I would consider taking it out; angulation looks off, soft tissue looks extremely thin which will cause issues with the implant in the long run anyways. Explant, graft and do a sinus lift (vertical approach or lateral depending on bone at time of placement) and make sure you have 3 mm of vertical soft tissue height above the implant platform.

How did you check integration?

A lot of these cases come down to patient expectations and what the patient wants and is willing to do. Ideally I would remove the implant graft and replace. The patient is unwilling to have the implant removed. You could do the best to clean around it and graft and if you get 50% bone back or even less than that, but it’s cleaner it might be OK moving forward if everything else is stable. It’s really important to have an honest conversation and set expectations with the patient and then do one of the two options. If you have to remove the implant, even though it’s partially integrated if you have the implant that would be fine and if not, there’s other kits out there to remove implants. Typically, it’s not as difficult as it sounds