Failed Immediate Implant: Feedback on this case?

Authors

The case you see below is a failed immediate implant tooth # 21. I placed the implant after atraumatic extraction in the palatal wall and left sufficient space between the implant and the labial wall and there was no pre-existing infection, rather a split tooth situation.

Everything looked radiographically and clinically fine until the patient returned after having the screw retained temporary in place for 6 weeks (9 months of osseointegration). At this point the lesion you see on the labial appeared. I then had another CT scan done and it appears as though there is little to no labial plate. My plan is to flap and graft the labial area. I think retrieval of the implant would be difficult as it is well integrated elsewhere.

I am not sure with such a graft if I can leave the temporary in place or if I should place a cover screw and let the site close over for optimal graft results? Any feedback on this case would be greatly appreciated.

(click images below for enlarged photos)

Healing Collar 7 Months

![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/06/7-months-healing-e1340888337914.jpg)

Temporary crown 9 month’s

![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/06/temporary-ay-6-weeks-e1340888368410.jpg)

Healing Collar 7 months

![]healing-collar-7-months](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/07/healing-collar-7-months-e1341352405557.jpg)


![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/07/healing-collar-7-months1-e1341352433774.jpg)