Malpositioned Implant in the Esthetic Area: The Peri-Implant Plastic Surgery and Angulated Welded Abutment Approach

Purpose: To describe treatment of malpositioned implants in the esthetic area using the angulated welded abutment (AWA) approach together with peri-implant soft tissue surgery. Materials and methods: A clinical case with extreme buccal angulation of two implants in the anterior maxilla was used to illustrate the AWA technique. After implant impressions, digital analysis of the ideal prosthetic angulation of the abutment and the ideal position of its screw-access hole in relation to the gingival margin of the adjacent teeth was undertaken. The AWA was designed in two combinable components that were meant to be welded together. Before the welding process, an angulated screw was included in the abutment. Since the angulated screw was inside the abutment, the screw-access hole could be designed as narrow as possible, and it was located where required. After periodontal and peri-implant surgery were carried out, the AWA was applied to the implants. Results: The AWA allowed for correction of the prosthetic axis. Moreover, relocation of the screw-access hole allowed the gingival tissue to creep over the abutment. In this way, a new esthetic restoration could be placed after the mucogingival surgery. Conclusion: The excessive implant misangulation in the present case was efficiently recovered. Further studies are needed to evaluate the long-term clinical success, and standardization of the technique is required for routine clinical use.