Most of us lose our baby teeth in childhood as the permanent ones push through. But in a small number of people, one or more permanent teeth simply never develop. When that tooth is an upper canine — the pointed tooth near the front of the smile — the baby version can stay in place for decades. Eventually, though, those baby teeth become loose, prone to decay, and noticeably out of proportion with the surrounding adult teeth.
Our team recently co-authored a peer-reviewed case report in Inside Dentistry describing how a combination of treatments can replace these over-retained baby canines with natural-looking dental implants. Below is a plain-language summary of what that case involved and why this kind of treatment takes careful planning.
What does “over-retained baby teeth” mean?
When a permanent tooth never forms, the condition is called agenesis. Missing permanent upper canines are uncommon — affecting roughly one to two people in a thousand in the general population, and somewhat more often in certain groups. Because there is no adult tooth waiting to come in, the baby canine has nothing to push it out, so it is retained well into adulthood.
Why these baby teeth eventually need to be replaced
Baby teeth were never built to last a lifetime. Over the years, several problems tend to add up:
- The roots gradually shorten and weaken, so the teeth begin to feel loose.
- Decay often develops, especially along the gumline.
- Baby canines are smaller and narrower than adult teeth, which can make the smile look uneven.
In the published case, a patient in her early thirties came in with both upper baby canines still in place. They had become loose, had developed cavities, and were affecting how she felt about her smile.
The hidden challenge: not enough bone
Replacing a tooth with an implant requires a solid foundation of bone to anchor it. When a permanent tooth never develops, the bone in that area never fully forms either. The result is a ridge that is too thin and often slightly hollowed on the lip side — not enough to hold an implant securely. This is why these cases can’t be solved with a simple extraction and implant; the site usually has to be rebuilt first.
A step-by-step team approach
Because several issues have to be addressed in sequence, this kind of treatment is multi-procedural and brings together different areas of expertise. In the published case it unfolded roughly like this:
1. Aligning the bite
Clear aligner orthodontics came first, to create proper spacing and set up the bite so the future implant teeth would blend naturally with their neighbors.
2. Rebuilding the ridge
The baby canines were removed and the thin areas of bone were rebuilt using a bone graft, which acts as a scaffold for the body to grow its own new bone. After placement, the graft was given several months to heal and mature.
3. Placing the implants
Once 3D imaging confirmed there was enough healthy bone, titanium implants were placed at the canine sites and allowed to fuse with the bone — a process that again takes a few months.
4. Finishing the smile
Finally, custom crowns were attached to the implants. The shade and shape were matched to the surrounding teeth so the new canines looked like they had always been there.
The result
By the end of treatment, the patient had stable, properly sized canine teeth, a balanced bite, and a smile she was happy with. What started as loose, decaying baby teeth became a durable, natural-looking restoration — the kind of outcome that simply isn’t possible by leaving over-retained baby teeth in place indefinitely.
Read the full clinical article
This summary is written for patients and leaves out the technical detail. The complete peer-reviewed case report — including the imaging, surgical steps, and references — was published in the January/February 2026 issue of Inside Dentistry and is available to read here:
Implant Treatment to Replace Over-Retained Deciduous Maxillary Canines — Inside Dentistry
Authored by Drs. Fred A. Puccio, Robert J. Defalco, Amy Parsol, and Gregori M. Kurtzman.
Think you might have a retained baby tooth?
If you have a tooth that has felt loose for years, or you’ve been told a permanent tooth never came in, it’s worth having it evaluated. Treatment options are most flexible before the tooth and surrounding bone deteriorate. Contact our office to schedule a consultation and find out what’s possible for your smile.