Interdisciplinary Management of Biological and Prosthetic Implant Complications in the Esthetic Zone: A Case Report

Abstract

Managing complications related to dental implants placed in the esthetic zone is difficult, often requiring interdisciplinary management to resolve them. This case report is aimed at describing the therapeutic stage approach used to manage complications in an upper central incisor with an implant-supported crown with esthetic, prosthetic, and biological failures. A female patient, 38 years old, consulted for an esthetic deficiency in relation to a crown supported by an implant placed and rehabilitated 8 years ago. The patient showed a high smile line and unfavorable mucosal zenith position associated with the excessive depth and buccopalatal angulation of the implant. Implant removal was performed, followed by vertical and horizontal bone augmentation and soft tissue management in both surgical stages. Then, an implant and a temporary crown were installed in the second-stage surgery to develop the emergence profile of the definitive crown. The 12-month CBCT showed the bone graft well incorporated over time, with increased ridge width and height. In addition, clinical soft tissue examination reported stable soft tissue health in quality and quantity. Management of biological, prosthetic, and esthetic complications in implant dentistry involves a comprehensive knowledge of techniques and disciplines to achieve optimal hard and soft tissue restitution. Proper planning should include an interdisciplinary approach, prosthetic-guided implant placement, stage approach management, and adequate prosthetic rehabilitation.