Labially positioned implant with recession

Dear colleagues

I want to share this complex case with you:

A young 35-year old female patient visited our clinic yesterday for the first time. She is concerned about her implant in position 21 which was placed alio loco, where she remarked a buccal recession.
Clinically the implant is massively bucally angulated and closely placed to the root of the tooth 21.
The patient has very high esthetic expectations and wants to avoid further surgical interventions if possible.
What would you recommend to do?

Thank you for your kind answers and best regards
Samuel

17.12.2015, 15:08
Dear Riccardo
Thank you very much for your comments.
After discussing different options with the patient we decided de following approach:

1. Removing the Healing Abutment, waiting for secondary healing of the mucosa
2. Explantation, if possible reimplantation and GBR in the same surgery
3. Connective tissue graft to improve the mucosal situation
4. Abutment connection, provisional screw-retained crown to form the emergence profile
5. Definitive screw-retained crown

I will report again after the first steps are done. Of course i'll be happy to read further comments of other colleagues.
Best regards
Samuel
29.02.2016, 19:33
Dear Samuel
Many thanks for sharing your very interesting case.
I think it could be difficult to avoid surgical interventions, especially if the patient has very high esthetic expectations.

In my opinion the possible options are:
Option 1
Removal of the implant, optimisation of the soft tissue situation with a connective tissue graft; after healing, new implant in a more palatal position and GBR; screw retained reconstruction

Option 2
Placing a cover screw and submerging the present implant under a connective tissue graft. After reopening and conditioning, individual abutment and cemented reconstruction.

Option 3 (depending on occlusion and vertical position of the implant)
Placing a cover screw and submerging the present implant under a connective tissue graft. Resin-bonded fixed dental prosthesis.

I'm looking forward to read further comments and suggestions of other colleagues
Best regards

Riccardo
18.02.2016, 16:17