Hi guys placed an implant too close natural tooth. What should I do next ? I had to place implant that far distal because centre had very thin bone . I think my case selection was wrong. Uploading cbct and pa . Any help is appreciated. Thanks
Pa of same area
Prosthetic will be compromised and food trap on the mesial. Also add mechanical stress on the platform with risk of fracture. Better graft before then place in best position.
You might want to consider extracting the molar and the second premolar and doing an implant supported bridge. Not sure of the premolar site as need pa to assess but the molar has 50 % bone loss and an unfavourable root structure.
Thanks for your reply. Do you think the tooth distal to it will be damaged especially the pdl?
No the tooth / pal is fine, no damage. There have been studies on implants close to teeth extraction not necessary
To me the answer is Would YOU want this in your mouth? I know for me the answer is NO!!
When was the implant placed? It is too close to the adjacent tooth. If it is fresh, removal will be easy and minimally traumatic. While you are grafting the osteotomy, add to the labial bone to the mesial so you can achieve better position.
Versah expansion technique might help you expand the lavishly plate mesially when placing new implant
It was placed yesterday
Implant will work, but as Dr_Dentiste said the prosthetics will be compromised, and as drtoast151 said, would you want this in your mouth? I would take the implant out IMHO. This is why I place the majority of my implants guided, to have a clear treatment plan for the surgery and to execute it predictably. Based on your imaging it looks like you could have easily have placed this implant in the most ideal, prosthetically driven position. Yes, you may have thin buccal bone, but you just do a contour graft and maybe even a connective tissue graft on the buccal also. If you are not comfortable with these techniques then I would suggest to get trained in them, because it will make you a much better surgeon. I would remove the implant, place one in the ideal prosthetic position, graft the explanted site and contour graft the buccal. Full view of CBCT and more info is obviously needed for what I would do definitively(such as type and size of implant, torque achieved, is this one stage or two stage placement, etc), but this is what my goal would be. If implant can’t go back in immediately then do all the grafting and go back in later. Obviously there are patient considerations you have to deal with also.
Dr. Acosta is spot on. Grow the bone. Gone are the days of placing implants only where existing bone is. Get proper training in treatment planning and plan your cases for long term success. Taking out a healthy tooth because of your errant placement is not a solution in my opinion. Losing a tooth to protect your implants, losing a PDL, having an implant or implants as terminal abutments means further compromise. Go to the AAID, Implant Pathway, Osteogenics seminars etc. Learn to plan first than grow bone and then place implants with long term successful outcomes. What was your plan for the huge mesial cantilever and force magnifier??
from the CT perhaps you were worried about the buccal concavity and avoided the proper position. Although you dont have the ideal alveolar ridge dimensions. i think its borderline and you can still use a 4-4.7mm diameter
implant. but i think you could have placed an implant w/ a cover screw and performed a veneer graft on the buccal w/ xeno/allo combo and placed a membrane. score the periosteum to advance the flap for tensionless closure. I think you can still have the patient return for treatment. Remove the implant. osteotomy the correct position, which is middle of the alveolar ridge between #13, 15. place the same implant which you removed and perform a veneer graft (make sure you do a big flap with vertical release a tooth mesial and distal) and graft the previous osteotomy and leave it for 6 months. and return for 2nd stage and restore the implant. good luck
You will have to bite the bullet on this one and explant it, wait ,and then redo it.
I had the exact same thing happen to me…
Your patient will be eternally grateful to you for doing it over properly
In addition to the perio condition of #15, what opposes this tooth #15. It may be considered toward Extr.
we are all human and make mistakes. although society put us on a higher platform. when we do make mistake. most important is to explain to pt and correct the problem. I hate it when my implants fail or restoration fail. sometimes it really is not my fault. but sometimes it is. You posting this and asking for advice shows your integrity and willingness to improve and learn.
Actually removed the implant t. Good learning experience. Thanks for your help
so did you GBR? what you do after you removed?
Removed it and packed with bone . Also the buccal defect in centre I placed bone graft and covered it with membrane
Kudos on you!! You’ll sleep well tonight !!!
Now wait 9 months before you go back in
Thanks for the great case! We decided to do a look up of the research on this topic using our AI and created a separate topic for that here: Discuss Implants Too Close To Tooth Research
