Fully Digital Guided Impacted Canine Extraction And Immediate Implant Restoration

A 44-year-old female patient presented without left maxillary canine. CBCT demonstrated the #23 was horizontally impacted. The treatment challenges in this case: 1.Locate the impacted #23 and minimalize the Extraction damage 2.Immediate implant placement and provisionallization with a bionic morphology in transmucosal area to shape the emergence profile No systematic disease was reported. CBCT showed #23 was closely approximates the apices of #21 to #25 and its crown embedded within a lesion. Reconstruction tooth #23 and surrounding bone respectively via CBCT, the surgical guide was designed to locate the #23′s crown and guide the implant placement. Piezoelectric osteotomy was preformed with the guide to extract the impacted #23. Implant placement, intraoral scan and horizontal bone augmentation was done sequentially. The temporary crown, designed and 3Dprinted with the morphology of #23, was delivered immediately. After 4-month, definitive restoration was achieved through scanning data superimposition of implant position, temporary crown in situ and the crown model to replicate the emergence profile. 1-year follow-up demonstrated stable gingival margin, papilla height and adequate contour. In this case, the guided approach accurately located #23, prevented #21-#25 injury and enhanced patient safety, achieving optimal clinical outcomes which was also proved by recent studies. Besides, 3D reconstruction of #23 enabled natural crown morphology acquisition and emergence profile bionic reconstruction, which guided soft tissue healing and kept it stable. Fully digital guided surgery improves surgical precision and minimally invasiveness. Furthermore, digital reconstruction of emergence profiles enhances final esthetic outcomes.