Hello Everyone. One of my case reported this. Implant with bone grafting has been done 3 months ago… what to do now?
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at 3 months. probably should remove. graft and come back after 4-6 months to place implant. does the patient have enough bone buccal/palatally? For max anterior, PA can be deceiving. there seem enough bone M/D. but often than not, not enough bone B/P. both implants don’t look too hot. what does the CT look like i wonder.
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If it were me I would remove the failed fixture and use the successful one next to it to you and your patient’s advantage. Remove the fixture and augment the bone AND SOFT TISSIUE while delivering a fixed cantilever provisional to attach to the integrated screw. By delivering a fixed provisional you can properly shape the site and form a more pleasing profile for the final. I would suggest prioritizing the soft tissue over the bone and accept the fact that the final restoration might just be cantilevered… which is not necessarily a bad thing. Proceed with the intent of placing an additional implant but start with a well contoured cantilever provisional and move slowly.
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The bone around both implants looks like it healed poorly. Certainly I’d bail on the one and reflect a flap that allows you to visualize the other.
Before that, review that patients medical history: Smoking, Diabetes, SSRI’s, SNRI’s, Calcium channel blockers, Bisphosphonates, proton pump inhibitors all affect how well bone will heal.
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I know many folks will balk at the idea of even considering a cantilever final prosthesis but consider the options especially given that you have very little chance of creating an esthetic soft tissue profile with your existing case. There is no inter-implant bone peak but rather a “U” shaped depression which compromises things considerably. With a cantilever you can create an “ovate” pontic which will support a better soft tissue profile and double your potential for something resembling an interdental papilla. Either way it is a compromise because you either compromise with a single implant cantilever or you compromise with utilizing an implant placed in a now compromised site with less chance of an esthetically pleasing outcome. At any rate thick and bulky soft tissue is going to be your best friend and good luck!
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