In this case, the explantation of a fractured implant from the upper jaw is performed and a new implant inserted in the adjacent area. The original plan was to treat the clinically apparent peri-implantitis and the bone defect visible in the X-ray through regenerative surgery. Following a ridge incision, Professor Hürzeler prepares a mucoperiosteal flap in order to expose the defect and to establish a clear overview for the operation. During this process, an implant fracture was found to be present which made an explantation necessary. A trephine is used to widen the bone defect so that the lower part of the implant can be loosened and removed.

In order to establish support for the existing bar-retained prosthesis, a new implant is planned to be inserted immediately close to the open bone defect caused by the removed implant. Drilling for the new implant is performed at an angle. Following pressure-free insertion, the new implant is covered using an angled abutment that counterbalances the angulation of the implant and a protective cap. A connective tissue pedicle flap is dissected from the palatal area.

Then the bone defect is filled with a bone substitute and covered by two membranes (double layer technique). The augmented area is covered with the pedicle flap that is fixed with a vertical mattress suture to the buccal part of the mucosal flap, and finally the wound edges are connected through suturing. The inserted implant can be incorporated into the existing bar construction after a healing period of several months.