A “midline dilemma” in an adult mutilated dentition

• Successful treatment for an adult with abraded and missing teeth, a midline deviation, and an implant.

Orthodontic treatment for adult patients who have mutilated dentitions can be clinically challenging. A 58-year-old man with several occlusally abraded teeth, a congenitally missing maxillary lateral incisor, and prior implant placement sought orthodontic treatment and restoration. Prosthetic restoration would not be possible. The “dilemma” for this patient was whether to trephine and remove an existing implant and make space for a new lateral incisor implant, or to restore the maxillary canine as a lateral incisor.