The case you see below is a failed immediate implant tooth # 21. I placed the implant after atraumatic extraction in the palatal wall and left sufficient space between the implant and the labial wall and there was no pre-existing infection, rather a split tooth situation.
Everything looked radiographically and clinically fine until the patient returned after having the screw retained temporary in place for 6 weeks (9 months of osseointegration). At this point the lesion you see on the labial appeared. I then had another CT scan done and it appears as though there is little to no labial plate. My plan is to flap and graft the labial area. I think retrieval of the implant would be difficult as it is well integrated elsewhere.
I am not sure with such a graft if I can leave the temporary in place or if I should place a cover screw and let the site close over for optimal graft results? Any feedback on this case would be greatly appreciated.
(click images below for enlarged photos)
Healing Collar 7 Months
Temporary crown 9 month’s
Healing Collar 7 months
Implant Troubleshooting Advice by Dr. Sam Jain
Remove the temp and look with 6x loupes, may be some debri or open margin, over hang , crack in provisional etc. clean with pgd… I scrub with cotton pallet soaked in clinda and replace the temp and then wait.
Sam