This is my first case I’ve posted, but I’ve used OsseoNews for awhile now and have learned so much from all of you, so thank you in advance.

I recently saw a patient last week for extraction #10 (left lateral incisor), with immediate placement of an implant. The extraction was atraumatic, five walls were visualized and accounted for after ext. I initiated my osteotomy palatal to the apex of the root concavity and advanced my drill sequence roughly 4mm past the apex of the extracted tooth. I then placed a Hiossen 3.5X13mm ETIII SA implant and achieved a torque value of 30-35Ncm. Due to achieving good primary stability, I decided at this point to immediately temporize the tooth with a screw retained, under contoured PEEK abutment. I adjusted the temporary to be completely out of direct occlusion as well as excursive movements. At this point I was pleased as well as the patient in that he got to leave with a tooth. Fast forward to 24 hour post op call, patient stated that he felt great, no pain, no bleeding and he even enjoyed dinner at… Outback steakhouse. Now I know I told him no less than five times that cannot under any circumstance bite on anything with this tooth. He stated that he bit down on a peppercorn and felt the implant move. He then stated that he simply pushed it back into position and everything has been fine. At this point, patient was told to come into the office as soon as he could. So, today officially 1 week post op, he comes in again stating that everything felt great, and as soon as I sit him back, I’m noticing that the implant is moving…

Short story long, I know I’m going to remove the implant however, I’m torn on whether to try and place a larger implant; temp with a flipper/essix, or just removing the implant, grafting come back in 4 months? Just wanted some input on what’s worked for anyone in the past and which of these treatment plans you would choose and why. Thanks again.

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