A new entity called "implant periapical lesion" has recently been described. This lesion could be the result of, for example, bone overheating, implant overloading, presence of a preexisting infection or residual root fragments and foreign bodies in the bone, contamination of the implant, or implant placement in an infected maxillary sinus. This case report describes a titanium implant that was placed in the maxillary premolar region. A fenestration involving the middle portion of the implant was present. After 7 months, the apical portion of the implant showed radiolucency. This lesion rapidly increased in size and a vestibular fistula appeared. A systemic course of antibiotics was not successful, and the implant was then removed. The histologic examination showed the presence of necrotic bone inside the antirotational hole of the implant. The etiology of the implant failure in this instance could possibly be related to bone overheating associated with an excessive tightening of the implant and compression of the bone chips inside the apical hole, producing subsequent necrosis.