Failing implants in lateral incisors with esthetic problems: Suggestions ?

Last Updated March 23, 2018

I have a new male patient who smokes. He had an implant placed in the maxillary right lateral incisor region (#12) five years ago. The dentist placed a provisional restoration that was never replaced with a final crown. When the patient came to my office he was wearing the same provisional, which he told me had been dislodged and re-cemented many times. It was a total mess. I removed that provisional, cleaned the region and placed a new provisional crown at the same appointment. I even found sutures from 5 years ago underneath the old provisional. The photo shows 15 days after the new provisional.

In this same first appointment he had an implant on the maxillary left lateral incisor (#22) which had been placed 2 months ago in another city. This implant had a provisional restoration that was made at the same appointment when the implant was placed (immediate loading). The patient’s complaint about this implant was that it was loose. When I tried to tighten, the implant rotated out easily and I removed it.

I requested a panoramic x-ray to take a general look and see what was going on. I saw that the remaining implant is probably doomed due to significant bone loss and esthetic issues. The implant has an external hex. I requested a CT scan but I still don’t have it.

I have work to do on both lateral incisors position. On the right side, it’s possible to see that both canine and central incisors have their soft tissues contours compromised due to the bone loss around the implant. What is the best choice here?

OBS: The remaining roots of tooth #37 were removed already.
OBS 2: Patient has a periapical pathology on #24. Was refered to an endodontist.

Treatment plan options:

1) Remove implant -> Bone Graft and connective tissue graft in the same surgical appointment?
2) Remove implant -> Bone graft, wait and do connective tissue graft at another opportunity?
3) Other

What do you recommend? Can’t wait to see the suggestions.
Thank you

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