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For the implant #4 with periimplantitis (4.5x14 mm), there are 2 options: exposed thread or implant removal. Either way, make an ample incision. Prepare long diamond burs. Soak several pieces of gauze in 1:1000 Epinephrine. The implant will be removed using 5/6 mm trephine bur or surgical handpiece, followed by immediate placement of a bone-level implant with the longest abutment cuff (Fig.1: 6 mm (pink)). Insert PRF (purple line) and allograft (red circles) prior to implantation. The implant/crown ratio is poor, place a long healing abutment or cemented abutment with the shortest abutment height (4 mm vs. 7 mm of the final one (Fig.1 blue, 6-8 months of healing)). If the site is unfavorable for implantation, a 3-unit bridge will be fabricated.
Xin Wei, DDS, PhD, MS 1st edition 04/21/2017, last revision 01/19/2018