Implant thread became exposed: best treatment technique?

In the future would suggest in the maxilla to use an ostetome following the initial pilot drill this will do two things 1. widen the ridge further and 2. increase bone density. When an implant is placed and some threads are exposed on the facial we can graft this and grafting will work best if we are not temporizing the implant at time of surgery so place graft to cover the area then a collagen membrane and get primary closure. if you plan on immediately temporizing it then use a non resorbable material as the graft so you dont loose any during healing as using human or bovine one tends to loose some when there is a temp present. I would not advise removing the implant unless the goal is to place deeper and what will determine that is where does the palatal bone end in relation to the top of the implant because the buccal crest is usually more apical then the palatal and placing the implant so its level with the buccal places it typically too deep for the palatal. tipping the implant does help and due to the angulation of the bone is often necessary.

Since the smallest diameter implants available from the major players are just over 3mm in diameter, a 4mm wide ridge is not sufficient for implant placement. If placed perfectly this would leave 0.5 mm of bone both buccal and lingual. If you don't get threads exposed at placement, you would certainly get them later as there will be inadequate blood supply to the remaining bone resulting in die back and dehiscence. Seems like site development should have occurred first. Isn't this the reason for the scan in the first place?

If it is only a few threads it should be fine with the grafting. I like the idea of motorized spreaders or osteotomies in thin maxillary ridges. If it is more than half the implant or involving the crestal bone it may be a problem. Is there good soft tissue thickness for esthetics?

You did a good job and handled correctly. Nothing is a 100 % predictable even with CBCT. Next time you don't have to do a second osteotomy: if the depth, position and angulation of the implant is OK, just graft buccally; membrane and primary closure (this often tends to dehiscence unfortunately). It will be OK. Osteotome techniques are very elegant especially combined with piezotome but I've experienced a lot of bone loss when pushing this method too far. I think a 4 mm crest this would be the limit. Can someone explain me how they do an expansion without flapping? How do you contain the graft particles then? or is it rather a split thickness flap? Thanks

I agree with rotary osteotome widening technique/ use of bone expanders for creation of adequate site bucco-lingually with more or less satisfactory bone volume for the implant - these kits are readily available online (amazon,ebay, etc). You'll have to do a lot of gymnastics to cover the threads but it can be done, I'm sure you can do it. Guided tissue regeneration with membrane use should work - make sure the patient doesn't have undiagnosed diabetes if possible. Good luck.

You don't need a second osteotomy to avoid treads exposure. Just perfome grafting, membrane an primary closure without inmediate load. Be sure that the stitches be not too tight to avoid dehiscence.

I think if you let the implanted implant in its place and cover it with Bone substitute material with small autogenous bone particles and cover it with collagen membrane.and suture the flap overit and do not do loading prior to 3 months. this will end in good result. Do not worry

Hi.in this situation first you must expand the remaining bone with expander kit Then if you have less than 2mm of buccal bone you should do gbr If you didnt that probably you have esthetic failure If your gbr and primary closure had been ideal dont warry