Improper planning and treatment results in absolute failure in all dental procedures and in particular dental implants (1). Implant placement need to be designed and it must be specifically placed within adequate hard and soft tissues in a way that allows it to remain in health, esthetic and function over an extended period of time (5). Case report: A 45-year-old woman with non-contributory medical history presented to our clinic with failed implants at #35 and #36. Implants were mobile (grade 3 mobility) with severe soft and hard tissue loss and shallow vestibular depth. Clinical and radiographic assessment including cone beam computed tomography (CBCT) were done after which implants were removed and sites were curetted and irrigated with saline. A free gingival graft (FGG) to develop the soft tissue and an autogenous bone graft to enhance alveolar ridge height and width were planned at 2 stages surgery. The FGG was first obtained from the hard palate and sutured into place with a partial thickness flap. After three weeks of healing, vestibular depth was adequate, keratinized mucosa had formed, and there was soft tissue improvement in volume, thickness, texture and shape (1, 4, 5). Two months after FGG stabilization, an autogenous bone block was harvested from the retromolar area near the defect site with a peizotome and fixed to the implants site with 2 titanium screws (1.2x15mm). Inorganic bovine bone minerals (xenograft particulate) was used to fill the gaps between the native bone and harvested graft, which was covered with bovine pericardium membrane (20x30mm) (2, 3). Flap was fully adapted and sutured with continuous mattress 4-0 vicryl suture. CBCT taken six months later shows alveolar ridge gain (7mm height and 12 mm width). A mucoperiosteal flap was then raised, fixation screws were removed, and two dental implants (Straumann 4.1x10 RN; 4.8x10 WN with 2mm size healing abutments) were placed at sites #35 and #36. Chlorhexidine rinse was advised for 4 weeks and sutures were removed 2 weeks after surgery. Provisional crowns were performed 2 months after implants placement with a definitive planning of final crowns after 4 month.
Conclusion: Soft and hard tissue restoration before implant placement has shown a predictable result in achieving both soft tissue covering as well as vertical and horizontal ridge augmentation at a site with severe soft tissue and bone defects.
