Implant surgery was performed one month back February 13, 2023 using surgical guide and flapless technique (due to lingual undercut) in lower left molar region(36) Healing abutment was placed (minimum height). Day 7 and day 14 evaluation was done- uneventful
Now post one month I saw a radiolucency surround the implant and mobility as well there was some suppuration. Planning to open the surgical flap to evaluate whether to debride and graft or explant. What is your opinion should I debride graft and place healing screw leave it for few months or explant and place new? If new then when? Attaching both xrays
You just experienced an implant failure and if you continue in this field you will see more. Just remove the implant and bring the patient back in 6 weeks to replace it. I would suggest that you lose the guided/flapless surgery charade and do conventional implant surgery as it affords a much better opportunity to visualize and evaluate the bone quality which in this case appears very dense and likely contributed to your problem. I can't imagine there will be any real need to graft at the time of removal. Don't go blaming the healing abutment, regardless of the height, as I can assure you a transmucossal attachment at the time of placement is no an issue.
Yes is this because of dense bone and heat generation high torque?
That is a possible explanation but in the end some times s#%t just happens and we need to be prepared to deal with it. Just remove it-wait 6-8 weeks-replace without the dog and pony show of a "Fully Guided" charade.
Implants can fail for a number of different reasons, some of which we don't know why. In your case ,best to explant and place collaplug and wait 4-6 months before going back in. Currette out the osteotomy before placing the collaplug, suture and then just be patient.
Having done this for nearly 20 years I do not agree with waiting 4-6 months. When dealing with a contained defect, which this is now just a glorified extraction socket, I have never found any value in waiting them out as if it were a lateral ridge augmentation which might very well take 4-6 months. Collaplug is a great idea but 6-8 weeks is plenty of time to wait before replacing.
Go for narrower implants without guided surgery and you will have more success .
"Without guided surgery" is correct. In my experience the term "Guided Surgery" is Greek for "I don't know how to perform surgery so I am going to just follow this plastic map"...