Immediate Implant Replacement with Bone Grafting at #46 Following Failed Implant Removal
Surgical Procedure
Chief Complaint
Patient presented with a dislodged implant crown at #46.
Clinical Findings
Implant crown at #46 dislodged.
Abutment screw and abutment fractured; screw extremely tight and non-salvageable.
Fractured abutment neck (“Snoopy head”).
Evidence of heavy bruxism and clenching.
Severe wear facets on remaining dentition, untreated.
CBCT taken showing suitable bone availability; no red flags.
Treatment Plan
Local anaesthesia (LA) for removal of the failed #46 implant.
Immediate implant placement at #46.
Bone grafting of the surgical site.
Post-operative review and long-term planning for:
Management of bruxism
Full-mouth rehabilitation
Treatment of infected #36 (prior RCT tooth with calcified lesion)
Pre-operative Assessment
CBCT reviewed: failed implant confirmed, adequate bone morphology for immediate replacement.
Surrounding anatomical structures assessed; IDN trajectory noted.
Patient medically fit for procedure.
Risks, benefits, alternatives, and limitations explained.
Informed consent obtained for implant removal + immediate replacement with bone grafting.
Anesthesia
Local anaesthesia administered. Patient cleaned, draped, and prepared for surgery.
Surgical Procedure
Incision made over #46 region.
Buccal and lingual flaps raised.
Failed implant at #46 trephined and removed in total.
Implant bed prepared with implant drills and osteotomes.
Dentium Superline 7.0 mm × 8.0 mm implant placed.
Dentium Healing Abutment 7.5 (M) inserted.
Bone grafting performed using 1.0 cc EthOss artificial graft material.
Flap released; BSS × 07 placed for primary closure.
Hemostasis achieved; post-operative instructions given.
Photographs taken.
Post-operative CBCT confirms good implant position and alignment; IDN not involved.
Post-operative Assessment
Patient stable and satisfied with outcome.
Good seating of implant and graft.
Healing progressing as expected.
Next Visit (N/V):
Suture removal in 1 week.
Treatment planning for infected #36 with gross calcification extending into cortical bone.
Address bruxism and design comprehensive full-mouth rehabilitation plan.
Restore implant approximately 3 months post-op (March 2023 equivalent).