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The ridge at #14 seems wide 6 months post implant removal and bone graft (before and after incision). In fact the palatal bone is low, which was the basis for periimplantitis. The new osteotomy is not initiated buccal enough. When a 4.5x14 mm tap is placed (Fig.1), the palatal threads are exposed. The buccal bone of the osteotomy has to be removed before placement of a 4.5x11 mm with 1 thread exposure palatal (Fig.2). Periimplantitis at #13 is found intraop (Fig.1 *). After removal of granulation tissue and use of Titanium brush, allograft is placed at #13 and 14 (Fig.2 ^) and is covered by PRF. If there is difficulty in restoration due to deep implant placement, it has to be backed up using torque wrench. The implant is subgingival nearly 3 months postop (Fig.4 ^: gingival margin).
Xin Wei, DDS, PhD, MS 1st edition 11/18/2019, last revision 01/09/2020