The thin buccal plate in site # 4 splintered off. I put it back in place and grafted over it. Looking back at the photo, I wonder if this was really a good idea considering it had lost all of its blood supply. Would you have done the same or alternatively would you have just “chucked it” and grafted directly onto the implant surface?
I would leave it and just make sure it has a thick band of connective tissue…if not then a courtesy CT graft to protect it. IMHO the implant is stable/solid and even if you graft that bone will be a non-factor because it is the soft tissue that will dictate the future success of this.
It looks like the two implants were placed in a mature ridge although, I’m not certain of that. If so I would treat it the way your photos show, keeping the fractured piece of buccal bone over the implant, grafting over top of that and covering with a resorbable collagen membrane. I would achieve primary flap closure and uncover the implants and place healing abutments 3 months later. At the second stage surgery I rarely fully elevate the buccal flap, preferring to leave it attached to the grafted buccal bone.
