Sorry to come in late in this conversation. It appears to me that this edentulous space is larger mesio-distally than a single molar. By recentering the implant all you will be doing is creating plaque traps both mesially and distally. My solution would have been to place an additional implant in the mesial portion of the space, and restore with 2 premolars, instead of a single oversized molar. What is clear to me is the patient is missing both #14 and 15. In treatment planning, one must correctly identify the defect you are dealing with an plan accordingly.
1 Like
Thank you for your reply!Agree with you Dr Misiek. Space is 12 mm . Too wide for one crown and too small for 2 .
We all do mistakes, thanks for sharing yours.
Your patient would appreciate an open and clear discussion on the risks associated in keeping this implant. Explant, bone graft, and guided surgery for the second placement. The other option is to explant, bone graft, refund the patient out of goodwill, and refer out.
1 Like
Hey Daleā¦you were my attending at LSU/VA in 1991ā¦I think the very first thing to have done here is a waxup and models to determine the final occlusion with the opposing arch. Then, virtually place implants with virtual crowns to see what you getā¦then decide on any simultaneous placement and grafting as needed for an ideal occlusion. Second stage uncovering and HC placement followed by 4 weeks then custom abutments and crown fabrication by the restorative doc. Thoughts? Scott Avoid Titanicsā¦ 
1 Like
also good Versah case
Hi Dr Noren ! Thanks for your reply. Space between those 2 teeth is 12 mm . If I place 1 implant then crown will be too wide . If I place 2 implants not enough room . Lets say I use 4 mm implant then 1.5 mm + 4 mm+ 3 mm+ 4 mm + 1.5 mm ( minimum 14 mm space needed for 2 implants) . I am referring this patient out but just want to know what could be done to properly restore ? Thanks
Ideally ortho would be done prior to implant placement but in the real world of compromised dentistry a single implant placed mesial, rather than distal, to the concavity and leave a 1/4-1/2 tooth space on the distalā¦
1 Like
Thanks for your reply!
or you can place some compost on either side to close the space. really not a big deal. ideal is 10mm. but iāve made molars smaller than 10mm and made molars bigger than 10mm. really not an issue. but you do want to place the implant in the middle of the space. like i said. i would have placed implant and did a veneer graft w/ membrane. even if the implant facially was slightly outside of bone. your veneer graft would have been fine.
1 Like