Sometimes efforts at saving an implant make things worse. This case showed signs of recession shortly after the final crown was placed. Tissue recedes when there is no bone to support it and getting it back can be extremely difficult. In this case, the site was grafted five times before the patient gave up and sought another opinion.
When the area was flapped there was no cortical bone on the facial of the implant and there was no choice but to remove the implant and start over. Without the pre-treatment records it is challenging to know what the site looked like prior to implant placement. The patient didn't know if any grafting was done at the time of surgery, but the implant was placed immediately.
The resulting defect after the implant was removed was significant and the patient really wanted an implant in the area. Gaining vertical bone height is usually done with either a block graft or a mesh with recombinant bone morphogenic protein or a combination of those techniques and other grafting materials.
The case has been grafted with rBMP, particulate bone and a titanium mesh. Hopefully, we will end up with enough bone to achieve an esthetic result.
The story here is that this most likely could have been avoided if the dentist had planned the case with a surgeon and used appropriate records beforehand. Rather, he placed the implant after a weekend course and then tried to save it using techniques that were doomed to failure.
We all have bad stuff out there; it happens to each of us. The lesson learned is that creating an interdisciplinary team mitigates the possibilities of these things happening.