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| 10/29/2012 10:51:29 PM | Dean Martin | | How best to manage this esthetic implant failure? | | Good Morning. My suggestion is to keep it "simple". Because both implants are not in ideal positions BUT bone augmentation has established labial support, use a CTG (if required) to "bulk" up the crestal ridge & do a 4-unit fixed bridge using the central & canine. This would result in better aesthetics; less cost & surgical morbidity; predictable treatment success & a Happy Patient. Thoughts? | | Register For Free To Reply |
| 10/29/2012 1:42:23 AM | narayan tv | | How best to manage this esthetic implant failure? | | That's a thought. Should be the solution for inter-implant papilla | | Register For Free To Reply |
| 10/27/2012 9:21:49 PM | Maurice Salama | | How best to manage this esthetic implant failure? | | Thanks. I have added additional CTG at this uncovering to thicken biotype but would expect some artificial gingiva needed to achieve a papilla UNLESS we utilize ONLY 1 implant and a cantilever pontic. Thoughts??
Dr. Salama | | Register For Free To Reply |
| 10/25/2012 10:24:48 PM | Waeil El.Misalati | | How best to manage this esthetic implant failure? | | Impressive results Dr. Salama. I am amazed. Wonderful surgery by great surgeon :)
Wael | | Register For Free To Reply |
| 10/25/2012 9:18:56 PM | narayan tv | | How best to manage this esthetic implant failure? | | Dear Dr. Salama,
You have achieved remarkable bone after the CTi -ACM chips/Putty? combo.Soft tissue will follow bone and the biotype would have considerably improved. The question now is the contour similar to the contra-lateral side, as this is not really appreciable from your photographs. If so, then the implants look good to restore, maybe with an additional connective tissue procedure and long term provisionalization without abutment disconnection for final restorations.Would love to see the final outcome.
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| 7/25/2012 11:35:36 AM | omid moghaddas | | How best to manage this esthetic implant failure? | | Dear Dr Salama
In this case one problem is the position of dental implants,one is the soft tissue and hard tissue.one of the options is segmental repositioning if the implants are well integrated,and one option is to explant them,reconstruct the bone and soft tissue and place implants in ideal position,which I am more agree with the second one,especially because it's in esthetic zone | | Register For Free To Reply |
| 7/8/2012 9:11:13 AM | Tommy McGee | | How best to manage this esthetic implant failure? | | If I put myself in the patient's position, I am not sure I would choose distraction or even bone augmentation procedures. I think even if those procedures were successful the esthetic outcome would still be considerably compromised. Worse, if heroic procedures fail the situation gets dramatically worse. Personally, I might choose to sleep the implants, augment the soft tissue as much as possible to plump it up, and then finish the case as a fixed bridge using the right canine and remaining central and lateral as abutments. | | Register For Free To Reply |
| 5/30/2012 11:46:31 AM | Robert Burstein | | How best to manage this esthetic implant failure? | | Its hard to judge by 4 pictures. It looks like there are orthodontic considerations as well. Has there been any discussion of distraction techniques to bring down the implants and bone in block? | | Register For Free To Reply |
| 5/27/2012 4:14:04 PM | amir shirani | | How best to manage this esthetic implant failure? | | dear dr. salama.i think that we need cbct for this case.both of implants are not in good position.we can remove them and use block graft and tissue graft for better result and after healing two new implants in new position | | Register For Free To Reply |
| 5/13/2012 8:06:24 PM | Jeffrey Sims | | How best to manage this esthetic implant failure? | | Have a really terrific ceramist like Pinhas Adar, Christian Coachman or Jhonatan Bocutti ! | | Register For Free To Reply |
| 5/12/2012 7:50:07 AM | amin jalaljalali | | How best to manage this esthetic implant failure? | | wath is the implant system ?would you please post radiography . moreover , i think the best way of treating this situation is guided gingival growth with costem healing aboutments . | | Register For Free To Reply |
| 5/3/2012 10:50:28 PM | Jeff Rabinowitz | | How best to manage this esthetic implant failure? | | Even if osseous support is substantial, I think the apical-coronal positioning of the implants, combined with their poor angulation and the gingival/ridge deficiency warrant the removal of both implants. Soft tissue grafting will likely, if successful, yield a buccal prominence that is inconsistent with that of the adjacent teeth.
I would develop a very good long term provisional strategy, i.e. a fixed bridge # 06-09, and remove the implants with concurrent ridge augmentation - likely via an onlay graft from the ramus. Follow up with secondary grafting as indicated and with a more correct implant placement of one implant (cantilever restoration) or two implants.
The alternative of a segmental osteotmy would require both changing the implant height and re-angulating the fixtures, a lot to acomplish, and soft tissue onlay grafts to establish wnl gingival/ridge contours and running room will fall short of aesthetic demands in this high smile line pt.
CT scan/x-rays would be helpful in Tx planning this case, a very challenging one. | | Register For Free To Reply |
| 5/3/2012 11:41:15 AM | abdol samad SHAFIEI KAZEROONI | | How best to manage this esthetic implant failure? | | Dear Dr salama.I think GBR around these implants .and soft tissue augmentation.with connetive tissue grafting | | Register For Free To Reply |
| 5/1/2012 8:54:29 AM | Yosreldin Koheil | | How best to manage this esthetic implant failure? | | Pink composite/porcelain | | Register For Free To Reply |
| 5/1/2012 2:47:46 AM | abdelsalam elaskary | | How best to manage this esthetic implant failure? | | Removal of the two implants, leave soft tissue healing time , restore keratinzed tissue band , tissue expansion to the optimal height , 3 dimension Osseous reconstruction via ti mesh or block graft , leave healing time , prosthetic time | | Register For Free To Reply |
| 4/30/2012 2:56:43 PM | Waeil El.Misalati | | How best to manage this esthetic implant failure? | | Thanks Dr. Salama for discussing this case with us. Ny question is whether there is enough buccal bone around these implants or not?
If yes, then
1. I will remove the crowns and the abutments and put cover screws on top of these implants and burry them and wait until healing with secondary intention.
2. An ESSEX is preferred to temp the case to eliminate the chance of any pressure on the soft tissue.
3. After that I will go back and start the soft tissue augmentation with connective tissue grafting and coronal flap advancement and wait until it heals.
N.B. Usually in cases like this I like to track the case back from the beginning. Meaning if we have the CBCT before or at the time of implant installation and whether it was an immediate or delayed placement. I'm not sure if the gingival biotype is a contributory factor in those kinds of scenarios.
If we don't have enough buccal bone, then I proceed with one of two options:
Option 1:
If these is a substantial amount of bone loss, then I will remove these implant and do a staged three dimensional hard and soft tissue augmentation procedures. Then I place my implants either free handed or guided
Option 2:
If there is not much bone destruction around these implants , then I will proceed with a more regenerative approach. Trying to gain as much bone and soft tissue especially with the recombinant growth factors like rh-PDGF BB and Enamel Matrix Derivatives " Emdogain"
I'm still a Perio resident and I might be wrong :)
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| 4/30/2012 2:52:57 PM | Waeil El.Misalati | | How best to manage this esthetic implant failure? | | Thanks Dr. Salama for discussing this case with us. My question is whether there is enough buccal bone around these implants or not?
If yes, then
1. I will remove the crowns and the abutments and put cover screws on top of these implants and burry them and wait until healing with secondary intention.
2. An ESSEX is preferred to temp the case to eliminate any pressure on the soft tissue.
3. After that I will go back and start the soft tissue augmentation with connective tissue grafting and coronal flap advancement and wait until it heals.
N.B. Usually in cases like this I like to track the case back from the beginning. Meaning if we have the CBCT before or at the time of implant installation and whether it was an immediate or delayed placement. I'm not sure if the gingival biotype is a contributory factor in those kinds of scenarios.
If we don't have enough buccal bone, I will proceed with one of the following options:
Option 1:
If these is a substantial amount of bone loss, then I will remove these implant and do a staged three dimensional hard and soft tissue augmentation procedures. Then I place my implants either free handed or guided. Finish it with EMAX or PFM. Hopefully no need for pink ceramic. Although, I'm not sure if I can do an esthetic crown lengthening on the adjacent teeth to enhance the outcome. I don't know how predictable a cantilever is if I want to place one implant!
Option 2:
If there is not much bone destruction around these implants , then I will proceed with a more regenerative approach. Trying to gain as much bone and soft tissue especially with the recombinant growth factors like rh-PDGF BB and Enamel Matrix Derivatives " Emdogain" wait and restore as above.
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| 4/30/2012 2:24:41 PM | benz manz768 | | How best to manage this esthetic implant failure? | | I would say radiograph will make prognosis of these implants more clear. nonetheless always going to be challenging. I am sure Dr. Salama will do justice with it(if he hasnt treated it already:) ).
It will be interesting to know whether they were immediate placements?
Restorative status of UL1 can dictate if conventional bridge is an option after CT graft.
As it stands unless multiple soft tissue with a possible hard tissue graft considered, it can only be managed with some pink porcelain once peri-implantitis is taken care of. Even then high smile line will make compromise obvious.
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| 4/30/2012 1:20:41 PM | bradford klassman | | How best to manage this esthetic implant failure? | | Mo, are we looking at a sulcus former or cover dscrew on the central.... also how much gingival height do you have on the lateral.... Looking at the smile shot it is going to be a compromise... which ever implants gives you the most "running room" i would use as custom abutment and plan on burrying the other.. May need some pink porcelain as well. These are the cases that need presurgical planning! And the hands of a prosthetic specialist. | | Register For Free To Reply |
| 4/30/2012 12:33:04 PM | mukesh soni | | How best to manage this esthetic implant failure? | | Options:
1- Segmental osteotomy to lower the position of the implants. this is a difficult option
2- place temps and repeat several soft tissue grafts to bulk out tissue
3- remove the abutment/sulcus former. Soft tissue grafts to bulk out tissue. then use one implant and a cantilever bridge
All of the above will help the aesthetics-- but they are demanding and technique sensitive options | | Register For Free To Reply |
| 4/30/2012 12:21:29 PM | Sherif Salama | | How best to manage this esthetic implant failure? | | Well i dont know professor maurice but both of them dont look like repairable too much angulation and the bone width doesnt look so good to me so if this can be confirmed by cone beam then i would think they should be removed specially because of the force that will be exagerated due to the angulation so maybe remove them do a bone graft abd redo the whole case because even if we can repair them esthetically 80% i dont know about the functional prognosis.
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| 7/25/2012 11:41:00 AM | omid moghaddas | | How best to manage this esthetic implant failure? | | Dear alireza
Well I think leaving the central implant there and using a cantilever Pontic on the Mesial side of the lateral implant doesn't solve the problem,and with crown lengthening the lateral incisor on other side the esthetic going to be more compromised.using cantilever in central area with loads on it will make the scenario worst for lateral implant,I prefer ex planting both,augmenting the area and soft tissue ,installing implants in optimum area,on the second option if the implants are in healthy situation we can do segmental repositioning. | | Register For Free To Reply |
| 4/30/2012 11:57:15 AM | Juan Flores | | How best to manage this esthetic implant failure? | | what about submerging both of them plus a CTG? Re-do uncovering trying to cover the implant platform. | | Register For Free To Reply |
| 4/30/2012 11:55:38 AM | alireza torabi | | How best to manage this esthetic implant failure? | | Dear Professor Maurice Salama : Thank you for your challenging case : however both of implants are not in good restorative position but I think if we leave central implant without crown and mention as an sleeping implant it is better and in final restore its space with Pontiac. And after that Crown lengthening in contra lateral incisor.
I think this is a conservative treatment,however, one important factor is patients' satisfying. | | Register For Free To Reply |
| 4/30/2012 11:17:31 AM | Maurice Salama | | How best to manage this esthetic implant failure? | | Patient presents with 2 implants previously placed in Maxillary Right Central and Lateral incisor positions with significant bone and ginvial recession. He wishes a esthetic solution and long term survivability.
Thoughts from our XP community. my treatment and results.
Thanks Dr. S | | Register For Free To Reply |
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