Abscess like formation in implant zone: how would you proceed?

Are any of the implants loose? Immediately remove any loose implants. If none are loose, treat the swelling accordingly. It appears to be a local infection. Expose the implant and check the bone height. It looks like there is a little peri-cover-screw infection that will be resolved with exposure of the implant. It's difficult to tell on these pics. It appears an apically positioned flap is indicated. The PAs look OK but what about the other two?

The radiographic images are not very clear, however, if there is bone loss around your implants 6/52 post placement, or swelling due to infection then best plan is to remove the implants , wait for two weeks and place new implants. Its cheaper, easier and in the long run better to start with uncompromised implants. I recommend two weeks wait due to the history of infection, immediate placement can be attempted but best to let the body show you that it is healing. Best of luck.

The labial bone facial to the two natural roots as seen in the photographs seems very this. There might be a dehiscence which is causing the infection. This patient has an amazing about of bone in the symphysis, I would personally opt to remove the implants, wait 4-6 weeks, and return to the site and use longer implants, and bury them much deeper.

Implants are too close and will cause lots of problem , Remove it and there is enough space infront of the foremen to place the implant 3 to 5 mm distal to the infected one.

Seen it before.. it is from the denture impinging on the tissues.. I would: 1- expose 2- Ostell check 3- load Implants using the gingiva formers.. “the denture is loading implants” 4- check implants.. If Osstel below 60 then explant

The implants are failing and need to be removed. I suggest before attempting to place anymore implants please review your treatment plan and the patient's suitability for implant treatment. Judging the case with the status of the maxillary teeth, is the patient really an appropriate candidate for implant treatment? How good will she be in looking after the implants? What was the diagnosis to extract the mandibular teeth? What do you think about the size, number and position of the implants? What type of restoration were the implants meant to support, removable or fixed? If the answer is 'fixed', how posterior could you extend your restoration considering the position of the implants, which are concentrated in the anterior mandible. If the answer is ,removable', couldn't you make a descent RPP by using the remaining teeth instead. The teeth and the implants are gone. I suggest you rehabilitate the patients remaining dentition and refer the patient to a colleague with enough experience to deal with the failing implants and restoration of the edentulous mandible. You have not been able to plan, execute and assess the treatment. The treatment has been perhaps beyond your experience and comfort zone. We all learn from our mistakes and failures.

Looking at the pre-op picture it looks like the cuspid had no labial bone. If a flap were reflected you might have seen this. If the tooth was simply extracted and the fixture placed, then there is no labial bone round the fixture now as well. Lay a flap, explant, graft, membrane, etc. and re-evaluate this case.

I agree with the above comments. Remove all the implants. There was no treatment plan in place for this patient. You were most likely planning a fixed hybrid type of restoration but you do not have enough interarch space. After you remove the implants, remove at least a centimeter of bone before placing new implants. Also deal with the deteriorating maxillary teeth. These patients deserve an overall treatment plan before the implants are placed.

Agree with most comment on removing the implants. Were the implants placed into sockets ? Any flap ? This case should have be done with full flap, bone reduction to get proper bone width and inter arch prothetic space. Implants should be also placed deeper. What is the plan for the upper arch ?

On the post op panoramic image it appears that there was extensive grafting done with particulate graft material and only the apical portion of the implants is in native bone. Is this correct?

It is the big mistake to insert implants before to treat periodontal lesions, cavities, extractions and maintain oral hygiene in the oral cavity!

Most likely the denture caused some pressure on the implants and they are failing remove those two. It seems like there is adequate bone in the molar-premolars areas for additional AP spread for locators. I would also advise even-ing out the hump of the anterior ridge since there appears to be adequate height for alveoplasty. Four implants in canine and molar areas would be the way to go. What is plan for maxilla?

Thank you all for your replies. I will take into consideration every comment and will post pics upon resolvement of this case.

Thank you for your comment. If we judge patients on not being candidates for implants on the basis of missing and failing teeth, then why does implant dentistry exist? considering most implants are indicated in replacing teeth that have been lost do to cavities, perio issues resulting from bad oral hygiene. I respect your opinion but it is kind of contradictory. Natural teeth had mobility and a hybrid was never planned in this case due to cost. Oring or locator type attacments were planned. I will resolve this case even if i have to leave only two anterior implants to support the overdenture, all is not lost. The maxillary teeth are bieng rehabilitated as well. My main concern was the infected implant and how to proceed.