Management of buccal bone loss at aesthetic area: experience?

It is best to remove the implants and graft and wait 3-4 months and then place a new implant being sure you have 2mm of facial bone thickness and 2mm attached tissue.

Very interesting article and very interested. Thank You. I have lost 6 implants. I am almost toothless. I am showing this article to my OS as I am sick of partial denture glue in my mouth and using flippers. I do have some bone loss on the failed implants. I am Senior Citizen.

Are you sure there was ever buccal bone to begin with? The cbct now looks like the whole plate is missing, that likely would not happen after a year of function. I think the implants were placed too far buccally which would explain the pain the patient has been having from the beginning. Additionally, what's her occlusion like? Any posterior teeth missing? It also looks like there's a "pap" at the apex of one of the implants. I think these are failures and need to be removed grafted and placed again. My concern in just attempting GBR is that you could end up with recession and a need to remake the crowns anyway over an unpredictable result. 22 yo female is going to be unforgiving about her front teeth.

Pain is mostly likely indicative of peri-implantitis. GBR is very unpredictable. Removal, site management and development, and replace with adequate bone and soft tissue along with 3-D planning and surgical guide.

Don´t.... remove everything, graft and start over, this is a complicated case now and a future nightmare if you stay on this track.

Bone grafting will not work. The implants appear to be too far buccal for successful grafting. I agree with all the above suggestions: remove the implants, graft, and place implants at a later date.

The implant diameter appears to huge relative the ridge thickness. The chances of a successful bone augmentation over a titanium area of this dimension are pretty slim. There would be inadequate blood supply to the graft. Best to remove implants, augment with GBR or autogenous block grafting at time of removal. Later, use CBCT to plan new implants so that they will be well within the confines of available bone.

Need to investigate more as the CBCT shows radiolucency both apically & palatally in addition to the existing exposure of the implants labially. Can you see any sign of mobility??? One suggestion is to surgically expose both (exploratory surgery) & if you have good osseointgration palatally, then it is a good idea to either etche or laser treat the exposed part of the implants, autograft materials & the use of PRF for both grafting materials & membranes, keeping in mind the esthetic part of the procedure. Any way it is a difficult & challenging case. Good luck.

Over time(30 years of practice with 20 placing implants) I’ve tried to graft these cases with some success. I’ve had some success with limited but not complete buccal bone loss on maxilla. Typically these patients have had youth on their size. My regimen was a wide flap, GBR with disinfecting surfaces with chorohex, bone fenestrations adjacent to implant, and the “off label usage” of Arrestin on the implant prior to bone placement. Again, success probably youth and luck. I don’t disagree with explanting, but I’d present both options to patient along with a guarded prognosis with the GBR. My take away over the years is to use an implant diameter smaller than the root God gave the patient. Maxillary cancellous bone will disappear under the slightest of undue force Just my 2 cents

Assuming there is no mobility I would start with a thick connective tissue graft to augment her facial mucosa. There is no photo but the CT would indicate a thin biotype. Regardless of the final outcome you are going to need adequate quality and quantity of surrounding soft tissue in order to achieve any sort of desireable result. GBR is unpredictable around avascular titanium and even more unpredictable without adequate soft tissue to manipulate. When dealing with implants I have found that “we” are quick to assume a “bone” problem when inadequate soft tissue is often the real problem.