Straumann Implant Failed in Maxilla: Any thoughts?

Good morning, Doctor, I will toss in my $.02 in an attempt to help. First, no comments here are criticism - I've been placing implants for 24 years and have my share of failures. Nobody has 100% success, so kudos to you from trying to learn from a failure. First, the appearance of the bone on the postop PAs is "sketchy" at the crest, showing decreased density and lack of a crestal cortical shell. The bone density appears significantly lower around the crestal 1/3 of the implant as well. This makes me wonder if there was incomplete healing from previous surgeries or extractions and what the bone thickness was at the crest. At 5 weeks, a non-HA coated implant is at a very low point in its pullout strength and thus susceptible to a parafunctional habit such as tongue pressure. Indeed, excessive force is second only to infection in an early failure such as this. Do we have a cone beam or other exam to determine the bone volume? Your technique sounds impeccable, so therefore I would look at the patient's mouth for reasons for this failure, and I'm going to suggest poor quality bone (generally, bone in this area is Misch Class D4, equivalent to good quality styrofoam) of inadequate volume (in this case, less than a solid 1.5mm on the facial and palatal surfaces of the entire implant body length) and possibly a higher than normal extension of the mucosal collar into the mouth conspired to overload this particular implant. If I had access to a cone beam unit I would personally image the patient to see if I had underestimated bone volume or perhaps placed the implant in a less than ideal orientation. This is complete conjecture on my part based on failure statistics, the appearances of the two PAs, and personal experience, and I hope there is something useful in there to help you figure this out. Best wishes and prayers to you and your patient.