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Sheikh-Fig 2

2A. A Pre-operative radiograph of a 57-year-old male patient, non-smoker, with non-contributory medical history, presenting with a circumferential bone defect around an implant #3.5 that had been loaded for 2 years. The patient was placed on Escitalopram (SSRI) 20 mg/day, one year after the implant was loaded. 2B. The crown was removed, and a healing screw was placed until partial soft tissue coverage was achieved. Suppuration was evident upon compression. 2C. Upon full thickness flap elevation and thorough debridement of the defect, angular bone loss pattern is observed around the implant. 2D. The implant surface was rubbed with a cotton pellet soaked in 0.12% chlorhexidine for 1 minute, followed by thorough rinsing with sterile saline. A contour approach was used to regenerate the bone defect; first, autogenous bone chips were harvested from a nearby area and packed within the defect. 2E. The autogenous bone chips were overlaid with deproteinized bovine bone matrix (DBBM) xenograft, and a non-crosslinked collagen membrane was placed over the implant. 2F. The flap was sutured in order to attain complete, passive coverage of the implant. 2G. The implant was exposed at seven months; good quality of the soft tissues is seen, despite less-than-ideal plaque control in the adjacent dentition. 3 mm of keratinized tissue was preserved on the buccal aspect with no bleeding on probing or suppuration around the implant. 2H. Seven-month post-operative radiograph prior to crown placement showing complete resolution of the bone defect.