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There is constant postop pain. When the pain subsides, the abutment is found to be loose. Three weeks postop, the mobile implant is removed. The site is bone grafted as well as placement of collagen plug (Fig.4). Yellow dashed line: osteotomy after implant removal; red dashed line: the superior border of the Inferior Alveolar Canal.
Two months post implant removal, the socket appears to have healed and be ready for implant placement (5-6x7 mm IBS as lingual as possible, equi- or sub-crestal buccally, Fig.5). Pack allograft in the buccal crest prior to implant placement and simply apply bone graft over the coronal threads of the implant to repair buccal plate defect. B/L: the superior border of the buccal/lingual plates; pink: gingival thickness; yellow: differential distance of the buccal and lingual plates; green: implant; blue: the 7 mm long implant can be subcrestal (1.08 mm) with enough clearance (purple: 1.24 mm).
Xin Wei, DDS, PhD, MS 1st edition 06/18/2017, last revision 06/19/2017