Malpositioned maxillary anterior implants correction using segmental osteotomy with three-dimensional guide and micro-saw: a technical note

The maxillary anterior region, often referred to as the “esthetic zone,” presents unique challenges in implant dentistry, especially when complications such as implant malposition occur. Malpositioned implants can lead to esthetic concerns, including gingival recession or implant fixture exposure, often resulting from facial placement following immediate implantation after tooth extraction. This case report outlines the successful correction of a facially malpositioned maxillary anterior implant using segmental osteotomy facilitated by three-dimensional (3D) technology and a micro-saw, combined with simultaneous autogenous bone grafting to enhance prosthetic esthetics. The segmental osteotomy was performed with a pre-fabricated 3D guide. The bone segment was rotated 180° and repositioned to achieve optimal implant orientation, securing primary stability without additional fixation. Postoperative outcomes showed complete resolution of buccal exposure, satisfactory soft tissue contour, and successful osseointegration. Subsequently, a provisional and definitive restoration was fabricated for molding gingival contour using a digital technique. This technique also shortened the treatment timeline by avoiding implant removal and additional grafting procedures. These findings suggest that segmental osteotomy with 3D guidance is a minimally invasive and effective approach for correcting malpositioned implants.