The esthetic success of a case requiring implant therapy mainly depends on both the correct planning and the surgical-prosthetic execution. However, planning and surgical implementation according to prosthetically guided criteria are not always possible due to contingent anatomical limitations. When this is further complicated by the presence of mucogingival deficiencies in a highly visible esthetic area, the management of the case can become very complex. The present case report describes the presurgical and surgical management of a case of maxillary lateral incisor agenesis in the absence of sufficient vertical space. Through orthodontic therapy, the opening of the deep overbite and the alignment of the maxillary and mandibular arches were obtained, allowing for an implant positioning without compromises dictated by anatomical limitations. Finally, through mucogingival surgery and careful management of the provisional prosthetic phase, an optimal esthetic profile was achieved.
