To manage or restart?
This 35 year old healthy lady presented with long due maintenance of her implant retained prosthesis. She had lost all her teeth at 15 years of age due to hypoplasia. She received her implants and prosthesis at an academic institution in the OMFS clinic. She had not had any maintenance visits for 20 years! Clinically, the implants are now outside the bony envelope perhaps due to the natural resorptive process over time. There is minimal attached tissue around the implants as seen in the clinical pictures. I removed her prosthesis and cleaned up, torqued the implants to 45 N to determine their stability and they are. Given the muco-gingival defects and lack of bony envelope around the implants, I feel like the construction is bound to fail in the coming years. Question to the forum: What would you do? Predictability of bone grafting around the existing implants? Soft tissue grafting to improve attached tissue? Explant and replace?