This area has been something of a nightmare. Thankfully the patient is very understanding. Having successfully placed and restored implants in the #14 and 18 positions, she understands and appreciates the process. She also understands the complications which can arise, as I had a previously placed a Bicon implant in the #31 position in 2010 which was the distal abutment of a 3 unit bridge. Patient had to transfer to another office due to insurance and had not been seen for 5 years. When patient came back, #31 was found to have failed. The three unit bridge was sectioned between #29 and #30 pontic and the area was grafted with allograft on 1/5/16. After a period of 1 yr the current implant was placed 1/17/17. This implant is an Implant Direct HA coated Legacy 2 10 x 4.7, 4.5 platform. Flapless surgery was uneventful. The lack of attached gingiva was a concern but it was decided that a graft would not be done due to patient’s wishes. #31 was initially restored with a cement retained bridge, but came loose (3/23/18) and was ultimately replaced with a screw retained distal abutment, 5/22/18. Patient was seen today, 10/19/18, and reports on and off soreness there. The radiographs included with this case clearly show the implant is failing. Although I think I know the answer….remove, graft and start over…from reading posts here and through my own experience, has anyone had some “thinking out of the box” success treating this situation without doing that?