Immediate implant placed: leave it or remove it?

Last Updated June 09, 2017

This 18 y o female presented for extraction of retained primary tooth C (#6 had been previously horizontally impacted and extracted years ago) and implant. Once I removed C (atraumatic and intact 4 walls) we agreed to place the implant immediately. I kept the angles right and felt like it had a good prognosis (3.7 x 10.0 mm legacy 2 Implant Direct). Before placement I verified the osteotomy as being intact to the apical depth. Upon placement I had primary stability (35 N) and visible circumferential bone. Closed it up, adjusted her flipper, and took a CT to let her go.

The CT showed that the implant is fully exposed on the palatal, very disappointing. I’m getting her back early next week. I consider my options to be:
1) Take the implant out, GBR on the palate (I’m expecting a defect there), and reintroduce the implant in 3 months, maybe a 3.2 this time? Do you think resorbable membrane or PTFE membrane?
2) Save the implant and do GBR on the palatal? Same question, resorbable or PTFE membrane?
3) Wait and see how her body heals?

She is currently feeling well and has some slight tenderness on the palate side, consistent with the situation. Thoughts?

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