Peri-implantitis on the anterior implant, peri-implant health on the posterio

Lack of KT on that implant as a risk factor

Hockey stick incision to avoid severing the hemidesmosomal-epithelial attachment to the healthy implant

Release of the lingual flap with stripping of the mylohyoid fibers for passing advancement

Note how the lingual flap is coronal to the abutment

Implant surface decontamination.
The most critical part of the entire procedure.
Implant specific cleaning approach

Membrane tacked into place for stability and then packed with 0.5cc Perio Glas morsels

Membrane secured

Coronal flap advancement with periosteal release

Primary passive closure

Follow up of the case a couple of months later / Temporary Restoration

Restoration placed. Note how it was recountourned, now we can observe a healthy periodontal tissue around the implant and the restoration.

*Case Courtesy: George Kotsakis, Associate Professor (Perio), UTHSCSA, San Antonio, Texas