right side is the PA taken on the day of implant placement, early april this year, extraction socket without prior infection, 5*8.5mm fixture placed with primary stability 25ncm, grafted and customised HA made
4 months later the pa still shows radiolucency at apical 2/3 of the implant even though the implant is firm, when i torque the screw to 15ncm patient was ok, should this implant be loaded or removed???
I think it is fine and since you did not specify what type of graft you used I will assume it must have a large % of demineralized particles which will not demonstrate radiopacity for 6-12 months sometimes. While demineralized allograft does have some inherit benefits visibility on a recent radiograph is not one of them. I think it is fine and you are just seeing remodeling graft material.
If you used an allograft, I agree with the previous comment. I have been doing bone grafting since 1990. It has always been unpredictable, and when you get results like you got above, it makes you scratch your head. So I have been searching the literature and research for the last 2 years. What I am being led to is that there is a problem with allografts. The explanation is complicated. I have been talking to Dr. Greg Steiner, who has done a lot of the research in this. Go to his website, SteinerBio.com. There is a lot of information there that will, or should, peek your curiosity.
I would verify integration with an Ostell device. It’s an objective way to see what the ISQ value is(implant stability quotient).
Guys thanks for the reply
Yes I used cortico-cancellous mix (Raptos). My concern is that shouldn’t the socket has already remodeled to form bone around the implant (I.e the apical 2/3) regardless the area was grafted or not? Thank you very much everyone🙏🏻
Osstel good idea. But just based on the xray image it looks like the bone has healed at the level of the interproximal bone. I like to apply digital (finger) pressure at the gingival and see if there’s any suppuration. If not and there are no other complaints of discomfort from the pt you should be good. Nice custom temp healing abutment, Cerec? No mobility? You could leave the healing abut on for an additional month. Altho its hypo occlusion there are still forces on it. The Osstel might be a good investment.
The healing abutment was made of flowable
The gum looks ok, not much issue. Just worried the bone to implant contact is bad:(
Fibrous tissue encapsulation highly suspect looking at the 2 radiographs. It may “exfoliate” while doing impressions- I’d wait and explain suspicions if Osstel unavailable. If it was May mouth I wouldn’t continue just yet unles integration confirmed. 
I would not expect it to “exfoliate” while doing impressions as it has obviously survived multiple reps of inserting/removing a healing abutment without being removed. You mentioned that you put 15Ncm on the healing abutment and it was fine so I would suggest you either trust that or go ahead and put 30-35Ncm just to convince yourself but it is fine…
