Why is this case new information? There is insufficient evidence on the long-term efficacy of narrow-diameter implants. Clinical treatment guidelines are not sufficiently available. This paper presents an alternative approach to managing a specific scenario where mesial-distance distance is limited using root amputation of an adjacent compromised tooth What are the keys to successful management of this case? Comprehensive diagnosis and stringent case selection Multidisciplinary treatment planning Evidence-based decision making What are the primary limitations to success in these cases? Very specific clinical application; adjacent compromised tooth Long-term follow up is required.