PMC5340929_01
(a) At the clinical oral examination a retained #63 with complete transposition of #23 is observed. On the right maxillary arch a peg lateral incisor is present. (b) #63 with gingival margin lower than transposed #25. Gingival biotype was determined as being thick. (c) Scanned models in intercuspal position. Distovestibular rotation of transposed #23 is observed. (d) Digital wax-up of the maxillary canine implant crown according to the planned position. (e) Print-screen of the treatment plan. Bone characteristics can be observed and buccal plate can be measured in R2GATE software.
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fig1
The mid-facial gingival margin of #63 was slightly lower than transposed #23 and that of the contralateral tooth (Figures 1(a) and 1(b)). In figures treatment plan on R2GATE software 1.0 is illustrated (Figure 1(e)).
(a) 3D printed surgical template. (b) Temporary screw-retained crown manufactured before surgery according to the planned implant position. (c) Atraumatic extraction of #63. (d) #63 after extraction with almost no root resorption. (e) Flapless dental implant insertion utilizing the stereolithographic surgical template.
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In figures treatment plan on R2GATE software 1.0 is illustrated (Figure 1(e)). Screw-retained provisional was manufactured according to the planed implant position and delivered before surgery with the computer aided design and manufacturing (CAD-CAM) surgical template (Figures 2(a) and 2(b)). Atraumatic extraction of the primary canine using periotomes was performed (Figures 2(c) and 2(d)). A 10 mm with 3,5 mm diameter Megagen AnyRidge  (Korea) was inserted flapless, under local anesthesia, according to the planned 3D position with the use of the stereolithographic template (Figure 2(e)).
(a) Patient after surgery with the temporary crown screwed into the implant. (b) Eight weeks after implant surgery, temporary crown was removed and dentogingival complex was successfully preserved. (c) Digital impression with scannable coping screwed into the implant. (d) Digital wax-up of the final crown.
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fig3
After implant insertion the prefabricated provisional crown was screwed into the implant and occlusal adjustments were performed (Figure 3(a)). Eight weeks after implant surgery, after uneventful osseointegration, the provisional crown was unscrewed and an excellent healing of dentogingival complex and papilla preservation were observed (Figure 3(b)). Digital impression was performed (Figure 3(c)) and a CAD-CAM zirconia customized abutment and ceramic crown were manufactured according to patient's request (Figure 3(d)).
(a) Zirconia customized abutment screwed on the implant. (b) Final full ceramic crown cemented. (c) CBCT at one-year follow-up. No bone resorption was noticed. (d) Final crown at 1-year follow-up. Distal and mesial papilla are present. PES and WES scored 14/14 and 9/10, respectively. WES score is 9 due to nonperfect resemblance of the restored canine. The patient's option was reproducing a canine crown resembling a premolar and not #13.
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fig4
At the annual recall the implant showed no signs of complications nor infection (Figure 4(c)). On the CBCT evaluation no buccal bone resorption was observed after one year of function (Figure 4(d)).