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Implant Placement with Bone Grafting at #12 and #14 Following Failed PFM Bridge Removal

Surgical Procedure

Chief Complaint

Patient presented with a leaking 4-unit PFM bridge spanning #12 to #15 and requested evaluation for replacement of missing teeth at #12 and #14 with implant-supported restorations.

Clinical Findings

Existing prosthesis:

  • #12 cantilever pontic

  • #13 bridge abutment

  • #14 bridge pontic

  • #15 bridge abutment

Bridge from #12 to #15 showed leakage.

CBCT assessment performed (previous scan older than 6 months).
Bone condition evaluated and implant placement positions planned at #12 and #14.

During surgery:

  • Apical portion of #12 implant noted partially exposed outside native bone support

  • Additional grafting required for reinforcement

Treatment Plan

  1. Sectioning of bridge at:

  • #13 (mesial and distal)

  • #15 (mesial)

  1. Removal of pontics at:

  • #12

  • #14

  1. Implant placement at:

  • #12

  • #14

  1. Bone grafting at implant sites

  2. Additional grafting at apical region of #12 implant

Pre-operative Assessment

Pre-operative CBCT taken and reviewed.
Implant positions planned carefully prior to surgery.
Risks, benefits, and procedural steps explained.
Patient understood and agreed to proceed.
Informed consent obtained for implant placement and grafting procedures.

Anesthesia

Local anesthesia administered.
Patient cleaned and draped under sterile protocol.

Surgical Procedure

Bridge sectioned and pontics removed at #12 and #14.

Incision made.
Buccal flap raised.

Implant osteotomy sites prepared using implant drills and osteotomes.

Implants placed:

  • #12: 4.5 mm × 8.0 mm Dentium Superline III implant with healing abutment placed

  • #14: 4.5 mm × 10.0 mm Dentium Superline III implant with healing abutment placed

Bone grafting performed using Dentium Osteon Collagen artificial bone graft material at both implant sites.

Flap released.

Primary closure achieved:

  • 4 BSS sutures at #12

  • 4 BSS sutures at #14

Hemostasis achieved.

Post-operative CBCT taken showing satisfactory implant positioning.

Apical exposure noted at #12 implant site.

Additional procedure performed:

Incision made at buccal region of #11 free gingiva.
Tunnel flap raised to access apical portion of #12 implant.
Additional bone graft placed using Dentium Osteon Collagen artificial bone graft material.
3 BSS sutures placed for primary closure.

Repeat post-operative CBCT confirmed dense graft placement and improved coverage.

Post-operative instructions provided.

Post-operative Assessment

Implants positioned satisfactorily at #12 and #14.
Supplementary grafting successfully performed at apical portion of #12 implant.
Radiographic assessment showed dense graft adaptation.
Healing abutments stable.
Patient tolerated procedure well and was reassured post-operatively.

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