Implant failure after apicectomy?

This healthy, non-smoking patient had his 46 (rct, apicectomy) removed by a maxillofacial surgeon. The tooth came out piecemeal, but healing was uneventful and the implant was placed 5 months later. It was torqued in at just under 30 Ncm, follow up at 1, 3 and 10 days had no pain, gingiva adapted and healed well at the 10 day follow up. This was a most straight forwardly executed case.

3 weeks after placement he presents with mild swelling and pain. The implant is not loose, there is no drainage or gingival recession.

The xray shows an apical area.

Upon looking back, I can see a denser area than the surrounding bone where the root apex used to be, as well as scattered white spots which I assume to be spread out retrograde filling. If the denser area is Condensing osteitis, could this be the cause? or is the scattered retrograde filling material the cause?

Or more importantly, can this be treated with antibiotics? And if not, when this implant is removed, how to avoid failure in the future: is proper curettage enough?

Manosteel comments:

This implant appears to be failing. I would take it out graft with allograft prp and overlay with prf membrane. Go back in 4-6 months and place another implant. Not really sure why it failed other than residual diseased tissue left behind?

10lan comments:

I think there might have been root fragment left in that x-ray, unless a more thorough debridement was done of the socket. If a piece of that root was left, it could cause latent infection. Just my $0.02

Delicate Olive comments:

No explanation really, it could be from the retrograde material. Best thing now is to remove it, curette the area very well and re graft it as you see fit. I would try to place the implant more mesially and try to engage native bone between the too roots.

Anjan shah comments:

If you look up the literature there are a lot of reported cases of apical periimplantitis- most are post endo extractions and all are with rough surface implants. Never seem to happen with machined surface