How to Prevent Fenetration?

The fenetration found buccal to #25 two months post cementation persists, although asymptomatic, 4 months post cementation.  Blood is drawn for PRF.  In fact the implants at #24 and 25 are exposed buccal; there is limited amount of the buccal bone (Fig.1 *).  After granulation tissue removal, Titanium brush is used to clean the implant threads.  Allograft and Osteogen are mixed with PRF liquid to form gel, which is placed over the exposed implant threads.  The bone graft is covered with a piece of PRF membrane and a piece of collagen membrane (Fig.2 C).  Immediately postop PA (Fig.3) and CBCT (Fig.4) show that the implants have sufficient clearance between them.  The implant thread exposure is most likely due to failure to place the implants deep enough and the implants are slightly large relative to the ridge (Fig.5-8).  If the bone graft does not heal, new type of 1-piece implants (Fig.9,10 (green) smaller in diameter, 2 or 2.5 mm ) with longer abutment (pink) will be placed subcrestal buccal with guide.

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2Xin Wei, DDS, PhD, MS 1st edition 01/06/2019, last revision 01/07/2019