19/05/2026
Some cases are not ideal.
Patients come with previous treatments, biological limitations, trauma history, or financial constraints. And despite that, as orthodontists, we try to achieve the best possible outcome within those conditions.
I say this because social media often makes us afraid to show anything less than ideal.
This is a 33 year old patient who sought treatment for her anterior open bite and wanted facial changes rather than simple dental compensation. Therefore, an orthodontic-surgical approach was proposed.
The main challenge was a history of dentoalveolar trauma during adolescence, resulting in the loss of three lower incisors and rehabilitation with a dental implant more than 15 years ago.
At the time of consultation, the implant lacked attached gingiva and was surrounded mainly by movable mucosa. Esthetically, it was not ideal, and arguably not ideal from a periodontal standpoint either. However, it had remained functional for more than 15 years without major complications.
The ideal solution?
Probably removing the implant, performing bone regeneration, and placing a new implant.
The reasonable solution for this patient?
Trying to solve the problem in a simpler way while considering costs, time, and the patient’s circumstances.
To perform orthognathic surgery, changes in incisor inclination were required (orthodontic VTO planning). For that reason, I requested a change in the implant-supported crown angulation using an angled abutment, turning that crown into a skeletal reference to position the rest of the arch.
And that is what I find interesting about this case:
Orthodontics rarely happens under ideal conditions.
Much of clinical decision making consists of navigating limitations, accepting trade-offs, and trying to achieve the best possible outcome for each individual patient.
