I had installed an immediate implant in #12 site [maxillary left first premolar; 24] in a young patient. The tooth had a periapical granuloma which I thoroughly curretted out after the extraction. The extraction was atraumatic and the buccal cortical plate was left intact. The buccal cortical plate showed perforation in the apical area due to the granuloma. The implant placment was done towards the palatal side without any contact with the buccal bone. Novabone putty graft was placed in the buccal side and sutured. Primary closure was achieved. The patient was supposed to come after 6 months for second stage but for some reason got delayed and the patient finally turned after 15months. Until then there were no complications. The implant was submerged and healed well. I have attached the IOPA at implant placement and the IOPA after 15 months. I see a coronal radilolucent lesion around the implant. On uncovering the implant and laying a uccal flap, it revealed good buccal bone, but I did not reflect the palatal flap, just to be more conservative in my surgical approach. I am not sure how significant the coronal radiolucent lesion is when I can see a good amount of bone all around the implant clinically except the palatal area which I did not reflect. Is there a problem with the palatal bone? Your opinion will be highly appreciates.
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