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)
Implant Troubleshooting Advice by Dr. Sam Jain