Case 2

A 45-year-old man consulted our department with an impacted right maxillary canine and a persistent primary canine with evident mobility and in need of removal (Fig. 10). The patient chose for a single implant treatment because he wanted to have a long lasting and fixed solution for the failing tooth. All general health prerequisites were met and intra-oral examination revealed a healthy, well-maintained dentition. Clinically, adequate bone volume was present at the future implant site. In all dimensions, sufficient space was available for an implant crown with an anatomical design. The CBCT image (i-CAT® 17–19) revealed an impacted canine situated on the palatal side (Fig. 11) without any other pathology of the dentition as well as sufficient bone volume on the apical part of the future implant site.

Preoperative preparations were the same as for the first case. Next, after administration of local anesthesia (Ultracaine D-S Forte), a full-thickness palatal flap, by an intrasulcular incision on the palatal gingiva from the distal margin of the first premolar to the mesial margin of the central incisor, was elevated for good access to the impacted canine (Fig. 12). Extraction was done carefully, again using a round drill and a bone scraper (Safescraper®), with preservation of the alveolar crest and buccal bone wall. The roots of the neighboring teeth were not exposed. Afterwards, the primary canine was extracted using a forceps.

Because of sufficient bone remaining, an implant (NobelActive NP, 18 mm) was placed immediately into the extraction socket according to the prescribed manufacturer’s procedure and guided by the surgical template, with good primary stability of >45 Ncm. An 18-mm implant was chosen for good primary stability because of the bone defect. Bone augmentation was done as described in the first case (Fig. 13). Installation of the provisional implant crown, about six hours following implant placement, was also done according to the procedure described for the first case and with special attention to avoid any contact to the antagonist and contour of the crown. Post-operative care instruction was identical to the first case too. Sutures were removed two weeks after implant placement. Three months after implant installation, the definitive implant crown was placed.

During both follow-up appointments, scheduled 1 and 12 months after installation of the final implant crown (Fig. 14), intra-oral examination revealed healthy peri-implant tissues. Radiographic examination showed minimal bone resorption mesial and distal of the implant (Fig. 15).