Abutment is hitting adjacent tooth?

It seems you already know the answer. you cannot deliver it the way it is and IF the custom abutment can resolve the problem, then you cannot help going that route. But i can see failure of the adjacent tooth due to recurrent caries in the future. IF this case can be a screw retained, i would recommend you to use a UCLA Abutment and have it all made with adequate support for the porcelain, and also make it accessible to remove IF needed. in tight spaces like this, precise Virtual surgical planning and using an Accurate Surgical Guide to place the fixture exactly as planned can save you a lot of head ache and make the treatment more predictable and less costly. Good luck.

Well said, PerioProsth - perhaps an other option would be to modify the abutment in situ, so that there is sufficient clearance inter proximally, then take the impression.Then, cement crown, normally - leave the abutment in and do not take it out. It is difficult in any case.

The case appears not to have been planned with the restoration in mind. I have seen a well placed implant in the middle of the space function better than what you are going to need to do here. Your laboratory (or yourself if you can prep the abutment on a model) can reduce the flare of the emergence on the side of the central incisor as much as possible to try to save as much interproximal tissue as possible. In this situation, a wel chosen and properly prepared prefabricated abutment may work just as well as a custom abutment , although it is hard to say since you do not show an incisal view of the abutment. Good luck.

I think this case is salvageable......after a good impression is taken, and a model made with the lab analog in the proper position, it is very simple to take the plastic castable abutment, that will be screw retained, reduce the area that is impinging on the natural tooth and complete the wax up. This will be a screw retained casting to support the two incisers.

Unfortunately, your placement was off, it happens to the best of is, maybe next time guided. You have 2 options, replace fixture or multi angled abutment if your system supports that. Also. Inform patient that surgery wasn't optimal at this tight space and to have excellent oh regime to avoid issues with both implant a d tooth. All the best ST

There must have not been room buccolingually for a larger diameter implant to be more centrally located to support a two unit fixture. I think the above suggestions are solid, and think a customed cast screw retained fixture is certainly the way to go. Make sure it is hygienic. JM2C.

Crown the adjacent tooth for more room.

Problem is the implant was placed too close to the tooth, which is neither here nor there at this point. I would suggest due to the limited space to consider a screw retained crown. A custom abutment wont leave much space between the abutment and adjacent tooth for the crown. You can get by with less material total thickness with the screw retained crown option.

Custom abutment/crowns and perhaps some conservative enamel stripping on the adjacent teeth would probably suffice. Because of all the "off long axis" force created in this case, teeth should be kept out of hard occlusion, especially if this patient is a grinder. Also, I would explore placement of a 2nd mini implant ( 2.4mm-3.0mm ) to better support the prosthetics.

All the above comments are relevant and mostly applicable – except I would not suggest crowning the adjacent tooth to salvage the situation (I do not think that could be justified). Since the implant is already in position you might want to chance leaving it and hope the adjacent interprox bone is not lost. If you are willing to do this, then in reality the problem is a laboratory one. Ideally this should all be sorted in the lab and certainly a custom abutment would be the smart way to go. However given the lab has already constructed the bridge, I would suggest to the manager that they modify the existing respective crown so that the bridge fits. The obvious problem is that the diameter of the abutment is too wide – so if you construct a custom abutment then you would design it with a lesser diameter and emergence profile. So my suggestion would be that the lab reduces the interprox width of the abutment by grinding carefully and then polishing. They should NOT go anywhere near the fixture surface and it should be done under magnification – which any good lab should be able to do. Depending on the path of insertion of the bridge, you should screw it into place. I would not recommend cementing the bridge – you already have enough problems without adding excess cement to the issues. And really you need to be able to easily remove the bridge if there are later problems. Then review the bone height every 6 months for several years to ensure no pathology develops. One problem you may face is the interproximal gap between the crown and the adjacent tooth (it depends on the path of insertion). However it seems to me from the radiographs that you should be able to construct the bridge with no gap. Clearly this suggestion is not ideal but it offers you a way to move forward with minimal intervention – PROVIDED you inform the patient about the problem and emphasise it needs regular review (and ideally you would provide reviews at no charge).

possibly a custom abutment can provide a slight angle away from the adjacent tooth and use of a seating jig to confirm proper seating