Thread exposure of Adin implant: suggestions?

Not sure why the collar of the implant is placed at the level of the adjacent CEJ. This is going to be a restorative nightmare as no magical procedure can hide the improper placement. Either convince the patient to never smile or remove and replace.

Remove, graft and replace. Fixture should be about 3mm below the adjacent CEJ as well. Implant was to placed too caudally.

Remove and replace

Send the pt back to the OS asking for a re-do.

I do agree with everyone else- remove, bone graft and replace. A placement 3mm below adjacent CEJ will be better, which you can now do with the new implant.

I would not rush to explant this, the implant platform is at the position it should be any more apical then its esthetic issues. I would flap the area, laser treat the exposed threads apply doxy paste on them to detoxify the exposed metal, rinse off, place graft like NovaBone putty cover the entire implant including cover screw, place a resorbable membrane and get primary closure (use of PRF would help if you do that) the allow to heal 4 months uncover expose the cover screw and restore.

Extract replace put a narrow implant more depth!

I agree with Dr. Kurtzman. The problem is lack of tissue height, not the implant level, although I will admit thinking that indeed was the error on initial glance at radiograph. So, everything Dr. Kurtzman said up to the point of membrane placement. I tend to get better results in these type cases with the CT-VIP flap, ala Dr. Anthony Sclar.

Is there circumferential bone loss? I believe there is because of the exposed threads on the buccal, and I can only predict this also exists on the lingual. Circumferential bone loss is very difficult to treat and I think in the long term, removal of the implant, with GBR and a soft tissue graft is the way to go.

consider to remove it and graft, doubtful to gain bone horizontally to this extent - with any method. Hiossen sells a very high hand torque wrench. May be possible to vibrate it with a ultrasonic circumferentially and torque it out of there as opposed to a trephine removal.

It would be very helpful to see a photo and xray of the # 22 site before the procedure was started. The crest of the edentulous ridge seems very apical to the adjacent #21.........the ridge has to be built up to the proper height...and that could be accomplished using the implant as Dr. Kurtzman suggested....because removing the implant, may not be so simple....Adin implants are very tenacious, and there is good bone-implant contact. If the bone can be built up, regardless of the method of doing it, then the end result will be very good.........good luck!!

I do agree with Dr Kurtzman however the challenge you will face will be maintaining the vertical height of the graft. I have used titanium membranes from Megagen called I Gen with excellent results. I think that should help you solve the problem. Best of luck.

I do not often say this , as enjoy the challenge of regeneration but best to remove this one , for the long term

I only have experience with placement of Bicon implants, so can you guys tell me if this is even a viable implant, and can be hygienically restored even if cosmetically it was not a problem? I thought that the implant should be at the crest or below. I need to learn other systems so that I can fully understand the dialogues on this site. I love how much I have learned just by reading and looking at xrays. Thanks for all those who contribute.

Dr Kurtzman you said about the doxy paste. How much time to you prefer the doxy paste to detoxify the metal surface.

Don't try to rectify it yourself. Not only will it be difficult, but once you touch it you're responsible. Back to O.S..

I have been using Adin Implants long before they came to North America, have taken situations such as this and by placing a folded titanium mesh screwed to the implant and using good quality regeneration products along with PRF, I have achieved excellent results. Adin has my documented photos of some of these situations and will share them with anyone interested, or you might contact me directly and I will send them on. As mentioned above, Adin implants are very tenacious, and attempting to remove an osseointegrated implant in the esthetic zone, may cause more problems .... try to regenerate the bone over the implant as a starter.

the most ideal treatment would probably be removal, graft and re-do. there are many factors involved in particular, does the patient want to go through a removal process and wait all that time to make it "perfect". what is the patient's expectations for perfection? if the patient is reasonable, and is not expecting perfection, I believe a good way to go would be to grind the exposed threads and create a highly polished "collar". at the same time, do a coronally positioned flap with and place a connective tissue graft from palate, collagen membrane, or acellular dermal graft.