Implants in compromised position: How do I restore this?

Due to the vertical and mesial cantilever on #3, I would splint and consider leaving a large mesial open contact of 3mm for easy cleansibility. Good luck with this one, thanks for posting.

#2 is not deep enough, and #3 appears to have no bone around the apical 2/3 of the fixture. I would remove, elevate the sinus, and redo just #3.

The radiograph does not show enough detail for an accurate assessment but I would think the #2 is not viable long term (and would seem difficult to restore in a reasonable occlusal plane). Whether you leave or remove it needs to be decided by you. In reality there is no functional requirement for #2 implant, so I would probably not be looking to replace it. #3 seems adequate but I cannot see enough detail to say whether there is enough bone support. You would need to decide this (presumably with a CT scan). If there is good support then you have a decision to make about restoration. Whether you leave a gap or not depends a little on what would suit the patient best. Certainly one large unit restoration will be hard to clean and as such not desirable. However, I think a cantilever crown and small pontic is worth considering, with special emphasis on the design to allow for easy maintenance.

Boy that's a tough one. If that came to me I would do as was already said and restore only the #3 implant. It would be very hard for the patient to maintain a two unit splint. I would have to see more but I might try a single crown built out to mesial to contact tooth 4. Def screw retained.

#2 is predominately not within bone crestally and I would explant it. Since no lower 2nd molar I would not replace the implant at #2. With regards #3 take a closed tray impression (with the angulation wont be able to do open tray) have a custom abutment made, insert it then take an impression to have the crown made.

Assuming it is stable just restore #3 and leave #2 as is. Other than the distance from the adjacent tooth #3 is not in bad angulation. There should be no problem with simply restoring #3 as is and leave #2 asleep.

I think this is a case that has not been planned the way any case should. If orthodontics is indicated, and it is, I would complete the orthodontic therapy before placing my implants unless they were needed for anchorage, and in this case they obviously were placed without a prosthetic plan in mind, and before the fixed appliance therapy was finished. Other things to consider are probable sinus pathology in the contralateral side to the implants, and endodontic therapy that probably needs retreatment in #30. As an exercise, you could restore the implant in the area of #3 with questionable long term prognosis, but the most distal implant appears unusable. Good luck.

I would leave #2 alone as is and restore #3 with a screw retained crown. Close mesial contact and teach the patient to floss under the crown like a pontic. Inform the patient the crown may come loose over time, which will require the screw to be replaced.

Need CBCT. But, if implants stable & integrated / healthy in whatever amount of bone it is in. With appropriate consent from patient. Use temporary abutments or angulated abutments - make screw retained crowns in PMMA / composite- like we did for transistional loading. I would prefer seperate crowns so that you know if any is failing. Then observe. This is less expensive & will not hit you back with malpractice.

Take them out ....

I think the short and wide implant has been inserted to get extra money from patient on the third molar tooth region. Because there is no wisdom tooth at the opposite side. The treatment plan should be: 1- Remove the short implant 2- Make a bridge between next implant and first molar tooth.

I completed my perio residency in 2007 and I trained along side with prosth residents. We were taught to manage complicated and/or compromised situations. Since that time my CE has been primarily annual perio meetings, journals, and topic specific lectures. I have noticed a trend, especially by those posting on this site, to remove and replace any implant deemed less than ideal. As I thumb through the multiple "throw away" journals I can't help but notice the advertisements by the implant manufacturers and the "training courses" they offer. I can only assume that they are driving this train and teaching profit through the remove and replace approach. In this particular case there appears, based on the information provided, to be very little compromise with the #3 fixture while the #1/#2 just needs to be left alone and put to sleep. The process of removing an otherwise stable implant is still a surgery with inherent risks. Maybe I am just too conservative but a simple approach would seem to satisfy the needs of this patient. I we take time to evaluate patients with implants in function, regardless of who placed the implants (us vs. another dentist), we will noticed a lot of well functioning compromised implants. I guess what I am proposing is to at least consider a simple approach and avoid over complicating manageable situations.

I agree to leave #2. When restoring #3 I agree w Dr Gerke: build a proper tooth contour with a small, non-occluding pontic. Was the original plan to place an implant at #31? Certainly there is not much bone to implant contact on #2 for that restorative plan.

proper placement of implant fixtures will bring success to the restorative crown. Improper placement of fixtures will certainly result in failure and complications once the restorative crowns will be done. Also If another implant dentist reviews this case , it would be hard to justify Do take them out... or send back to Doctor who placed them to deal with it