Hi! I just placed a 4.2mmD x 10mm implant yesterday for number 30. Want to know if the implant will cause me an issue in the future or is the position acceptable. There was little to no primary stability. Bone was D4.
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You will end up with a large distal cantilever. This may create food impaction problems. That’s why a direction indicator x-Ray prior to placing your implant is recommended. Coupled with your poor bone quality, I would recommend removal and either placement of a new larger diameter implant and graft this defect or grafting and come back later. Without a CBCT it is hard to see the size implants available to you or if you require additional grafting. For a molar implant if you can place a wider diameter implant in the center of the space, your force factors and implant occlusion can be optimized.
I would agree with Ninjadds, The long term outcome is iffy. I have restored these before and they become headaches. A Wider implant centered will give a much better result.
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This is one that you’ll unfortunately have to eat.
it’ll be easy to explant --only been 48 hours
Bone loss around the neck of the implant, fracture of abutment hex or screw, is the future of this case : -(. if you have placed it - please redo it correctly
D4 bone was because it is in the socket & not in the septum - Hope this helps
I totally disagree with everything that others have posted. While this is far from perfect it has been my experience that imperfect stuff works and quite often it works better than anticipated while the so called perfect stuff gives problems. Notice that everyone likes to criticize but these critics never seem to post cases of their own. IMHO this fixture is just as likely to integrate as if it were perfectly placed and while the final contours of the restoration may be less than perfect I have seen many examples of much worse providing years of satisfactory function.
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What would be the big deal to simply remove and replace? In the future just remove it immediately and restart so that you do not have to bring the patient back.
Of course it will integrate as likely as one placed in the middle but that is not the point or your concern. It may even be successful in the long term. But, if it does fail it will become a long term problem for you and costly. I have wven removed implants and immediately re-implanted the same implant. Only twice so this is anecdotal
I agree I made the mistake of not positioning it right in the middle. But why most of you are with removing? Regarding the distal cantilever crown if I ask the lab to adjust the concavity underneath and removing part of the soft tissue in that area to svoid food impaction will that work?
I’ve certainly made this mistake. When I correct problems right away, I tend not to repeat them. The distal cantilever may be functionable, yet is it the quality of care you want to provide? When we evaluate our own work we are looking through the lens of our values and integrity.
Nobody has bothered to mention that this x-ray is clearly taken from an extreme distal angle so it is likely that the fixture is not as far off center as it appears. This does not address the issue of platform size but it does potentially make it slightly closer to ideal…
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If you’re, and the patient are ok with removing and reposition, this would be optimal. Otherwise, during uncovery maximize your tissue thickness to compensate for possible food impaction in the distal portion of the crown. Clinically, may look more centered than a radiograph too. Use a collagen matrix maybe during uncovery, APF or FGG.
Thanks you for having the courage to post this case as your sharing will benefit many others. We all perform at our best when we are doing something and we usually make course corrections if needed. My trigger to remove and replace is the comment that the implant was not stable upon insertion. I see intraseptal bone on the provided PA. It will be easy to remove this implant but first make a surgical guide to accurately nail the septum. You will go into the explant/ reimplant surgery with confidence that the implant will be placed where you planned presurgically. Bone graft will benefit the outcome.
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Could be to restore the implant. Ideally the tridimensional position of the implant would be more centered and wider diameter implant. Talk to the patien and make a final decision, remember a long time predictability of the crown and the implant in this case.
Can you restore this ? Probably. Should you ? Probably no. Replace by a larger and centered one would be my choice. And probably a Tissue Level implant. Why start with a compromise implant ? Thanks