55-year-old female presented complaining of the appearance of the implant placed at position #31 (24) approximately 10 years previously following a motorcycle accident.
On examination, there was a Straumann tissue level implant with a visible abutment collar and a cement retained crown. A CT scan showed thin bone labially, so removal would risk further bone loss.
Two options were presented to the patient: Firstly, removal of the implant, grafting and replacement after healing. This would allow replacement of the implant with a tissue level implant and reduce the risk of the collar shining through the gum. It would still be necessary to perform bone and soft tissue regeneration in order to achieve a good result.
The second option was to perform bone and soft tissue augmentation, remove the horizontal collar from the abutment and place a new crown using a vertical margin technique. This ran the risk of still having grey shine through. It would however still leave flexibility to replace the implant if the patient found the result unacceptable, with lower risk of excessive bone loss.
The patient opted for the second option, as she is not able to attend the practice regularly at present, and soft and hard tissue augmentation would still leave flexibility to replace the implant later.
