Pt is a very healthy 86 yr old female . She may live to 100!
She wants teeth to chew with . Does not like PDU/ PDL .
Root form fixture placed Aug 15, 2016 , using lab constructed Surgical Guide. .
Fixture at 17 placed recently.
I observe at buccal of 15- thin biotype. At the time of implant placement , I performed atraumatic extraction of 15, evaluated buccal bone , and noted it was intact fully apical to coronal . Using the Guide , implant was placed subcrestally immediately.
Now - I am able to see thru the thin gingiva the shadow / color of the fixture at the buccal. . No inflammation . No syptoms .
See the CBCT of implant . It looks to me like it is lacking/ absent of bone at buccal . And the position does not appear the same as indicated on Guide planning ( enclosed) . I suspect it may have shifted during placement ?? Position certainly could be more palatal .
So what must I do to fix this ?
1. Flap, inspect , place GBR -- this will be onlay graft , and likely fail , especially with thin biotype . Tissues are very delicate and be difficult to handle .
2. Remove implant , perform socket preservation graft ; close and wait 4 mo.
3. Remove implant , place a new fixture more palatally. Certainly threads will be exposed ; graft would be within bony envelope, so better chance of success . Placing the implant in proper position, however will be a challenge.. And bone density is on soft side .
Any suggestions would be welcome .
OOps , I think I included an unnecessary image.
by Madeson Basie at Tue, Feb 28, 2017 8:05 PM
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