Central Implant: How to minimize collateral damage?

58 Rating(s).

Posted on By Ace Jovanovski In Failures

Military patient, had work done in Japan a few years back, implant #9 Too deep and too facial (pretty much out of alveolar housing), but with no clinical symptoms/probing, There was collateral damage (recession and increased crown length on 8, 10).

He didn't like the esthetics after a while so he went to a surgeon for evaluation. Came to me for a second opinion after a bone graft that was attempted on #9, and black triangles opened up.

Unfortunates of the case:
1. High smile line
2. High esthetic demand
3. CBCT of implant

Ortho extrusion is an option, but he is only in the state for <1year, due to travel schedule.

Explantation would for sure make the soft tissue outcome even worse.

Suggestions? Strategy?

Any benefit of removing implant crown, placing cover screw, then, coronal repositioning + CT graft?? Any benefit to re-doing crowns on 8, 10, biologic shaping of tooth/root, with a margin that is more incisal to try to get gingival re-attachment to root?


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Implant Explantation and Soft Tissue graft as 1st procedure. Followed by Bone graft after healing and then implant third. If there are no symptoms and patient is accepting of situation, then only follow up. regards Dr. Salama


I would do nothing as long as no clinical symtoms...just observation and follow up .....otherwise considering explantation and redo , this is a long task with multiple surgeries to correct soft and hard tissues then late implantation....i will try hard to convince the patient to accept the result untill symptoms occur ...


I agree with the other comments here. Treatment is opening up a huge can of worms. Explantation likely necessary followed by soft tissue and bone aug. If all goes well , implant and restoration . Probably close to a year of treatment time. Otherwise keep re evaluating at recare.


consider soft tissue graft to build it up vertically and horizontally to submerge the implant. in the mean time temporize the space with a bridge 8-10 and using ovate pontic to guide tissue healing. finalize the case with a bridge leaving implant submerged . This may give you best aesthetics in least amount of time since not dealing with bone graft healing time.