Twenty-two implants inserted in the anterior area in 15 patients, and 24 implants inserted in the posterior area in 9 patients, for a total of 46 implants in orthodontic patients suffering from single or multiple agenesis, were analyzed retrospectively. The average time of follow-up, subsequent to the prosthetic insertion was 60.3 months. The average time from actual diagnosis of agenesis to the completion of therapy was 76.2 months. There were no implant failures, although 17.4% experienced prosthetic complications. Analysis of the sample identified 5 critical issues that are frequently underestimated at the time of determining the therapeutic strategy. 1. Timely comprehensive management of the patient; 2. management of the biological interface (surgery and hygiene maintenance); 3. prosthetic problems; 4. long term effects of bone remodeling; 5. alternative therapy.