Failed implant site: what are my options?

Good luck coming up with a treatment plan using this scan/copy. I hope your copy is better

Well,without a better quality scan or without a panoramic rx,I can`t make much of this one you`ve posted...the ideea should have been to graft the implant site after removal of failed implant,or to thouroghly clean the granulation tissue and replace the implant with a more palatal direction,if possible..now,your option is to place, if the bone offer is good enough,another implant,in the same position with the failed one or a little distal from it...you should have used at least 6 implant in the maxillary arch,but then again,i can`t make nothing of the scans you posted,so i can`t really figure out the situation.. My advice to you,with no offence i hope,is to have a little more training regarding bone grafting techniques and in this case to reffer it to another specialist who has that experience..It is not a shame in admitting when a case is more than we can handle in the present moment..better that to a lawsuit and all that implies including loosing confidence..i hope the pacient is understanding,and all goes well. Dr.Tudor Adrian,DMD,Oral surgeon

6 mini-implants in the maxilla. An overdenture with o-ring attachments might work well for this patient. The procedure is straightforward and can be accomplished in only a few visits. If you haven't done these types, refer to a prosthodontist(?). Good luck!

Can't be certain but it seems that the other implants may be failing, check the palatal bone loss. I would have you place the three locators. If it fails you can always retrofit. If you want a fourth implant do a sinus lift. Hopefully the implants were placed parallel with 15 degree or less of draw for the locators. Good luck. If the patient was wearing a plate over these implants the movement of the denture is contributed to the implant failure, most likely.

Depends on age and medical health of the patient ( Smoker ? ) the state of the lower dentition . If aged with a lower denture , link them with with a bar and make removable appliance . There are more issues with this patient in their own life that will confuse the matter and is maybe why you they are at this situation now. Peter

Why not try placing a long and angulated implant avoiding the sinus.. then using and angulated abutment.. like the All -on - 4 concept... won't that solve the problem..?

How does your patient feel about full palatal coverage? The implants would help resist displacement of the denture, and the tissue supported denture would not over load the implants provided that somewhat resilient attachments such as 'O' rings were used. If other implants are desired or needed they could be added later. Try to minimize the forces that these implants will be subject to. This is far from an ideal situation.