Implant for missing lateral tooth with mesiodistal space: recommendations?

I treatment planned this patient for an implant supported crown on a 3.5×13 TBR implant fixture to replace a missing lateral incisor. The mesial distal space was 4.3mm. Please see the radiograph. I installed the implant without complications but is this implant too close to the roots of the adjacent teeth? I have had the patient evaluated by an orthodontist who can easily move the adjacent teeth away from the edentulous space to create an additional 2mm mesial distal space. What do you recommend for this case? remove the implant?

Implant view

6 Comments on Implant for missing lateral tooth with mesiodistal space: recommendations?

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Huw

8/21/2014

I always get the Orthodontist to set up the case with slightly divergent roots. 4.3 mm is very narrow and even with a 3mm implant placed perfectly you are going to be very near the roots. Not sure if the orthodontist can help you out by moving the teeth further apart but it seems logical.

peter Fairbairn

8/23/2014

Better rads would help , but a tight one all around , as a lateral a mini may have been a better solution ! but maybe a customized Zr abutment .. Peter

CRS

8/23/2014

If there is no damage to the adjacent teeth, the more pressing issue is the emergence profile. With that flat implant top can you platform switch in this esthetic area? What does the other lateral look like so that the root forms match. I can't say that a smaller 3.0 would be okay in a 4.3 space. I don't think this can be restored. Implant placement is restoratively driven surgery but you know that. It not do much the roots but the crestal emergence, a non tapered implant would be the way to go. But I must base my comments on one periapical. When the implant was placed was there a fixture mount? Sometimes that can help to see how the implant will be restored . Tipping the adjacent teeth may make the problem worse vs bodily movement to open the space. Time to do this would have been prior to implant placement. Now you have a restorative issue the adjacent roots appear to okay.

sb oms

8/26/2014

Your surgery is executed perfectly from what I can see from the poor quality x-ray. This is, however, a treatment planning disaster, and asking an orthodontist to try and move teeth now in not within the standard of care. Upper lateral incisor cases are the most challenging cases we treat. I will attempt to post a case showing what I feel is the proper implant shape, and lower limit of size. Stay tuned.

Dr Bob

8/27/2014

CRS, platform switch is a good suggestion to try. If it can not do the trick perhaps let the implant sleep in place and do a bonded bridge.

andrew

9/6/2014

I feel you have great skill to place an implant in that space without doing damage to the adjacent teeth !