Ailing Biohorizon Implant: suggestions?

Is there suppuration or bleeding on probing?

If asymptomatic, no treatment is indicated in this case.

Looks fine.

Looks fine. Upper Laser Lock portion designed to be in tissue. Just make sure no occlusal overload on it.

Dr Denise Tarnow has many articles that discussed the bone loss around dental implants and the formation of the Biologic width and the reason behind it. You will get some bone loss most of the time, it is important to know "why" it is happening and differentiate the biologic bone loss from the Pathological bone loss. i recommend you try to find them and read and learn what Micro-Gap & Platform Switching on the implants mean. Good observation.

Are there fine threads that are laser lok meant for soft tissue attachment on this implant? If so I am not convinced these fine threads maintain bone as well as they do soft tissue. I have had better results keeping laser lock inside tissue like they were designed for.

Compare to the X-rays when initially crown was placed. Check patient for occlusal overloading and see if patient clencher or Bruxer and accordingly make night guard p to prevent future problems.

Is the crown to root ratio OK? Could that be the issue?

Seems to me that this is a cemented Crown. There are so many implants that failed because the cement traped below the free marginal gingiva. The problem is, that you can not be sure of having removed all the cement.

It’s not failing. Leave it alone. Learn about biological width dictated by the location of the “micro gap” (where the abutment meets the Implant).. bone will remodel around the gap, similar to crown margins.. bone likes to have around 3mm distance from any margin (micro gap).

If this Biohorizons implant system has the same tolerance for abutment fit and uses the same design screw as the old Maestro, then the "microgap" is smaller than the size of a single fibroblast. Cement however is likely the problem if there is periimplantitis.

The implant complex looks very acceptable. Hows the tissue around it? Monitor it in recall. Worry about something else! Thanks for posting.

I am more concerned with the abutment to implant connection, does anyone else see the micro gap between the abutment and implant. Is this a machined Titanium hexed abutment or Zirconia abutment? If Zirconia abutment it looks like it has fractured at the implant connection.