of the dentition was pre-existent. Because of this favorable starting point, it was decided to extract the primary canine and to surgically remove the secondary canine, immediately followed by insertion of an implant according to an immediate loading protocol.

Preoperatively, a cast was made for planning the preferred position of the implant from a prosthodontic perspective. Next, a transparent acrylic resin template (Vertex Castapress; Vertex-Dental BV, Zeist, the Netherlands) was made of this cast with the future implant crown in the preferred position. This template was transferred to a surgical guide. Care was taken to design the surgical guide as such that the guide channel allowed for screw retaining of the provisional restoration.