Placing an Implant in the Presence of an Impacted Maxillary Canine - Rationale and Technique Using a Computer Guiding Software in a Two Stage Procedure

Introduction: Replacing a missing tooth or an irrational tooth to treat with an implant supported prosthesis, is common practice today and first choice in most events.

Cases where placing an implant is not possible due to anatomical limitations and deficiencies like impacted teeth, lacerated roots, the infra alveolar nerve or bone not available, demand a pre-operative preparative procedure or an alternative.

Upper maxillary impacted canines usually influence the pre-maxillary area interfering the normal development and arrangement of the upper anterior six teeth. Their abnormal impaction position in the jaws, accompanied routinely with proximity to roots and teeth’ apices, creates a complicated situation which is difficult to treat.

The Objective: An alternative to active orthodontic eruption or extraction of an impacted canine, is offered using computer guided software in two stages.

The Technique: In the first stage, a template will be produced for surgery with the aid of a computer guiding software, for a drilling action through the impacted canine, to create a path for implant insertion in the second stage. The drilling must be made with conical maneuver to broaden the diameter in the apical part of the action, to gain the most out of this preparation. Human bone substitute will be used to fill the osteotomy for healing purposes and preservation. After proper healing time, a second CT scan will be performed and the result will be evaluated. The drilled path is expected to show newly grown bone through the canine root to enable the second stage of the treatment plan, implant placement according to a surgical template produced with a computer guiding software.

The Result and Conclusion: The main goal of this procedure is to place an implant through the impacted root in the prepared osteotomy path in new bone created, avoiding any contacts to the root parts.

A clinical case will be used to show the procedure and its results with a follow up of 10 years.