Implant Restoration Of Traumatic Ankylosed Tooth In Esthetic Zone

Dental trauma in adolescent patients may lead to tooth ankylosis. As these patients are in a peak growth phase, implant restoration is generally not performed. After reaching adulthood, ankylosed teeth may result in infra-occlusion, insufficient alveolar bone development, and occlusal disorders, which significantly increase the complexity of dental implant rehabilitation. A 20-year-old female patient presented with a history of trauma to the right upper central incisor 10 years ago. The tooth was preserved after root canal therapy but later diagnosed with ankylosis. Clinical examination revealed a defective incisal edge with infraocclusion, gingival margin recession compared to the contralateral tooth and crown discoloration. CBCT demonstrated internal root resorption and labial bone plate deficiency. In consideration of the labial bone deficiency, after the ankylosed tooth extraction, "ice cream cone" flapless grafting technique was employed for ridge preservation to maintain alveolar ridge dimensions and facilitate soft tissue healing. 6 months post-preservation, intraoral scans and CT data were acquired to design a surgical guide. Guided minimally invasive implant insertion was performed, followed by immediate provisional restoration for gingival contouring. After 5 months of adjustments with formed gingival papillae and harmonious gingival margins, final prosthesis was delivered. For adolescent patients unsuitable for immediate implantation, “decoronation” or socket preservation can maintain alveolar ridge until skeletal maturity. Precise 3-dimensional implant positioning and meticulous gingival morphology refinement are critical for successful aesthetic outcomes in implant rehabilitation. Clinical intervention can prevent alveolar bone resorption and preserve the ridge, especially for ankylosed tooth.