Objective: A 26-year-old woman came for orthodontic treatment to improve her profile with protrusive lips. Diagnosed as bimaxillary protrusion, extraction followed by anterior retraction was indispensable for the case. However, her left upper lateral incisor was absent, the left upper canine had moved mesially and replaced the adjacent incisor, and the original canine location was restored with a long implant, which was in good condition. Surgical removal of the implant would be tricky and might lead to atrophy of the alveolar bone. In addition, the upper left central incisor had a short, curved root, which could not undergo significant movement.
Materials and methods: After crucial discussion between orthodontists and implantologists, based on digital setup, an innovative treatment plan was developed. Four incisors were extracted followed by clear aligner therapy for anterior retraction. An individualized zirconia abutment was installed on the upper left implant in a retroclined direction, cemented with a zirconia crown to replace the upper lateral incisor. Minimally invasive veneers were made to reshape the other upper incisors for better esthetics.
Results: Finally, the patient had her profile greatly improved and the teeth well aligned without removal of the implant.
Conclusion: Thus, the seemingly mission impossible was accomplished with a satisfactory outcome, thanks to imaginative treatment planning and delicate interdisciplinary collaboration based on digital simulation.
Keywords: Bimaxillary protrusion; Clear aligner; Implant; Incisor extraction; Interdisciplinary treatment.
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