A tricky situation with failing implant in esthetic zone

64 Rating(s).


Posted on By Ehab Moussa In Anterior/Esthetic

Hello all,
This patient presents for an emergency with a failing implant in #8 that is slightly mobile. Radiographs show a significant dehiscence defect on the labial aspect and about 40% loss of the IHB on the mesial of #7. Bone sounding confirms the radiographic findings.
Patient has a high smile line and more than likely elevation of a flap will result in severe tissue loss particularly in the papilla between #7,8.
How would you approach this case?
Staging of procedures?
Flap design?

Best regards,
Ehab

Presentation
PA

CBCT
Probing pocket depths


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11 Comments

Very challenging...remove implant and tissue graft from tuberosity. Re-eval after 12 weeks. Decide on lateral incisor and move to bone graft....Khoury or GBR. Regards Dr. Salama


Reply

Ehab, I agree with Maurice but my friend this is a disaster waiting to happen. How is the patients' smile line. I do not think that you will be able to avoid some papillae loss here, unless there is a not detectable radiographically bone layer on the mesial of the lateral. I would be very explanatory to this patient before I touch him. You could always refer to someone not being nice to you :)))


Reply

Definitely agree Yiannis, patient has been prepared for suboptimal esthetic results along with the idea that he may loose #7. Although smile line is high, fortunately patient is more forgiving with regards to esthetics.

Thank you,
Ehab


Reply

Thank you Dr Salama. What has been your experience in regrowing the lost IHB in cases such as this ? Do you feel extracting #7 is a viable option?

Regards,
Ehab


Reply

I agree with Maurice, indeed very challenging to deal with given the high smile line. This is a Calcitek Integral implant (Omniloc or Spline connection) that has been discontinued about 23 years ago. So this implant must have been placed at least 20 years ago; nevertheless, Gingival levels are maintained despite the poor collar design with HA to the neck of the implant and stress concentration in the cervical segment. Main problem at removal is that the Bone-to- implant contact with this HA coated system exceeeds 96%. In my own experience, even with severe bone loss, it is difficult to remove this implant without causing significant bone damage and recession. I would try LAPIP first (Non invasive Laser Assisted Perimplantitis therapy) since no recession occurs. It should buy a few more years. If inadequate or unstable then I would resort to removal , GBR/GSTR for a new implant.


Reply

Thank you Dr Nasr,
This implant was already mobile on presentation. So the decision was to remove and replace.
Regards,
Ehab


Reply

Ehab,

Tough - Great advice from both Maurice and Hisham - You said no mobility in the case no purulence? And if we were going to manage to Perimplantitis ? say you didn’t have a laser what was your option B as you said any flap elevation and tissues moving north

Cheers,

Richard


Reply

Dear Rich,
Implant presents with mobility and purulence, so implant has got to go. Still I was thinking how to regenerate the site without losing tissue in the process !!

Regards,
Ehab


Reply

Can not wait to see what you do here?


Reply

Thank you Dr Salama. Case still very fresh and will update post as soon as I have some progress :)
Best regards,
Ehab


Reply

Very nice case Bob! If the lateral is to be retained in that case then it is one of the most challenging regenerative situations. Please keep us posted!

Michel


Reply


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