Management of a patient with malpositioned two-stage implant via immediate loading protocol: A case report

Successful implant rehabilitation in the anterior maxilla requires precise three-dimensional positioning to satisfy high esthetic and functional demands. Malpositioned implants can adversely affect prosthetic design, peri-implant tissue health, and long-term prognosis. This case report describes the management of a 24-year-old male patient who presented with a labially placed, unrestorable implant in the maxillary right central incisor region. The failed fixture was atraumatically removed using a reverse torque technique, ensuring preservation of the surrounding alveolar bone and soft tissues. Immediate implant placement was performed with three single-piece implants in sites 12, 11, and 21, followed by the delivery of provisional restorations to maintain gingival contour and esthetics during healing. After a three-month osseointegration period, definitive porcelain-fused-to-metal crowns were fabricated and cemented. At the one-year follow-up, both clinical and radiographic assessments revealed stable osseointegration, healthy peri-implant mucosa, and excellent esthetic harmony with adjacent teeth. This case demonstrates that immediate implant replacement with early loading can be a predictable and conservative approach for managing failed implants in esthetically demanding anterior regions.