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: 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