Defecto vestibular

Vestibular defect

The following 68-year-old male patient was referred to us for assessment. His medical history presented controlled arterial hypertension; four years ago, he was fitted with 4 dental implants in the mandible, since which time the patient has experienced irritation and, recently, pain.
We requested a mandibular CT scan, where we observed massive bone loss around the implants. We attributed this situation to a previous bone deficit which, since the placement of the implants, has left an excessively thin buccal bone plate. Along with the poor quality of the soft tissue this was a factor for bone loss near the implants.
We planned our surgery in two stages; in the first, we were to perform the explantation of the previous implants, bone regularisation, and placement of 4 new implants. In the second, we were to perform gingiva former surgery as well as improving soft tissues gaining keratinised adhered gum and bone plate.

The day of the operation, the patient commented that the distal implants fell out 3 weeks ago. We made a crestal incision, cleaned the beds of the previous implants and explanted the mesial implants with trephine drills.
We performed the regularisation, placed the 4 new dental implants and grafted around these implants with particulate autologous bone taken from the drill.
After 3 months of osteointegration, you can see how all the implants were surrounded by bone; as a small complicaction, we had the exposure of the implant in position 34. We scheduled for the patient to undergo the second stage and an epithelial free graft from the palate to improve the soft tissues which we will see later, in another post.
Below you can see photographs from the surgery. You can view the evolution of this case here: Lower overdenture: improving soft tissues

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