I had implant placed 3 months ago (molar 36). After surgery implant was hidden below gums. Last week a healing cap was placed and I started to wonder if this placement is correct. Isn’t it too close to adjacent tooth and too close to buco lingual side? I’ve decided on implant after almost 15 years of missing tooth. Is my implant incorrectly placed? What are threats to failure of keeping it this way? Please advise.
it's nothing to brag about but it will work. much rather have it too far lingual than too far facial . too close to 29 yes but as long as 29 pulp tests ok then don't worry. This is a case where an angled stock abutment is pushed to the limits and a custom abutment will work. next time take more time. if you are right handed this should not have occurred as visibility allows placement freehand to within less than 1mm. next time do you test X-ray just barely into cortical bone to get your site selection and angulation. you were distracted and falling behind schedule when you did this because you weren't worried about the mental foramen you though it would be a slam dunk and it fooled you
The implant probably was placed in its lingualized position because of atrophy of the alveolar ridge at the expense of the buccal bone. Such bone loss is to be expected when the tooth has been missing for so many years. And yes, the implant is woefully too close to the premolar. These deficiencies will lead to all sorts of problems during and after when it comes to placing an abutment and crown. This implant should be removed, the ridge augmented, with later placement of an implant in the proper position. Or, a fixed bridge is a reasonable alternative if you don’t want to proceed with the above. Also, it is wise to use a surgical guide even when placing a single implant in a site such as this. This helps preclude sometimes unforeseen problems. (PS: #46 looks like it is need of attention.)
The implant was placed in the position that the gap for the crown allowed. Actually pretty accurate placement. The alternative would have been to prosthodontically or orthodontically upright the second molar, reduce the overeruption on the opposing tooth and then place the implant in the ideal position. A normal stock standard straight abutment will work, but your concern always will be food impaction to the distal and subsequent bone loss. Make sure good oral hygiene is followed and monitor this 6 monhly.
Greg Kammeyer comments:
Take some courses in guided bone regeneration. Look over the apposing teeth....looks like there could be decay. A 4.3mm x 8mm should keep you well away from the IAN.