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Implant #12 too close to tooth#13?

Last Updated: Jun 12, 2015

I just installed an implant in #12 site [maxillary left first premolar; 24] between natural teeth in #13 and 11 sites in a 59-year old male patient. The platform of the implant appears to be about 1mm from #13. At 1 and 3-week follow up visits #13 had normal periodontal probing and normal responses to cold and lateral percussion. But when I percussed #13 in a vertical direction, it felt different but was not painful. Patient returned in another 3 weeks [6 weeks from implant installation] see radiograph below. I also got a CBVT scan which showed a bit more than 1mm space between the implant and #13. What do you recommend that I do? Should I explant the implant? Should I have the patient return every week for re-evaluation? My primary treatment plan was for a bridge but the patient wanted an implant instead. I had advised against the implant because of lack of mesiodistal space. I could attempt to convince him to accept the bridge.

![]case](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/06/case-e1434140713263.jpg)

4 Comments on Implant #12 too close to tooth#13?

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CRS

6/13/2015

Based on the X-ray I would advise removing the supra erupted middle tooth which has about 50% bone around it. It can be used to protect the implant while it is osteointegrating. The placement is not the issue, it is the prosthetic plan. You can let the patient know that #13 is the problem not the implant and future extraction will be necessary negotiate a price on the bridge since trying to place a crown here will be difficult and you'll be removing 13 in the future and then another implant will be needed. The patient will be happy about the savings. No harm in the surgery just difficult sales job, patient's don't dictate the treatment. Be very careful since you are playing catch up here, bottom line this is a non restorable tooth regardless of the implant placement. Learn from this since it is the patient's desires that put you in a corner now and removal of 13 would have been better at implant placement this there is some risk in removal next to an integrating / integrated implant. You worked very hard in this difficult but well placed implant but that middle tooth will be a problem in the future trust me. Good Luck.

DrT

6/16/2015

If you do not extract tooth #13, the periodontal disease on this tooth will compromise the periodontal status of the implants, especially the distal one. Extraction is strongly indicated and then a 3 unit fixed bridge.

andrew

6/17/2015

First of all, it is very difficult to accurately tell distance between implant and tooth from a periapical radiograph. It is dependant on the angulation you take it at. CRS, I do not quite understand why there would be a prosthetic issue? Implant is very well angulated down long axis of a future implant crown and I do not see an issue with restoring this implant (may have to thin down the impression coping a little narrower, but doable).

CRS

6/17/2015

Make life easier and more predictable remove tooth 13. There is not much bone around it and compromising the implant restoration to accommodate an "iffy" natural tooth may not be worth it. Or put in a temp and see what happens with the natural tooth I bet you a soda it won't be there long I see this often but it is not my call.

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