Journal of Oral Implantology December 2014 - (Page 737)
CASE LETTER
Correction of Esthetic Complications of a Malpositioned
Implant: A Case Letter
Sergio Alexandre Gehrke, PhD
INTRODUCTION
I
nitially, implant dentistry was focused on
successful osseointegration of the implant
body. Today, osseointegration of implants is
readily attainable with high long-term survival
rates. Good results in implant dentistry are
based on adequate training, proper patient selection, precise surgery, thorough treatment planning,
and comprehensive postoperative care. Currently,
clinicians are focusing on improving implant
esthetics and are incorporating this parameter into
their definition of implant success. The most
important objective is to create a natural smile.
The attainment of this objective is far less complex if
the natural anatomy of the soft tissue is preserved
over time.1
The placement of immediate implants into a
fresh extraction socket is based on the concept of
maximum preservation of the original anatomy of
soft and hard tissues.2 However, considerations
must be made especially with regard to the loss of
the wall of the buccal bone of the alveoli and
consequent exposure of the implant.3,4 The esthetic
restoration of dental implants in the anterior maxilla
may be complex because of excessive alveolar ridge
and soft-tissue loss following tooth extraction. The
most common esthetic complication is gingival
recession that exposes the implant-abutment junction. Poor shade selection for the prosthesis and
lack of interdental papillae also account for implant
esthetic failures.5
Thus, among the conditions considered essential
for success in rehabilitation with dental implants,
the prosthesis made over the implant has to be
satisfactory to the clinician and patient.6 In cases of
failure in treatment planning of implant placement
Biotecnos, Santa Maria, Brazil, and Catholic University of
Uruguay, Montevideo, Uruguay.
Corresponding author, e-mail: sergio.gehrke@hotmail.com
DOI: 10.1563/AAID-JOI-D-12-00252
or technique errors, some alternative measures can
be applied to favor the restoration. These include
angled abutments and/or custom porcelain overcoat, artificial gingiva, elongated crowns, and
secondary grafts.7
In extremely compromised cases, the treatment
has been limited to abandonment, submersion, or
surgical removal of the implant. However, surgical
removal of the malpositioned implant often results
in defects in bone and soft-tissue anatomy that
require subsequent surgical repair.8
This article aims to demonstrate the correction
of an esthetic problem caused by the improper
positioning of a dental implant done simultaneously
with the extraction.
DESCRIPTION
OF THE
CASE
A 43-year-old Caucasian man was treated for
evaluation of a dental implant that had been
placed 5 years previously to replace tooth No. 9
(maxillary left central incisor). Clinical examination
revealed that the gingival margin was found to be
approximately 6 mm above the gingival margin of
that found on the adjacent teeth. Periodontal
examination revealed a pink-colored gingiva
without inflammation and probing depths within
the normal range. The implant had no mobility.
The patient reported that the implant began to
appear out of the gum 30 days after its surgical
placement, and multiple gingival graft attempts
were made without success. To compensate for
the lack of proper soft-tissue anatomy, the
existing crown was made with an extension. The
patient's chief complaint was the poor esthetics
and the difficulty in cleaning the region (Figure
1a). The radiographic evaluation revealed that the
implant did have adequate bone support (Figure
1b).
The proposed treatment plan presented to the
patient was removal of the implant, placement of
Journal of Oral Implantology
737
Table of Contents for the Digital Edition of Journal of Oral Implantology December 2014
Effect of Splinting in Accuracy of Two Implant Impression Techniques
Assessment of the Stress Transmitted to Dental Implants Connected to Screw-Retained Bars Using Different Casting Techniques
Retentiveness of Various Luting Agents Used With Implant-Supported Prosthesis: An In Vitro Study
Role of rhBMP-2 and rhBMP-7 in the Metabolism and Differentiation of Osteoblast-Like Cells Cultured on Chemically Modified Titanium Surfaces
Coated vs Uncoated Implants: Bone Defect Configurations After Progressive Peri-implantitis in Dogs
Why Guided When Freehand Is Easier, Quicker, and Less Costly?
Advanced Platelet-Rich Fibrin: A New Concept for Cell-Based Tissue Engineering by Means of Inflammatory Cells
Flapless Alveolar Ridge Preservation Utilizing the ‘‘Socket-Plug’’ Technique: Clinical Technique and Review of the Literature
Implants Placed in the Nasopalatine Canal to Rehabilitate Severely Atrophic Maxillae: A Retrospective Study With Long Follow-up
Severe Mandibular Atrophy Treated With a Subperiosteal Implant and Simultaneous Graft With rhBMP-2 and Mineralized Allograft: A Case Report
Full-Mouth Rehabilitation of a Patient With Ectodermal Dysplasia With Dental Implants
The 2-Visit CAD-CAM Implant-Retained Overdenture: A Clinical Report
Assessment of Implant-Related Treatment With Edited Three-Dimensional Reconstructed Images From Cone-Beam Computerized Tomography: A Technical Note
Retrieval of a Separated Implant Screwdriver Fragment
Correction of Esthetic Complications of a Malpositioned Implant: A Case Letter
Fixed Partial Denture Treatment With Mini Dental Implants
Replacement of an Implant and Prosthesis in the Premaxilla Due to a Malposition and Prosthetic Failure: A Clinical Case Letter
A New Restorative Technique for the Perishing Implant Due to Abutment Screw Fracture
Fit of CAD/CAM Implant Frameworks: A Comprehensive Review
Journal of Oral Implantology December 2014
http://www.brightcopy.net/allen/orim/Glossary
https://www.nxtbook.com/allen/orim/40-6
https://www.nxtbook.com/allen/orim/40-5
https://www.nxtbook.com/allen/orim/40-4
https://www.nxtbook.com/allen/orim/40-s1
https://www.nxtbook.com/allen/orim/40-3
https://www.nxtbook.com/allen/orim/40-2
https://www.nxtbook.com/allen/orim/40-1
https://www.nxtbook.com/allen/orim/39-6
https://www.nxtbook.com/allen/orim/39-5
https://www.nxtbook.com/allen/orim/39-4
https://www.nxtbook.com/allen/orim/39-3
https://www.nxtbook.com/allen/orim/39-s1
https://www.nxtbook.com/allen/orim/39-2
https://www.nxtbook.com/allen/orim/39-1
https://www.nxtbook.com/allen/orim/38-6
https://www.nxtbook.com/allen/orim/38-5
https://www.nxtbook.com/allen/orim/38-s1
https://www.nxtbook.com/allen/orim/38-4
https://www.nxtbook.com/allen/orim/38-3
https://www.nxtbook.com/allen/orim/38-2
https://www.nxtbook.com/allen/orim/38-1
https://www.nxtbookmedia.com