Deep Dental Implants: Explant or graft or both?

Last Updated July 29, 2020
Reviewed By:  OsseoNews Team

Patient has implants on upper left incisors (FDI 21 and 22) that are situated at an unfavorably deep level. This was probably due to the fact that incisors show bony dehiscences due to alveolar protrusion and unhealthy veneers.

On the implants suboptimal FPD with plump emergence profile, pink porcelain, loss of papilla and impossible to clean. There is loss of bone resulting in a buccal concavity.

Few months ago patient fell on his face and upper lateral incisor right (FDI12) was irrestorably broken.

I would take the opportunity to provide him with a more esthetic FPD.

My plan would be:

  • 1. Remove implant 21 (central left) and place a closure screw in implant 22 (lateral incisor left) in order to create a papilla mesially later on with pontic. Note that there is possibly a buccal bone dehiscence on this implant!. Frenectomy to prevent later soft tissue retraction.

  • 2. After healing augment the site buccal and coronally with a soft tissue graft.

  • 3. After healing extract 11 and 12 and immediate implant on 12, uncover implant 22 and immediate provisional bridge (lab made with temp. cylinder on 22 and chairside bonding to a temp cylinder on implant 12 with dual zone technique.

I have to figure out how this can be made. Please comments and suggestions on treatment plan. Would a soft tissue graft do or should both implants be removed and the bone augmented vertically and buccaly? How about the provisional?

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