Orthodontic, regenerative, and implant management of a mandibular anterior defect: 5-year outcome

Severe alveolar ridge defects in the mandibular anterior region, often associated with congenital tooth absence and subsequent loss of retained primary teeth, present significant challenges for implant rehabilitation. Limited space, horizontal ridge deficiency, and complex site anatomy often require a multidisciplinary approach to achieve stable hard- and soft-tissue outcomes.

A 30-year-old woman presented with absence of teeth #23 and #25, distal rotation of tooth #24, and insufficient mesiodistal space for implant placement. After 15 months of orthodontic space creation, severe horizontal ridge deficiency was confirmed clinically and by cone-beam computed tomography (CBCT). A single-stage surgical protocol was performed consisting of implant placement with guided bone regeneration (GBR) at sites #23 and #25 and guided tissue regeneration (GTR) at adjacent teeth #24 and #26. Deproteinized bovine bone mineral and an absorbable collagen membrane were used for defect regeneration, followed by tension-free primary closure.

Healing was uneventful. At the 5-year follow-up, clinical and radiographic evaluation demonstrated stable buccolingual ridge dimensions, adequate keratinized mucosa, and healthy peri-implant soft-tissue contours. CBCT confirmed maintenance of regenerated bone at the implant sites and adjacent natural teeth, with no evidence of mucosal or gingival recession and preserved bone volume.

This case illustrates that a coordinated approach involving orthodontic space creation followed by implant placement with simultaneous GBR and GTR may support long-term rehabilitation of mandibular anterior defects. Stable hard- and soft-tissue conditions and favorable functional and esthetic outcomes were maintained over a 5-year follow-up. The simultaneous use of GBR and GTR at adjacent implant and natural-tooth sites, documented over 5 years, distinguishes this case from conventional staged approaches.

Orthodontic space creation is often essential for prosthetically driven implant placement in mandibular anterior mesiodistal defects. Simultaneous guided bone regeneration and guided tissue regeneration can allow reconstruction of combined implant- and tooth-related defects. Performing regenerative procedures and implant placement during a single surgical intervention reduces the number of surgeries for the patient.

Missing teeth in the front lower jaw can be challenging to replace when there is not enough bone to support implants and when nearby natural teeth have developed supporting tissue problems related to orthodontic treatment. This case report describes the treatment of a patient with missing teeth who first received orthodontic treatment to create enough space for implants. The patient then received dental implants along with procedures to rebuild bone around the implants and regenerate the supporting tissues around nearby natural teeth. Both procedures were performed during the same surgery, and the patient was followed for 5 years. The results showed that the bone and gum tissues around both the implants and natural teeth remained stable, with good function and appearance. This combined treatment approach may be a possible option for carefully selected patients with complex conditions. However, because this report describes only one patient, further studies involving more patients are needed to confirm these findings.