Immediate Implant Pain and Mobile Crown: Recommendations?

Unfortunately it looks like a failure to integrate. I would remove implant graft heal and replace.

This is an early failure. Remove said implant, degranulate, detoxify the site, decorticating, graft and later place a wider and longer implant if possible. These things happen.

All have given you good advice. Remove implant as soon as possible.

If the natural tooth was a failed endo then it may have been an E. faecalis colonization. Yes explant, debride and graft and wait 4 moths for healing then replace the implant. Consider a 3.2X13 implant.

What about the deep subgingival cavity in the neighbour tooth?

Radiographically there is a thin radiolucency around the implant and that combined with the slight mobility you describe say the implant has failed and needs to be removed. Any mobility on an implant indicates its failed.

Can’t believe you placed that implant before addressing the large cavities on Other teeth...

Often we don't know the reason an implant fails. Sometimes we can pinpoint the reason. 1) Agree with people that you should remove and debride the site. Graft right away. When debriding, make sure that you have intact bone around the osteotomy. Sometimes the buccal plate is perforated at implant placement or the resorptive process cause loss of the plate. 2) I highly recommend doing ISQ tests prior to restoring an implant. I have been doing this in my practice for about 7 years now. It is not foolproof but does tell you how stable the implant is and can let you know if you should wait longer for integration or if you should even restore if the stability isn't good. There are lots of studies discussing how to use ISQ and what the numbers can mean.

Lot's of possible reasons but they all lead the same way. Remove the fixture and start again. Be sure you get adequate torque on the new fixture when you place it. Sorry.

More than likely #11 is necrotic and was probably necrotic at the time you placed the implant. It may have been a sub-clinical infection in which case the patient may have been asymptomatic. So, the immune system is staying ahead of the infection. Then the stress of surgery taxes the immune system just enough that the infection becomes clinical. The infection will take the path of least resistance and track straight over to the freshly created osteotomy. Frequently though, the patient will still remain asymptomatic because the infection will drain up along the wall of the osteotomy and into the oral cavity, so the typical abscess pain will not develop. This will cause the whole implant to become septic, as well as the bone around the original osteotomy. I have found this sequence of events to often be the cause of catastrophic failure of dental implants, as in your case. The other possibilities are that the original socket was septic or that you overheated the bone when making the original osteotomy. You only choice is to remove the implant, debrief the site and graft, then replace the implant after 4-6 months of healing. A bummer, but it happens.

I agree with all comments here. I would like to add tooth #6 needs and endo and crown as well. All contributes to implant integration. Bacteria loves these open spaces at the gum line. The only integration you have is at the apex of the implant which is why you were able to load it. You also might have wrong size abutment if the healing abutment kept popping out. Also, implant needs to be longer and you have plenty of great bone above to place a better sized implant. I would decorticate the implant site after implant removal and bone graft. Make sure membrane spans from your bucal wall and tucked under your palatial tissue. Suture over membrane to insure membrane stability. Wait until bone is fully mature 3-6 months before placing a longer implant. I would also give the new implant 4-6 months to fully integrate before loading it. You most likely have one more chance at this without fully losing bucal plate and attachment on adjacent teeth. You also need a cone scan on this patient to get specifics. If your new to implants, I would recommend a mentor. Calderon Institute has helped me tremendously over the years and walked me through my cases when I first started placing implants. Highly recommended. Thanks for posting.

Sometimes implants fail, immediate implants at a slightly higher rate. Remove, graft and come back in an 12 weeks. Good luck!

Explant, graft and by all means treat the decay on the canine asap. I do not think a wider implant is indicated; perhaps a longer one. Try to stay at least a mm and a half from adjacent natural teeth. Wait 4-6 months before placing another implant

1. Remove Implant. Currate it well 2. Bicortical engagement with longer implant 3. .5mm wider implant should be used 4. Close it with prf for 6 month

Hello This seems to be a conventional two piece Korean implant. The suggestion I'm going to put forward might not be supported by many. Remove the implant, clean the site. Place bi cortical engaging polished surface implant giving immediate functional support (Based on Osseofixation and not integration). Best of luck. Regards

What is the rationale of immediate placement and after 5 months second stage surgery? U should place more slender but longer implants immediately and graft the gap. U should also have placed a healing abutment instead of a closure cap. Please stop implanting and read some articles.

how lucky you are to have all these great opinions and know stuff happens. it happens to everyone even if you do things right and then you go back months later and it works good news it is not 15-17 years ago when you did not have a lot of these experienced HONEST docs telling you the facts.

When cleaning the site: currette and then agressively run a round bur all around the socket. That will decrease the bacterial count left from the extraction. Phase the replacement: Don't put a bigger or longer implant into this site.

good case, thanks for sharing

Thanks a lot for all your valuable suggestions. It has given me a fair insight into my shortcomings and aspects I would not have been able to pay attention otherwise. I ll definitely improvise over this case. Thanks again!!

Failed , I bet never integrated , the most likely perforation of the buccal plate at the apex , if you lay flap you will see it or take scan , I Treated one case seminar to this . And the implant is Too large . Good luck

Great comments we have here. Love all of them. Even though we are all implantologist now, remember that we are dentist first and treat teeth with caries during phase 1 therapy before getting to implant placement. While we are talking about this failed implant, we may be preparing to extract the cuspid with large sugingival caries. After caries excavation, that tooth may need crown lengthening. Thank you for all the feedbacks

implant too large for receptor site remove implant no need for graft at this time, wait to re-evaluate socket post op and rule out any perforations , if healthy, and no neighborhood infection exists, then do another tx , cbct if all good , then plan smaller, slightly longer implant and then possible graft wait for implant integration before restoration

implant too large for receptor site remove implant no need for graft at this time, wait to re-evaluate socket post op and rule out any perforations , if healthy, and no neighborhood infection exists, then do another tx , cbct if all good , then plan smaller, then possible graft wait for implant integration before restoration