How to salvage angular bone defect around implant?

Why six months and a half for the second stage?

See the case two cases down as a similar topic and simmilar case , with and interesting debate Peter

I think there are 3 reasons being accounted for such situation. Firstly, have ever take the biologic width into consideration? If it for me, I would probably place the implant deeper. Secondly, It maybe wait too long to load the implant. Finally, surgical manipulation error, such as overheat.

How was the width of bone at the crest? What I see often is that the crest is much narrower at the top and when you place an implant and leave the top of implant flush with the crest of bone, you end up with very thin bone surrounding the top of the implant and this thin bone often just disappear. Another possibility is that when there is very thin gingival, bone loss also occurs. What I often do is that I place the implant deeper so that the top of implant will be surrounded by thicker bone and then I flare out the bone so that I can place a proper size healing abutment. One of the things you can do for this case is to perform GBR procedure. Yet another way is to remove the implant and start over and perform GBR. Yet another option would be to just restore and wait to see how things progress. What do u think CRS?

Is there a pinhole? Just kidding. Let's look at this logically, bone loss means a Periimplantitis or inflammatory bone loss vs dieback to the first thread, biological width issue. Since the implant is integrated then flap it, clean it out and graft. Membrane? Healing head vs flat screw? I absolutely hate when this happens since there are so many factors to consider on etiology. Also could there have been dormant bacteria from the original tooth, generalized perio or patient factors as Peter stated. I feel it is prudent to fix this prior to loading and warn the patient it may fail. I don't advise burying an implant deep since that is when biological width recession occurs but I understand this is a protocol with certain implant types of which I am not familiar. I think if you do nothing and restore the bone loss will continue and now the expensive crown will be a factor, possibly a provisional while waiting. I'd graft with reservation. It is possible that there was little buccal plate at placement to cause this also. I would love to see how the original tooth was lost for a possible clue.

is there any dehiscence from the closure ? like the cap seen half parts ? some bacteria can accumulate between the cap and the gingiva. I like flapless and put healing cap so patient can clean it like real tooth. i would not do anything with this case, since the bone grafting will not make any much differences, make a very good prosthetic so the food will not accumulate next door and keep it clean.. the bone height will be stable

I agree with dr. K. It looks as if the bone at the crest was thin at time of surgery. The flap elevation and the surgical trauma may have induced a strong remodelling of the bone. The bone around the implant looks healthy radiologically. I do not see signs of a periimplantitis. How is it possible that such an infection develops in a closed environment without a fistula or at least a dehiscence of the soft tissue?

Did you counter sink prior to placing the implant? What is the width of the ridge. I wonder if the theory of micro grooves is valid!

The height of tissue over the healing cap looks quite thin, maybe there was communication with the oral environment. If you have adequate gingiva I would not start over at this point. Why don't you restore with a nice temporary crown and see if things stabilize.

Question. What about placing crest just sincerest all then grafting bone from a trap to the sight on the front end? Next, how wide was the attached KT and what was the incision design? Was it away from the implant body, ie not crossing the platform? Incidentally, I have been using rapid PGA sutures and have had SEVERAL post sx inflammatory reactions at about the 2 week period. A few of them were pretty severe. so I'm going back to my old standard chromic gut. Anything to fully reduce the initial inflammatory response. JM2C. Bill

"Subcrestal" not "sincerest all". Response was from phone with autocorrect. Sorry!

open the implant side,currete the periimplant area .pack prf +bone graft material with resorbable membrane on top tugged in by cover screw and wait for two more months.

Couple thoughts - There is radiographical proof of bone resoprtion. Takeaway- Follow up on PT more often. I like to see them at 1 week PO, 3 week PO, 2 month PO for most questionable cases (big bone-grafts, split ridges, immediate implant). THIS IS NOT A LEAVE AND FORGET IT PROCECURE!!!!!! Management 1) Flap the Area 2) Curettage of implant around defect. 3) Wash w/antibacterial solution. I personally use Hydrogen peroxide soaked in sterile gauze. Other options are chlorhexidine, and iodine. Really up to you. 4) Add bone graft 5) Place resorbable membrane for small defect (3-5mm) or non-resorbable(6+mm) 6) Suture TIGHTLY. Warn pt about swelling, black and blue bruises, and pain 7) Wait 2-3 months to follow up on case before final prosthesis