Implant-osseous osteotomy for correction of the misaligned anterior maxillary implant.

The trend has been to use angled abutments to compensate for implants that have poor emergence profiles. This trend has resulted in increasing unfavorable forces being placed on the implant, poor soft tissue emergence and contours, or creation of areas that the patient cannot maintain properly. The end results are an esthetic compromise and ultimately implant failure. This case illustrates that a misplaced or misaligned integrated implant can be repositioned successfully within the maxillary alveolus. Careful treatment planning, flap design, and soft tissue manipulation must be considered to maintain the vascularity and integration within the implant-osseous segment as well as the soft tissue. The byproduct of maintaining vascular integrity is normal soft tissue morphology, especially of the interdental papillae (see Fig. 6).