Dr. Z. asks:
In July 2008, I extracted the maxillary right canine and central incisor and placed 2 immediate dental implants. The lateral incisor was already missing. I engaged the palatal walls of the sockets like I often do and grafted the void between the implants and buccal walls. There was no buccal bone loss at time of extraction. I placed a resorbable collagen membrane over each of the implants and closed the areas. Everything healed fine, no infection, no pain, no suppuration and I took radiographs at 3-months. No bone loss was evident. At the 5-month post-op, I see darkness through the buccal mucosa on the buccal of the canine area. It looks like the implant.
I decided to do stage-2 today uncover on the spot and I laid a flap to discover that the implant in the canine position is completely dehisced on the buccal, but the mesial, distal, palatal aspects are completely covered to the top of the implant with bone. Only the buccal was dehisced all the way down. The implant was completely osseointegrated on the other walls and very stable. I put tetracycline on the buccal surface of the implant, then placed an allograft bone graft (Oragraft) and covered it with a collagen resorbable membrane and closed everything back up. I plan to uncover again in another 5 months. Should I have trephined out the implant and tried to place it so all walls would be in bone? Any recommendations?