Guided Bone Regeneration and Healing Abutment Replacement at #36 Implant Site
Surgical Procedure
Chief Complaint
Patient presented after losing the healing abutment from implant at #36 site.
Clinical Findings
Previous CBCT reviewed.
PA lesion noted around #14 and #13 (bridge abutments for #14, #13 & #23).
Caries identified beneath bridge abutments at #13 and #14.
Soft tissue overgrowth observed within #36 implant site, preventing replacement of healing abutment.
Loose bone fragment noted on mesial and buccal surfaces during flap elevation.
Treatment Plan
Removal of gingival overgrowth and placement of new healing abutment at #36.
Guided Bone Regeneration (GBR) on buccal of #36 using autogenous bone graft and Geistlich Mucograft.
Post-operative CBCT to confirm bone graft density and nerve safety.
Pre-operative Assessment
Risks and procedures explained.
Bone grafting (GBR) quotation provided.
Patient understood and agreed to proceed.
Informed consent taken.
Anesthesia
Local anesthesia – left IDN, LN, and LBN block administered.
Surgical Procedure
Patient cleaned and draped.
Incision made and buccal flap raised, extending to the ascending ramus.
Granulation tissue around #36 implant removed.
Implant surface cleaned and irrigated with saline.
Autogenous bone harvested using trephine and chisel, then crushed for grafting.
Crushed bone packed around #36 and #37 implants.
Flap released and covered with Geistlich Mucograft (15mm × 20mm).
Sutured with Surgipro Polypropylene 6/0 (×8) around #36 & #37 and BSS 4/0 (×5) around #38 and harvest site.
6.5mm (M) healing abutment placed at #36.
Post-operative CBCT (after system glitch resolved) confirmed dense bone graft and intact IDN.
Post-operative Assessment
Healing abutment well-seated.
Bone graft dense and stable.
Inferior dental nerve intact.
Patient satisfied with the treatment outcome.