Bone Ridge Reconstruction after Failed Implants Removal

A 67-year old female came to my office  with the chief complaint of being dissatisfied with the aesthetic appearance of her lower anterior prosthetic bridge due to the exposed implant threads. The implants were placed 8 years earlier. During the clinical and radiographic examination, all implants were stable, with large buccal bone deficiencies and exposed threads and loss of the attached keratinized gingiva.

The treatment plan was to remove all involved implants, augment ( with Bond Apatite – Bone Graft Cement by Augma Biomaterials) and reconstruct the deficient bone ridge and soft tissue, and to place a new implants.

The flap was reflected according to recommended Bone Cement Envelope Technique, by performing mid-crestal incision continued with intra sulcular incisions in the teeth nearby and then reflecting a full thickness flap to create a pouch.  It is important to emphasize that during flap reflection the periosteal elevator should not go past the mucogingival junction by more than 2-3 mm. In that way, we prevent the engagement of the muscles of insertion. This takes the influence of muscle movements out of the equation. At this stage, implants were removed and complete debridement was performed.

At this stage before Bond Apatite placement, a stretching was performed by grasping the mesial corner of the flap with a needle holder and stretching.  Then the distal, than the middle. If we want to release it a bit more, we insert the periosteal elevator into the mesial apical corner of the pouch with a 45 degree angle and then distally. Then Bond Apatite cement was injected into the site, a dry sterile gauze pad was placed and pressed above the material for 3 seconds, and the flap was closed by stretching the mesial corner of the flap and suturing it and then the distal, then the middle. After 3 points of suturing, a predictability test was performed by placing a finger in the vestibule and vibrating it. If the sutures do not move at all it means that the muscles movements will not influence the stability of the graft during the healing phase, which can indicate that a high success rate will be guaranteed.

Healing went uneventfully and reentry and new implant placement took place 3 months post-op.



2 thoughts on “Bone Ridge Reconstruction after Failed Implants Removal

  1. Alex Zavyalov says:

    The diagnostic approach and treatment sequence of the case were presented very well but the author did not show any X ray after ridge reconstruction and implants insertion.

  2. Matt Helm DDS says:

    Alex is right: No case presentation is complete without full image documentation, i.e.:
    -at least post-op x-rays (if not a new CAT scan) after the ridge reconstruction healing phase is complete, prior to new implant placement
    -post-op x-rays immediately after new implant insertion
    -post-op x-rays at a minimum of 4-6 months post op
    -and, preferably post-op x-rays at 1 and 2 year post-op intervals.
    Also photos of the final restorations are definitely warranted.
    Otherwise nice presentation.

Leave a Comment:

Comment Guidelines: By posting comments you agree to accept our Terms of Use, Disclaimer and Privacy Policy. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Clinical Cases, Regenerative, Surgical.
Bookmark Bone Ridge Reconstruction after Failed Implants Removal

Videos to Watch:

Immediate Implant after Extraction

This video provides some excellent drilling tips, in cases where a decision has been made[...]

Watch Now!
Flapless Surgery and Immediate Loading

This video shows flapless immediate implant placement on a mandibular molar, and issues when considering[...]

Watch Now!
Sinus Lateral Approach followed by Immediate Placement

Immediate loading of implants, is generally considered quite difficult following sinus lift surgery. This video[...]

Watch Now!
Flapless 3-D Computer Guided Implant Surgery

This video shows flapless implant surgery assisted by implant planning software which allows 3D printing[...]

Watch Now!
Sinus Lift Crestal Approach using Hydraulic Pressure

This video demonstrates the crestal approach for sinus lift, following extensive maxillary sinus pneumatization after[...]

1 Comment

Watch Now!
GBR in Labial Plate Bone Fracture

This video case shows guided bone regeneration in a patient who presented with root and[...]

1 Comment

Watch Now!
Ridge Split Technique using Vestibular Incision Approach

The alveolar ridge split technique is a predictable and reliable procedure, though case selection is[...]

3 Comments

Watch Now!
Lateral Sinus Lift: Perforation, Repair, and Implants

These two videos demonstrate the lateral window sinus technique, and implant placement following the repair[...]

Watch Now!
Single Tooth Replacement with Implants in the Esthetic Zone

Dr. Jack Hahn provides tips and reviews cases for implant placement in the esthetic zone.[...]

Watch Now!
Surgical Consideration for the Flapless Approach

In this video, Dr. Jack Hahn discusses and presents cases to review the surgical considerations[...]

Watch Now!
Bond Apatite: Socket Preservation Cases

These 2 videos show the use of Bond Apatite in socket preservation cases, one with[...]

Watch Now!
3D Guided Implant Placement

The placement of multiple implants in this case was helped thru the use of 3d[...]

Watch Now!