This case started with a traumatic tooth. RCT was failing with lesion and bone loss, and facial recession. The extraction was done, as well as, a ridge augmentation. I also tried to improve the recession by adding connective tissue graft to the area. The recession is improved partially. PRF was used with cort/canc bone mix. Since PRF was used, I went in at around 3 months after ridge augmentation. Fully flapped, placed implant. The newly formed bone was still kind of soft, implant had a cover screw and primary closure was obtained. I flapped case again trying to correct recession on #7, and noted the bone loss, around apical portion of implant. There is no mobility so far, but threads are not in the bone. I added bone around around it, but really nothing healed, including gingival graft. Again prf was used, and there is also fenestration on facial of root #7. I took a CT scan and it shows that angulation of implant is not perfect, but when originally it was placed, I was trying to adapt to crown angulation of #9 ( I didn’t want abutment to go too buccally) and with that augmented ridge the whole implant was visually in the bone, but it all resorbed after implant placement. There is still no bone around apical third of implant. Implant was 3.5X11. Patient is a slow healer. Not sure what are my options now? Take it out and graft and do over again?
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