A 3.8x18 mm (definitive) implant is placed with <40 Ncm with the implant plateau apical to the lingual crest (Fig.4 (dashed line: upper border of the buccal defect)).  The buccal plate defect is repaired by Vanilla Graft (Fig.6 *) before and after insertion of a 4.5x4(3) mm abutment.  The buccal plate defect seems to being repaired 4 months postop (Fig.7).  The defect repair is close to completion 8 months post cementation (Fig.8). 

The crown/abutment is found to be loose 1 year 4 months post cementation and retightened without checking whether there is clinical 2nd DO caries of #3 (Fig.9, "sensitive to water pik").  A few days later, DO composite is being removed.  It is difficult to determine whether the 2nd DO caries or gap has been removed with the neighboring crown in place.  When the crown/abutment is removed and gingival retractions are inserted, there is no decay.  The gap is removed.  With Toflemire in place, the crown/abutment is reseated and hand tightened; after packable composite, the crown/abutment is removed, there is no more DO gap.

In fact there is a small buccal fistula, which is communicated with the underlying implant threads.  It appears that the buccal plate regeneration is incomplete (Fig.9 arrowheads).

Buccal Plate Defect Last Next

Xin Wei, DDS, PhD, MS 1st edition 12/03/2017, last revision 07/28/2019