Patient: Male, 20 years
Chief Complaint
Spacing in the upper anterior region and dissatisfaction with smile aesthetics.
Clinical Findings
- Skeletal Class III base with Class III molar and canine relationship
- Generalised spacing in the maxillary anterior region
- Congenitally missing #12 and #22
- Thick maxillary labial frenum
Treatment Plan
A multidisciplinary protocol was planned involving orthodontics, minor oral surgery, and prosthodontics:
- Orthodontic alignment and space creation using Damon self-ligating appliance system
- Frenectomy to address high frenum attachment
- Implant placement in #12 and #22 sites using Straumann SLA Active Roxolid implants (2.9 × 14 mm)
- Provisional restoration with Maryland bridge during osseointegration phase
- Final restoration with zirconia crowns following healing and soft tissue optimisation
Treatment Progress
Orthodontic Phase
- Damon SL brackets bonded in upper and lower arches
- Space gained for #12 and #22 using open coil springs
- Frenectomy performed to improve diastema closure and gingival aesthetics
- Final archwire sequence completed, followed by debonding
- Fixed mandibular retainer (34–44) and Essex retainers for both arches delivered
Surgical Phase
- Straumann SLA Active Roxolid implants placed at #12 and #22 sites under IV sedation
- Cover screws placed; healing period observed for osseointegration
Provisional Phase
- Maryland bridge fabricated and delivered to maintain aesthetics and function during healing
Prosthetic Phase
- Healing caps placed and adjusted (2 mm initially, later replaced with 3.5 mm and 4 mm for optimal emergence profile)
- Final zirconia crowns cemented at #12 and #22
Outcome
- Stable occlusion achieved with corrected anterior-posterior relationship
- Adequate mesio-distal space and optimal gingival contour established for prosthetic rehabilitation
- Excellent aesthetic match with adjacent dentition using zirconia crowns
- Patient reported improved confidence and satisfaction with functional and aesthetic outcomes
Discussion
This case demonstrates the effectiveness of integrating orthodontic space creation, surgical implant placement, and definitive prosthetic rehabilitation in young adults with congenitally missing lateral incisors. The use of temporary restorations during the osseointegration phase maintained patient aesthetics and compliance throughout treatment.