Immediate Full-Arch Implant Rehabilitation Through an Impacted Maxillary Canine: A 5-Year Case Report

A deeply impacted tooth within a planned implant trajectory may complicate implant-supported rehabilitation. Intentional transdental implant placement has been proposed as an alternative to extraction in selected patients. A 55-year-old woman with generalized advanced periodontitis, bruxism, and heavy tobacco use underwent bimaxillary fixed rehabilitation. Preoperative cone-beam computed tomography (CBCT) analysis identified a deeply impacted maxillary left canine within the planned implant trajectory. Extraction was expected to create a substantial ridge defect that could compromise primary implant stability and necessitate augmentation and delayed implantation. Eleven implants were placed, including a 4.0 × 16 mm implant at position 25, inclined at 30° so that its apical portion traversed the impacted canine at position 23. All implants achieved insertion torque > 45 Ncm. Screw-retained provisional full-arch prostheses were delivered in full occlusal contact on postoperative Day 2 and definitive prostheses at 2 months. Analysis of the 2.5-year CBCT identified crestal bone within 1 mm of the transdental implant shoulder. At 5 years, the implant remained asymptomatic, without clinical signs of peri-implant inflammation. Qualitative panoramic assessment identified no pathology at the implant-tooth interface. Canine vitality remained undetermined, and no histological assessment was available. These findings do not establish dentointegration or quantify longitudinal bone-level change.