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Mark Kwon Replied at Tue, Sep 26, 2017 10:48 PM

Would like to see photos. 

Common reasons why we lose bone around anterior implants:

1. Implants too wide- encroaching on biological width 

2. Provisional crown too wide at the connection lvl - encroaching on biological width

3. Placed too buccally- leading to buccal bone loss

4. Narrow diameter implants prone to fractions 

note: the depth of fixture for anterior tooth should be approx 3-4mm below the buccal gingivae. 

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Bernard Jin Replied at Mon, Sep 25, 2017 4:25 PM

Hello Ilia

I believe Dr. Chung's explanation & recommendations are good.  I would re-treat the case entirely.  I would also consider a CTG if the soft tissue looks compromised.  I would only consider flapping, debridement & salvaging the implant IF the case has been in for a long while & the patient does NOT want it retreated.  Even so - doing this would only likely be a sort term patch solution.  In terms of long term solution - consider re-treating the case.

I would also recommend NOT replacing it with a Hiossen 3.5mm fixture.  We (the faculty) have noticed that those fixtures have been coming back with fractures on them.  If you are going to use a narrow fixture, consider another make - eg.  BioHorizons, Nobel Active, Straumann,....

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Ho-Young Chung Replied at Mon, Sep 25, 2017 1:52 PM

Hi Ilia,

This implant appears to have been placed supracrestally (fixture is above even on mesial side of 13).  Perhaps bone graft was completed in trying to regenerate what was lost prior to extraction (especially the mesial side of 12 fixture).  

In my opinion (and it's just my opinion), this was a vertical ridge augmentation which is not predictable with fixture placement normally.  Having said that, I think results would have been better had the fixture been placed deeper.

we covered these concepts this past weekend at the 2-day immediate anterior solution workshop at Bites:  biological width, emergence profile, rule of 4 (in this case more), implant positioning and angulation, just to name a few.  

I would not recommend flapping and smoothing threads.  Best solution unfortunately is starting over.  My decision to go flapless or doing a flap when removing and replacing this fixture would be based on both soft tissue and hard tissue defects.  

IMO, hygiene would have had zero effect on treatment outcome.  

I would also take a PA without the temp crown and check for a crack.  Those ET3 3.5s are prone to fracture even with a temporary abutment.  Advise the patient and send him/her back to the doctor who placed the implant or send it to someone who can resolve this issue for you.  

Thank you for posting Illia.

Ho-Young Chung