From Compromised to Predictable: Re-establishing the Anterior Implant Site

A 31-year-old female presented with recession and advanced peri-implantitis associated with a mandibular anterior implant. In addition to inflammation and loss of peri-implant support, the patient was concerned about the esthetic compromise created by soft tissue recession and an uneven tissue profile. The primary treatment objective was to eliminate the failing implant environment, rebuild the deficient hard and soft tissue architecture, and create a more predictable foundation for future implant placement.

The compromised implant was removed atraumatically, with careful debridement of the infected peri-implant tissues. Following explantation, the site was evaluated for residual bony defects and soft tissue volume deficiencies. Because the anterior mandible presents both functional and esthetic challenges, staged reconstruction was selected to improve long-term predictability. Soft tissue grafting was performed to enhance tissue thickness, support a healthier mucosal margin, and improve the final emergence profile. Ridge augmentation was then completed to restore the deficient alveolar contour and provide adequate volume for prosthetically driven implant placement.

After appropriate healing, the site was re-evaluated clinically and radiographically. Digital planning was used to guide the position of the new implant, allowing the restorative goals, available bone, and soft tissue contours to be coordinated before surgery. This approach helped ensure a more ideal implant trajectory, improved restorative access, and reduced the risk of repeating the biologic and esthetic complications seen with the previous implant.

The final outcome demonstrated stable peri-implant tissues, improved mucosal architecture, and a more harmonious esthetic result. Function was restored with a healthy, maintainable implant restoration. This case highlights the importance of recognizing when implant salvage is no longer predictable and demonstrates how staged hard and soft tissue reconstruction, combined with digital planning, can convert a compromised anterior implant site into a stable and esthetically favorable result.’