Can I still graft integrated implants?

I would graft if the implants are stable, at least a CT graft to cover the gray. Big question is how theses implants will function when loaded. When you placed the BMP did you use any particulate?

If the labial surface of the implants is within the alveolar housing of the adjacent teeth then an osseous graft may work. I would advise replacing the healinng cap with a cover screw and do the procedure as a closed GBR procedure. Also I am a bit confused that you did not get any new bone from your original bone graft; was there any exposure of the mesh or bone graft during the healing? What was the ridge width at the time of implant placement?

Yes you can and you can also do a soft tissue graft to improve the cosmetic result. When we do this we use Easygraft Crystal that needs no membrane and is only partially resorbable which will ensure thickness stability in the long run, the material has another plus, its really really white so it will mask the implant shade very well. In the same movement we usually make a soft tissue graft from palatine or retro molar tissue and the easygraft is highly compatible with this double technique. The good news is that the material is sold or will be sold shortly in the U.S. cheers

Your scenario raise important questions about the rationale of the plan adapted in the first place. If BMP was used with mesh then why did it not yield appropriate width of bone in a seemingly straight forward case? If the threads were exposed it isn't a big deal but there is no information on the amount of bone closer to crest and mid implant level. I presume this was deficient too in the hindsight and assuming the implants are integrated simply GBR could be the solution. Alloderm GBR is a good option to consider with any particulate allo or xenograft and sooner the better.Just avoid another surgical site in a patient who has had few things done already and palatal graft can easily be avoided. You could use RFA to see how well your implants are integrated but I would simply explain the scenario to patient and load it . Hope this helps.

The answer is yes, You can bone graft at this stage with osseointegrated implants. I do not recommend soft tissue grafting alone, as you need to have the implant covered by osseous hard tissue for tissue levels to be stable long term. Remember that osteogenic cells have to be present for bone to form so you have to think how you are going to make them available, if the graft bed will not provide them, you may need to use BMP's . A non resorbable bovine or partly resorbable particulate may also work to augment the hard tissue around the implant. Also consider why this happened. It is likely that the implants were placed in deficient grafted bone (you do not mention the width of the ridge after grafting) and if the labial bone was thin, the placement of the implant compromised the blood supply to the thin grafted bone causing it to dissappear. It may be necessary in these cases to graft again at the time the implant is placed. One final comment. Even though short implants are placed often these days, I would feel better with longer implants in this area. Thanks for posting and good luck!

What kind of temporary device or prosthesis did she have this entire time? If she had a stayplate or tissue born partial this may be the cause why the graft surgery didn't work well. You should consider this in future treatment.

Hi Alejandro , well done for Chile last night , big win for your boys .... As for the case , sometimes there is not enough thought about the biology of what we are trying to do merely putting product in , more the better route .... It can be grafted and as integrated should be no issue . A scan often can also give mis-leading picture so raise a flap and have a look prior to re-grafting but think about materials and what yoou want .. Peter

There is some really good advice here. I would recommend always using particulate with BMP, and use bio OSS for the onlay grafts either at implant placement and now as a general rule. The ct should be clinically verified with a flap and the case will require a connective tissue graft, autologous flap works well.Now here is my pearl, I use motorized expanders in thin grafted ridges to keep as much bone around during placement. I have had very poor results with Dynablast I use particulate with PRGF. Good luck.

Strange always , the use of words , Regeneration , is to help the body to return to its former healthy state , yet it is used when foreign material is left in situ possibly for life ? Maybe another terminology would be more apt ? Even referring to the repaired site as bone is misleading as histologically it is not.. Peter

Hi, Dr. from X-ray , seems bone had concave, 3-4mm from edge, initial bone graft should increase bone width, for what reason didnot work.

Yes, you can graft this site with a particulate (with or without PRP). I've found that OsteoTape from Impladent Ltd. works nicely for only grafting. All of the prior posters have given good solid advice.