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Case 5.

Adolescent female patient..Single implant to replace congenitally absent UR2, with bone expansion and restorative reconstruction of peg-shaped UL2.
Favourable biotype 11. Residual ridge form depressed labially in the region of the UR2 as a result of alveolar resobtion or which predispose to poor aesthetic outcome.

The patient has had orthodontic treatment to open the space in the region of the UR2, congenitally missing lateral incisors often associated with reduced alveolar ridge width.

This hard tissue defect will need to be addressed surgically to improve aesthetic out, fortunately the patient has a low smile line.
Peg-shaped UL2 - this malformation is often associated with a congenitally absent contralateral tooth.
PA radiograph confirms there is sufficient space between the roots to permit the safe insertion of an implant in the region. Often the roots may converge following orthodontic movement increasing the probability of damaging the adjacent roots during implant placement and site preparation.

OPG confirms absence of ectoptic teeth or supernumeraries.

Note : -reduced compliment of permanent teeth also a feature of this condition.
The soft tissue is manipulated and flap designed to increase soft tissue bulk in the region.

The orthodontic retainer and provisional restoration is adjusted so as not to load the soft tissue which would adversely affect aesthetic outcome.

Soft tissue left 3months to maturate.
Although the gingival zenith on UR2 is not at the same horizontal level as at UL2 , the local bone grafting and soft tissue manipulation techniques employed were tolerable to the patient and delivered a good aesthetic result. This was acceptable to the patient whose smile line is low. The UL2 peg-lateral was restored with a veneer using minimal preparation.