Management of an infectious complication appearing in a transcanine implant: a case report

Abstract

Background: Maxillary canine impaction is the second most common dental eruption anomaly, affecting approximately 0.2-3% of individuals, with a higher incidence in females. This condition often results in complications such as the misalignment of adjacent teeth, root resorption, and the development of cystic lesions. In some cases, abstention is recommended for impacted canine is kept with the lacteal tooth held on the dental arch. But in the longer term an implant therapy is nevertheless indicated.

Case presentation: A 42-year-old man presented with persistent swelling and pain in the maxillary region associated with a transcanine implant placed one year ago by his dental practitioner. Imaging assessment showed the implant's apex inserted into the impacted canine which presented a crown and root resorption and was associated to a radiolucency around. In order to preserve implant and reduce morbidity related to a full extraction of the tooth, a coronectomy was performed allowing inflammatory surrounding tissues curettage.

Discussion: This case shows an infectious complication of a transcanine implant and demonstrates an approach for managing these complications while preserving this implant. The coronectomy is a less invasive technique that reduces potential surgical complications and supports healing. A 2-year follow-up revealed complete bone reossification reinforcing the effectiveness of this method in similar clinical scenarios.

Conclusion: This case suggests that coronectomy may be a viable option for managing impacted canines in proximity to implants when complete extraction poses a high risk of complications. However, given the limited number of reported cases and the absence of long-term data, this approach should be considered with caution. Further studies are necessary to better define the indications, long-term outcomes, and potential risks of this technique.

Keywords: Ankylosis; Canine; Coronectomy; Decoronation; Dental implant; Impacted tooth; Transcanine.

Fig. 1

Reconstructed panoramic view of pre-operative CBCT assessment. This view is showing transcanine implant in the tooth 23

Fig. 2

Preoperative radiographic view. A Maxillary occlusal radiograph. B Orthoradial slice of maxillary through tooth 23. C Orthoradial slice of maxillary through tooth 22. Red arrows are showing insertion of implant apex inside the tooth. White arrows are showing internal–external resorption and red star is showing radiolucency

Fig. 3

CBCT views before transcanine implant placement. A Orthoradial slice of maxillary through tooth 23. B Axial slice of maxillary through tooth 23. C Frontal slice of maxillary through tooth 23. Red arrows are showing signs of ankylosis of cervical portion and white arrow are showing internal resorption

Fig. 4

Clinical views of surgical procedure. A Extracted fragments with the presence of the crown and mesial and distal root sections of implant 23. B Intraoral operative view showing the sectioning of the crown of the impacted canine and visualization of the apical portion of implant 23 (blue arrow), distant from the residual root. C Per operative maxillary occlusal radiograph confirms the complete removal of enamel before suturing

Fig. 5

CBCT views with follow-up at 8 months. A Reconstructed panoramic view. B Orthoradial slice of maxillary through implant 23. C Orthoradial slice of maxillary through residual apical root tooth 23. This view’s showing complete reossification of the bony defect around implant 23

Fig. 6

Intraoral view at 2 years of follow-up