Upper lateral incisor implant with bone resorption
27 yo female patient presents to the office referred from her orthodontist looking for a crown replacement for her implant, which has been placed 4 years ago. After clinical examination I decided to ask for a CBCT for better assessment of the case.
The implant has no mobility whatsoever. There was minor bleeding after proving. As you can se, she also has a high smile and thin biotype.
CBCT revealed loss of bone inter proximally and in the facial aspect, nevertheless she doesn't have a huge soft tissue loss... And of course the implant angulation could have been a lot better. Canine pulp is vital, so I believe that the apical radiolucency is related to orthodontic treatment
So this is my question to you all based on your experience and expertise, what would be the best way to procede with this case?
a) CTG and Bone graft (in that order)
b) Only CTG
c) Be more aggressive and remove the implant, guided bone regeneration perhaps a block bone graft, soft tissue graft and a new implant
Thank you for your kindness and your valuable input