This patient had failed root canal with large periodical pathology. The tooth was extracted and thoroughly curetted then allowed 6 months to heal. The patient also has chronic periodontal disease which had been treated and controlled, he has generalized moderate bone loss throughout his dentition, but had shown stability over the past few years. After 6 months, implant was placed with excellent primary stability, a screw retained temporary was placed for 5 months with great esthetic. There was no increase in clinical recession, tissue remained healthy throughout healing period. The implant was placed 2.5 mm apical to the desired final soft tissue margin, but due to pre-existing bone loss, this resulted in the implant being placed 1-2 mm supra-crestal.
The images shown are the pre- treatment ; 6 months later when the implant and temp was placed and then 5 months later when the final impression coping was placed. At the time of placement the implant head was 1.5 mm supracrestal, but 2.5 mm below the soft tissue margin and at the time of the final impression was 2 mm below the gingival margin.
In restropect the implant probably should have been placed deeper, but due to existing horizontal bone loss present, I didn’t want the crown -abutment to be so long and the implant head is already 5 mm below the CEJ on the adjacent lateral incisor. Please let me know any thoughts you may have on this case. Thank you.
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