Bone has Resorbed on the Buccal Cortical Plate: What Should I Do Now?

Yes this defect can be grafted. If you have never done this before I suggest you refer to someone who has a great deal of experience as there is a great risk of making matters worse.

why 4mm below alveolar crest?? this is a clear violation of biologic width principals. you set up a zone of inflamation and lost bone. I think that even if you are lucky enough to cover this type of peri-implantitis defect with a graft, it will happen again. refer this out. get a fresh perspective. sounds like there are soft tissue issues here as well. removing the fixture and starting over again with better biologic principals may be a better alternative.

You can use bone graft and membrane.

It is unclear whether you mean that the implant platform was 4mm or that the implant was submeged 4 mm below the crest. Both are unacceptable. The bone dieback to the implant platform will create a problem. You may be able to graft bone buccal to the implant, but if the soft tissue biotype is thin, you will still see the abutment through the tissue.

Dear Dr B, I guess there is a need to have some more details regarding the situation and its background. - How old is the patient? - Why did the pt lose only the incisor ? - Was it lost due to periodontitis or was their a history of trauma and consequent loss of tooth? - What is the nature of the occlusion in the anterior region? Is there a traumatic bite ? Going back to the time you placed the implant - if you had to submerge the implant by 4mm (usually not necessary even in immediate extraction implants, except in the esthetic zone, where it is placed around 1.5 to 3mm below the alveolar crest / adjacent gingival zenith as is appropriate) , below the crest, is it likely that the labial plate (alveolar) was thinned out considerably at the time. Was it the reason that prompted you to place the implant that far apical to the crest ? If the labial alveolar bone was so deficient around the central incisor, it is highly likely that the bone around the adjacent teeth in the vicinity (the other incisors) was also affected significantly. If the adjacent teeth had periodontitis at the time, it is not unexpected that the peri-implant bone has resorbed after implant placement from the periodontal disease and inflammation pre-exisitng in the immediate vicinity. Trying to graft the Labial bone deficit without assessing what caused it, would tantamount to "Filling a Leaking Tank"... Would be wise to recall an old saying - "An empty tank does not leak ; while a leaking tank never fills!" Cheers Jeevan

i guess if we are in front of a class 1 defect (implant body not extruding the cortical plate), than a GBR technique will safe your case predictabily.

"removing the fixture and starting over again with better biologic principals may be a better alternative." YUP

Dr.B March,22.2010 Thanks Dr.Sb Undercut on labial sourface below the crest of the mandible is very obviously. 1-Submerged 4 mim implant mean you lost cortical bone( which part of the bone is very dense, wide and impacted). 2-Luck of the circulation in bone by implants especially in this case face to the thin bone was a reason on buccal cortical plate bone lost. 3-Thin gingival layer helped to resorbed bone easier and reslt of bone lost. 4-Place implant to labially. Dr.A. VAZIRI

Be careful the success of bone grafting over an implant is very limited