Implant is too close to neighboring tooth?

Today I placed implants, and one of them (position of 20) seems quite close to 21. Before going to the surgery I planed with CT(from X-ray center), where and how to put. But right after the surgery, I could only take PA, because there is no CT in the clinic where I placed the implants. I could take at least small x ray between 20 and 21 to make sure... but yeah, I missed it. After seeing the PA, I assumed that there is at least 1.5 mm distance between 21 and 20's implant. But hours to hour, I am pondering whether they are in contact or not. I hope there won't be any symptoms, but if there will be, I would consider explanting asap. Thoughts? Thanks in advance for your opinions.

drgilani comments:

Do nothing on 35. It's OK. I am worried about 37 though.

JEASEUNG Kim comments:

36(with severel mesial periapical lesion + broken crown) has been extracted cleanly with dissection and I drilled distally from distal alveolar socket of 36, to place implant in 37 position. During drilling, the drill has been tilted to the distal socket direction and perforated. So I corrected the path and placed the implant vertically, put bone graft material into the perforated socket, membrane on top of it.

JEASEUNG Kim comments:

Thanks for your opinion about 35.

Joy comments:

Leave it. Its close to the tooth. But you wont have a problem.

JEASEUNG Kim comments:

Thanks for the opinion!

DMazza comments:

Based on literature, to avoid interproximal bone loss, 2mm distance is necessary between implant and adjacent tooth. My recommendation is to remove the implant and place it 2mm away from #21.

JEASEUNG Kim comments:

Thanks for the opinion

Neil Zachs comments:

It is close...probabaly a bit too close but at this point I would leave it. The bone around the other implant however does not look great.

As a note, and for the life of me I don’t understand why everyone doesn’t take a guide pin film after their first pilot drill. If a guide pin film was taken, this proximity issue could have been avoided. After the pilot drill, re-direction or even re-starting the prep in a different location is possible. It is a simple and easy way to avoid angulation problems as well as position issues. Live and learn.

Neil Zachs
Periodontist, Scottsdale AZ

JEASEUNG Kim comments:

Yes, I was thinking exactly about guide pin film. Thank you for the opinion.

Tim comments:

You may not have a papilla between 20-21 but I can't imagine that being a problem. You and the patient will be fine, don't sacrifice any sleep over this one. As a practicing periodontist I was trained to "perform" surgery rather than "plan" surgery with a software package and it is reasons like this that I still think it to be a superior method. My assumption is that if you were actually performing rather than digitally planning this surgery you would have instinctively placed it in a more ideal position. Don't worry though this is fine.

JEASEUNG Kim comments:

Thanks for your opinion!

perio D comments:

I agree with Neil Zachs and Tim. Leave it alone, its close but doesn't touch #21. Always use a guide post/x-ray after the first drill size at partial depth. Its easy to be off angle a little even when you have placed thousands of "free hand" implants, but it is easily correctable if you find out its off after the first drill. My experience with guided surgery is the same, extremely easy to end up at a slightly different angle that expected, so use the guide pin with these surgeries too.

JEASEUNG Kim comments:

Thanks for your opinion!

Dveneman1 comments:

You probably have slightly more bone between implant and 21, in my experience panoramic radiograghs give more overlap between teeth, a simple digital PA may validate this for you.