Case The patient attended complaining of anterior teeth that had been missing for many years. He previously had a denture but was unable to tolerate it and wanted a fixed solution. The patient initially attended with periodontal disease and mobility in the teeth adjacent to the gaps, so the option of bridge treatment was actively discouraged. We discussed the option of implant treatment but it was made very clear that it would be a long road because we would first have to remove teeth that had failed. We also had to ensure that we were able to successfully treat the periodontal disease and that this would be monitored for some time after treatment to ensure that this was stable. It was noted upon radiographic exposure that there was a retained upper right canine which was palatally positioned. A CT scan was taken to determine the exact position of the canine (#13) and whether it was going to impinge upon implant placement (Fig. 1, p. 15). It was noted that this would indeed be the case and so it was arranged for the patient to be seen at the local maxillofacial unit. The canine was removed under general anaesthetic. The initial phase of treatment was commenced. This included extraction of teeth with poor prognosis along with initial cleaning. Pocket charting before root surface debridement (RSD) was completed and then repeated two months after healing. There was favourable resolution of the periodontal condition with no bleeding and resolution of pockets all to 4mm or less. At this stage it was felt that we could 16 SUMMER 2018 // dentaltownuk.com Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 proceed with implant placement as all active disease had been managed. The ideal position of the front five teeth that were missing and then the position of the implants to best support those teeth were decided. Sites were chosen where the bone was deemed best. It is important to note that when placing bridges on implants, the rules many people would use to govern how to design bridges on teeth are not necessarily the same; hence ,it is worth reviewing the literature before committing to implant bridge design.http://www.dentaltownuk.com