Is this Straumann implant failing?

The pics seems to be in a wrong order. The 2nd pic (with the provisional titanium abutment is actually the last and most recent one)

Remove and graft

I also would remove and graft. When placing implants on patients that smoke I always place a cover screw and do it two stage.

Please review your physiology. Nothing is integrated after only 45 days. Don't confuse the friction fit of the threads with true bone osseointegration. Looks like the remains of a periapical lesion on the film since the beginning. Remove, debride and graft. Delayed placement.

Short answer .... yes its failing remove it graft the site wait 4 months place a new implant

Remove implant, wait 3-4 months and place new. Every time when implants fails dentist always saying patient smoker that’s why. This is very old information that smoking will cause failure. In my 13 years experience ( I can say in my own studies) i place multiple implants in patients who smoke and implants never failed. I am not saying implants don’t fail, yes they do fail in smoking and none smoking patients and this is not because of smoking. Number one reason why majority of implants fail is because implants place in very thin bone and there not anough bone around implants and that cause bone resorption. Reason two: infection Reason three: improper occlusal force But not smoking.

Smoking is a risk factor for periodontitis and thus also for peri-implantitis. Periodontitis is a risk factor for peri-implantitis. It appears that the existing oral pathogens have already demonstrated their ability to overcome the resistence of the host in these circumstances. Extract, graft and retreat. Also suggest a smoking cessation program to enhance host resistence and chances of success.

Remove and graft. It is failing with bone loss by threads. Why put healing collars on at time of surgery!!! Then the patient will chew on it (no matter how careful) One does not put force on two boards just glued. Wait!! The uncovering procedure is like 5 minutes. And the prosthetics two weeks later.

When placing implants on patients who smoke, I always do it in two stages.

Patients who smoke I recommend two stages implantation, insertion first, healing abutment second, no matter primary stability

Implant appears to be failing. Remove, graft and ask the patient to stop smoking (which I am sure you have done).

What about grafting in heavy smoker? I can imagine that heavy means 2 packs a day for example, not 2 cigarettes. Will that graft remodel into host bone without blood supply? You guys says that smoking doesn't matter? What does then? I think everything. One can be lucky and have succes in smokers the other will fail. It's not a game, we can't leave the healing process just to our and patients luck. I would ask him to give up smoking immediatelly or no treatment. You have tried already. Now don't try again but focus on minimalising all risk factors. I would explant it and start again with grafting 6 months after last patient's cigarette. Dont forget about vit D supplementation, check LDL and blood morphology.

I am going to speak plainly. Alot of judgement errors in the history to learn from. At placement leaving it exposed in a smoker, seeing with bone loss at 21 days then restoring at 45 days now a failing implant is being chased. Very expensive route. Now it needs to be removed. The key is case selection in a smoker leave the implant buried, check at 7-10 days for soft tissue response gives you a clue on tissue health and response. Then at 6-8 weeks X-ray will show if ossteointegration progressing or not. This is the biology going from mechanical stability to osseous stability. This is surgical response vs quick restoration. It is understanding how things heal. Get him on a patch while healing. Hopefully you will learn now you will eat the expense, surgical and restorative. The cheese stands alone without teamwork with an experienced surgeon. Implant business hopefully it was worth the implant fee. Implants are not a salm dunk no matter what is posted here, just saying from honest experience hope your ego can take it.