14/09/2025
From failed GBR ❌ to harmony in the esthetic zone ✅.
Young adult with a ridge defect at the left lateral, a fractured/ malpositioned implant at 22, and compromised 11–12(inadequate endodontics, limited ferrule) → asymmetrical smile.
1. Reset: Explantation, removal of fibro-/non-osseointegrated biomaterial, soft-tissue conditioning with a palatal pedicle flap;
2. Rebuild: Autogenous split-bone block (Khoury shell) from the retromolar area, only ~3 months ready to receive implants
3. Reposition: Two implants placed at 21 and 22 in correct prosthetically driven, leveled to adjacent natural teeth;
4. Sculpt: Uncovering + healing abutments, then provisionalization to shape peri-implant mucosa and the emergence profile.
5. Restore 11–12: Minimal crown lengthening for ferrule, endodontic retreatment, post-and-core; provisionals for tissue maturation.
6. Final: Definitive reconstructions on 11–12 and implants 21–22; contours, gingival levels shaping the interdental papillae, and smile line harmonized—implants blend with natural dentition.
