Overview
One of the challenges with a failed implant site is managing a large bone defect while maintaining control of the graft material during GBR. In this case, severe bone loss around implant #19 and the proximity to the inferior alveolar nerve required a staged treatment approach.
Treatment
The failed implant was removed first, followed by site development with GBR before implant replacement.
Treatment Planning
Due to the amount of bone loss, a staged approach was selected to reconstruct the defect before implant placement. The failed implant was removed, and the site was allowed to heal before re-entry for GBR using sticky bone and PRF membranes.
Clinical Steps
✓ Pre-operative evaluation
✓ Removal of the failed implant
✓ Sticky bone and PRF membrane preparation
Sticky bone makes graft handling much easier during the GBR procedure by improving graft stability and reducing particle migration. PRF membranes were used to cover the graft and support soft tissue healing.
✓ GBR and site development
Adequate flap release and tension-free closure are critical for predictable GBR outcomes. The graft and membrane were stabilized using membrane-holding sutures to minimize movement during healing.
Outcome
6 Months Post-GBR
The site demonstrated favorable bone regeneration at the 6-month follow-up. Implant placement was then completed in the regenerated ridge with adequate bone volume for implant support.
Clinical Pearls
✓ Staged treatment can be a predictable option for managing failed implant sites with significant bone loss.
✓ Sticky bone improves graft handling and stability during GBR procedures.
✓ PRF membranes can be used to support soft tissue healing and graft protection.
✓ Tension-free flap closure and membrane stabilization are key factors for successful GBR outcomes.
Detailed step-by-step protocols for GBR, phlebotomy, sticky bone preparation, and PRF membrane fabrication are covered in ECDA Module A.
