Implant position tilted too lingually. Remove, or restore?

your thoughts on implant positioning and restoration?

Hi. Thanks for your post.
In terms of the one slice you are showing: assuming there is no posterior crossbite, and that the implant is deep enough to develop a proper buccal emergence profile, and that the peri-implant soft tissue is thick enough, and that the lingual thickness of the crown will not impinge on the tongue space…this positioning is acceptable since the center of the implant is headed towards the functional palatal cusp (albeit slightly palatal) of the opposing tooth. I am being somewhat sarcastic on purpose just to make the point that there are so many factors to consider when determining “restorability”.
I think it is hard to judge this solely off one one CT slice or even off of just a CT scan. An intra-oral view with the adjacent teeth and opposing arch is necessary in order to answer this question with confidence. There are times when I could swear that clinically the positioning and the inclination of the implant is “ideal” and then on a post-op CT scan it looks different and more questionable.

Hey dr, sorry for a lack of info. No crossbite, mesiodistally implant position is fine, vertically as well, this is bone level implant. As for the soft tissues they are on the thinner side, so I plan to augment soft tissues once healing abutment will be placed. Overall, the only iffy question i had is that implant could have been placed not as tilted, although technically it seems to face palatal cusp of the antagonist.

Overall, thank you for your answer and your input on this community and all the content shared. Thank you so much!

Out of curiosity, did you place the implant or did someone else?

Other doctor did the surgery

I would tell him good job and restore :slight_smile:

When I was a perio resident 20 years ago we had to fabricate analog guides for all of our implant cases using only 2d radiographs and a stone dodel. We would go so far as to use a surveyor and would upright these fixtures too much as we would get fixated with optics and ignore anatomy. This fixture appears to be ideally placed as the angulation of lower molars is 20-30 degrees to the lingual…