Agenesis of the Maxillary Lateral Incisor and Implant Placement through Guided Surgery: Case Report

relato de caso

Abstract

Introduction: Osseointegration, which emerged in the 1980s, revolutionized the treatment of edentulism, enabling the use of fixed prostheses supported by implants. Currently, the challenge lies in the three-dimensional (3D) positioning of implants and prostheses due to the lack of bone thickness in some cases. The use of guided surgery and virtual planning has advanced significantly, providing greater predictability, comfort, and safety for both patients and professionals. Dental agenesis, an anomaly characterized by the absence of one or more teeth, is quite common, especially in maxillary lateral incisors. This condition can cause aesthetic and functional changes, affecting patients' quality of life. Multidisciplinary treatment, involving orthodontics, prosthetics, implantology, dentistry, and periodontics, is essential to restore masticatory function, phonetics, and aesthetics.

Case Description: This case involves a 33-year-old male patient, G.Q.G., who sought treatment due to aesthetic dissatisfaction with his anterior teeth because of agenesis of teeth 12 and 22. The patient had previously undergone orthodontic movement with an emphasis on the upper canines. Orthodontic traction was performed with mesialization of elements 13 and 23 to the region of the upper incisors, maintaining the anterior space in the canine region and the lack of aesthetic smile. Given the reduced remaining anterior space and the unfavorable position of the upper canine roots, which hindered implant placement by conventional technique, the patient was informed about the possibility of guided surgery for dental implant placement. Due to secure planning, the patient showed interest in undergoing guided surgery for implant placement, followed by oral rehabilitation with implant-supported prostheses and ceramic laminates for aesthetic correction. A treatment plan was presented, including oral scanning and computed tomography for the fabrication of the surgical guide and prosthetic planning, with the aim of restoring the aesthetic of the anterior smile region. Extra- and intraoral photographs were taken for proper planning, as well as oral scanning of the upper and lower arches for digital smile planning and the creation of a prototyped model. The patient underwent cone beam computed tomography for planning and three-dimensional verification of the bone structure. Based on the tomography and intraoral scanning data, planning and sending of the surgical guide for printing were carried out. After disinfection, the surgical guide was used in the surgery. The patient was anesthetized, and the surgical guide was positioned. The Arcsys – FGM guided implant system with 3.3x11mm implants was used. The surgery was performed using a single-drill technique and implant placement with the surgical guide.

Results: After the implant placement, the Arcsys system's healing abutment was used, and postoperative instructions were given to the patient. A final computed tomography was performed to verify the correct three-dimensional positioning of the implants. Gingival mucosa health care was initiated with the reline of the healing abutment with flow-type resin. Then, the prosthetic abutment was placed, and temporary prostheses were made. Implant-supported prostheses were performed, and ceramic laminates were cemented in the patient's anterior segment, according to the three-dimensional planning and initial prototype, followed by occlusal adjustment sessions.

Final Considerations: Nowadays, oral rehabilitation requires a multidisciplinary approach and the use of advanced techniques in modern dentistry. The incorporation of technology is not just an option but a necessity that has provided predictability and excellent results in various areas of dentistry. The presented case highlights how guided surgery and virtual planning are essential tools to achieve high-quality aesthetic and functional results, offering significant benefits for both patients and professionals.