Maxillary lateral incisor implants: planning with the aid of orthodontics

Implants are commonly used to replace congenitally missing lateral incisors in adolescent orthodontic patients. However, these restorations are often challenging for the orthodontist, surgeon, and restorative dentist. In some patients the space across the alveolar crest is too narrow to permit the surgeon to place the implant. Occasionally the root apices of the adjacent central incisor and canine are in close proximity. In other cases the ridge thickness could be inadequate and require augmentation. When the orthodontist opens the space, the papilla heights are adversely affected. Some adolescent patients have altered passive eruption after orthodontic treatment, which affects the level of the gingival margins. Finally, questions commonly arise regarding the appropriate age for implant placement in these young patients. If not addressed, these issues could compromise the aesthetics of the implant restoration. This article will use several clinical examples to discuss each of these 6 potential problems and provide guidelines for their solutions.