One complication in implant dentistry is the implant periapical lesion. This case report describes a 30-year-old man who after an injury was treated with a single implant that caused a fistula that appeared four months after the implant installation. Proper pharmaceutical intervention was not successful. The fistula did not disappear until the apical part of the implant together with granulomatous tissue was surgically removed. It is concluded that an extended period of pain after implant installation might be an early indication that the treatment is not uneventful, that a fistula always should lead up to a fistulography, and that the condition can be successfully treated with surgery.