A anterior implant case with aesthetic complications
Briefly, A 18 years old student with a thin biotype came to my office for an accidental fracture of his upper right central incisor in 2014, after meticulous examination and evaluation. The tooth was hopeless, and then I communicated with his mother and suggested doing immediate implant placement and immediate restoration. I installed the implant and provisional prosthesis without occlusal contact on an exact day. One week later, I came up for the revisit, and the healing was uneventful. Unfortunately, three weeks later, the patient complained about the mobility of the temporary. After my examination, the failure of the implant was diagnosed, and I removed the failing implant, and socket preservation was done simultaneously. After waiting for the following three months, the patient was revisited for the reentry. Unfortunately, I sound the vertical bone loss and facial gingival recession, especially on the distal interproximal aspect.
I inserted the fixture simultaneously combined with vertical bone augmentation using a Non-resorbable PTFE membrane. Unfortunately, two weeks later, the patient was revisited for suture removal. I discovered the disastrous exposure of the membrane. From the psychological point of view, there was no reason for the patient and me to fail again. At that time, simplification means more minor complications. I took out the membrane and waited for four weeks for the tissue to heal naturally. Then the patient comes up with soft tissue augmentation. Though healing was fair, three months later, the implant was not perfectly osseointegrated, we decided to move on to molding the soft tissue. After two years of temporary reshaping, the result is acceptable, and the final restoration was delivered. I thought the story was over.
Three days ago, the patient showed up to improve the aesthetic result for social needs. After my clinical evaluation, I can appreciate the black triangle around the distal side of the implant neck and gingival recession of the upper right later incisor on the facial aspect.
What am I supposed to do to improve the result?
Should I remove the crown and let it heal 4-to six weeks before reentry for another vertical bone augmentation de novo?
Or Should we try the lateral incisor orthodontic forced eruption?
Or Could I simply do the soft tissue augmentation?