Case Report Management of the Compromised Intertooth Space with Small- Diameter One-Piece Implants in the Esthetic Zone

T he use of dental implants to replace the natural tooth system has become commonplace in the contemporary restorative and surgical dental practice.1,2 Substantiation of their efficacy has been well-documented in restorative, cosmetic, and surgical dental literature,1,2 and with the advancements in surgical techniques and implant design features, their use in the esthetic zone has become a successful and predictable tooth replacement option.3-7 However, some impediments to the use of dental implants remain.9-12 Smaller edentulous intertooth spaces, reduced vertical or transverse dimension of the residual ridge, convergent roots, and/or close proximity of root trunks can cause the implant team to opt for other options to replace the natural tooth system, usually a resin-bonded fixed prosthesis or a removable prosthesis. Another common deterrent to the use of dental implants is the compromised edentulous space remaining in the congenitally missing lateral incisor area of the maxillary anterior, either preor postorthodontic treatment. Often times cases of this type result in tooth replacement options of a removable type or some type of resin-bonded bridge, as previously mentioned. Extreme treatment of these spaces can also end in a full-coverage restoration on the abutment teeth, with a fixed pontic to replace the edentulous space. In younger individuals, this can result in significant destruction to the natural teeth adjacent to the edentulous site, the possibility of future endodontic treatment, and premature tooth loss. Additionally, a compromised esthetic result is usually obtained due to the insufficient tooth-to-tooth space. 11-13 To properly form an ovate pontic emergence profile in the soft tissue, which is necessary to provide for a natural appearance of the pontic in the fixed bridge tooth replacement option, certain considerations must be discussed when replacing the congenitally missing or compromised intertooth edentulous space. Criteria of the routine ABSTRACT: The use of dental implants to replace the natural tooth system has become commonplace in the contemporary dental practice, but some impediments to their use have traditionally included the smaller edentulous intertooth spaces, reduced vertical or transverse dimension of the residual ridge, convergent roots, and/or close proximity of root trunks. However, the advent of smaller diameter implants and their documented use in the literature over the past 15 years lends to their acceptable placement for treatments ranging from immediate stabilization of bone augmented ridges to esthetic tooth replacement in the esthetic zone. This article presents two case reports to demonstrate the minimally invasive surgical placement of narrow-diameter implants for the treatment of congenitally missing lateral incisors in an esthetic manner.