Failed immediate implant: thoughts?

I placed a 3.75x13mm implant immediately after extraction.  I used 45Ncm on insertion and achieved primary stability.  I grafted with TCP (Beta-tricalcium phosphate).  The healing period was uneventful.  The patient is a heavy smoker (cigars).  After 4 months, I tried to manually unscrew the cover screw and the implant unscrewed with it.  What are your thoughts and recommendations?

2 thoughts on: Failed immediate implant: thoughts?

  1. Paul says:

    Based on one experience only I can share that I have a patient who is a smoker and placed a single implant and covered the implant completely with soft tissue.
    On the same patient I placed an implant in a different location of the maxilla with an immediate temporary restoration because patient insisted and signed uninformed consent against my advice because of smoking.
    Four months later that implant failed before a permanent restoration was provided. Patient did not experience any symptoms and the radiograph affirmed failure. On the other hand the implant that experienced osseous integration “under cover” is successful.

  2. WJ Starck DDS says:

    Not enough info to make an educated guess.

    But it looks to me like you were planning to replace a molar with a 3.75 mm implant. What was your reasoning for that?

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