Complex treatment of a soft tissue defect adjacent to an implant osseointegrated in malposition

The purpose of this case presentation is to illustrate the conservative, surgical and prosthetic rehabilitation of soft tissue defects caused by malpositioned implants, and to provide a treatment option in the case of aesthetically unfavorable changes around healed implants. The patient came to our office with previously placed and healed implants with the screwed healing abutments in positions of the maxillary right and left lateral incisors and the maxillary right second premolar. Furthermore temporary restorations were put on the maxillary central incisors, canines, premolars and right first molar. Her main complaint was the severe soft tissue dehiscence next to the two front implants, which made her smile aesthetically unacceptable, caused by the angulation and depth differences of the implants. Explantation and insertion of a new implants could presumably have resulted in large osseous defects, due to the aggravating effect of the completely osseointegrated implants and the limited volume of the buccal bone. Our treatment plan included the reduction of prosthetic abutments and surgical soft tissue management. After the healing period, the patient received definitive prosthodontic care. By the end of the treatment series, our patient was satisfied with both the pink and white aesthetics.