Failed implant: what would you do?

Here is what I would do, determine if it is integrated at exposure. Add additional bone in any bone defects. Determine if it is restorable, enough coverage, soft tissue on the lingual no exposed threads and restore. My rule of thumb on placement is to use the lingual plate as the guide for depth of placement it is easier to gain a small amount of height on the buccal. Once this is restored it will be impossible to get access to the lingual. Be sure an not place a crown with the emergence profile of the implant on the opposite side. Looks like a saucer shaped defect on the lingual which could be filled in, no membrane this time sometimes the Teflon can move and cause inflammation. The key is integration. Suggest screw retention if you decide to place a three unit bridge in future or require access if the implant needs future worl. Total judgement call vs removing and starting over. I would need to see this clinically at exposure to be sure. I think the membrane may have been the culprit difficult to graft and place implant at the same time, you are committed if the graft fails, next time stage it, easier to regroup

Just curious...what was your goal in placing this implant? With all the other issues in this patient's mouth, it seems that a single implant placed in this area was going to little to help him achieve optimal total oral health. Sadly, now he has another problem to deal with.

Dr. T has the right perspective by inquiring about your goal. You have not helped this patient much by placing this implant. The patient has no posterior support for his occlusion, which generally creates problems with his remaining dentition. If the implant has integrated, inspect the buccal and lingual plates, and if they are thin, graft to augment them. I am not a fan of bovine particulate (Bio-Oss) but since it does not easily resorb, it may help here. Unless you have an infra-bony defect or walls for a source of cells, it is unlikely that you will get bone in that area. Plan to place additional implants in the posterior region to provide a fixed partial denture with first molar occlusion, or make the patient a removable partial. Also investigate the sinus pathology on the patient's left side and plan for some maxillary implants as well. The patient will benefit the most from a fixed prosthesis in that area as well. Good luck, and thanks for sharing the case with us.