Implant fixture too close to adjacent root: what should I do?
I placed a a 9.5 mm long implant in the maxillary 2nd molar region with an indirect sinus lift procedure. The adjacent 1st molar which had been endodontically treated showed periapical lesions on both the mesial and distal roots on initial examination . So re-treatment of the endodontic therapy was was performed. I placed the implant 3 weeks after. I placed the implant using a stent. But after placement the implant appeared to be too close to the distal root of 1st molar. What should I do at this point? I placed implant 1 week ago.
23 Comments on Implant fixture too close to adjacent root: what should I do?
New comments are currently closed for this post.
Jashiv
7/30/2016
1st image shows the final implant placement
2nd image was before the complete placement.
3rd image is preoperative. Before carrying out re-rct in the adjacent molar.
Carlos Boudet, DDS DICOI
7/31/2016
Hi Jashiv,
Placing an implant next to a tooth that has visible periapical pathology can lead to the implant failing.
Three weeks after endodontic therapy is not enough time to allow for healing of the endodontic therapy and resolution of the lesion, so you jumped the gun there.
Another thing I see is that you did not address the periodontal health of the patient before placing the implant.
Don't be so eager to place an implant (in the second molar region no less!) that you neglect to provide basic dental services for your patient. There appears to be calculus and cement on both of the adjacent molars.
As far as what you can do, you might get lucky and the implant may heal without any problems, so unless you want to improve the placement of the implant, I would leave it and supervise it's healing until it is ready for restoration.
Good luck!
jashiv
8/2/2016
Hello Carlos Boudet,
Thank you for your valuable inputs. I have a few questions:
1) There are more chances of the implant failing or the adjacent natural tooth in regards to the close proximity to the distal root?
2) when should i load the implant? the primary stability achieved was 35.
3) what is more likely to happen- a short term (pre loading) failure or a long term failure?
4) What would have been the ideal time to place the implant?
5) Does doing an apisectomy of distal root with bone grafting help in such cases??
thanks a lot.
jashiv
Keith Hollander, DDS, MAG
8/2/2016
good call on the surrounding environment
Vasant Ramlaggan, D.D.S.,
8/2/2016
I think you might be looking for long term failure. However, I've seen amazing healing too over time. It will for sure depend on loading, ensuring no extra cement on the crown, etc. Ensure ideal abutment shape.
It looks like you placed a NobelActive? I like that for this situation so I hope it works well for you.
Also, in my office, we have a yearly disinfecting program in place beyond scaling (use a laser, etc) to ensure reduction of bacterial count.
All the best!
jashiv
8/3/2016
Thank you for your inputs. can u also elaborate on the disinfection program?
Vasant Ramlaggan, D.D.S.,
8/3/2016
We used to use Periowave (solution and light). Now we simply use a diode laser. I currently have the NV Laser from Denmat which is portable and amazing!
VR
8/4/2016
Again, disinfection other than Oravital and Soft Tissue Management programs used in our office, is by NV diode laser.
Gregori M. Kurtzman, DDS,
8/2/2016
I would agree with Carlos implant placement was rushed and should have allowed time for radiographic evidence that the apical area had healed.
On another note the implant should have been more centered in the space (more mesial)
also the implant platform is almost at the level of the MD root tip
At this time I would consider explanting it, graft the area to fill in the implant site and raise the crest to its proper level and wait 2months before placing a new implant more mesial.
Jashiv
8/4/2016
Thank you.
Apart from explantation( as i would like to not do that ) any other suggestion/ advice ??
Bruce Smoler
11/13/2016
Of interesting note is the distortion of the PA films. Yes one does indeed seem that the platform of the implant is at the apical level of the DB root tip, but not the second PA film. Disceiving to say the least...
Bruce Smoler
11/13/2016
I am of the mindset to observe and track any untoward healing. There is a good possibility it will be fine and restored to clinically ok conditions. Good luck
Dr. Gerald Rudick
8/2/2016
There is some information missing in this case... we do not know the age of the patient, the sex, or the health issues.
Carlos Boudet made some good observations in that periodontal health is very important, and that hopefully the retreatment of the endodontics on the first molar will be successful.
Although, not ideally placed,if osseointegration takes place and the tissues are healthy, I think the restoration of this implant will not pose a problem; and I would not consider removing it.
jashiv
8/3/2016
50 year old female patient with no systemic ailment and otherwise good oral hygiene. are there more chances of adjacent root resorption or the implant failing?
Vasant Ramlaggan, D.D.S.,
8/3/2016
Bone density loss with aging can affect anything. Good general health follow up is important for that. Avoid heavy loading (or any loading at all) of the crown, especially in excursive movements.
Jashiv
8/4/2016
Yes will keep that in mind. Thank you
David Levitt
8/2/2016
If you do a mesio-buccal apoicoectomy you have solved the proximity issue. You can graft at the same time. Short of that, explant and try again.
Jashiv
8/4/2016
For now i am planning to wait and watch since patient also wants to do the same.
DrT
8/3/2016
Did you take any images of guide pins? I am just wondering how, even with a stent, your mesio-distal positioning was in error. Thank you
Jashiv
8/4/2016
I know!! I feel horrible. This is my 20 th implant placement . And this is the first time i have landed up doing something so terrible 😑
DrT
8/4/2016
Do you take any images during implant placement, to confirm positioning and direction??
Jashiv
8/5/2016
Yes i did. Tried to improve it. But limited mouth opening prevented me from changimg the angulation. But the final blow was when i was used the torque wrench . There was really soft bone in the lesion adjacent to distal root. So fixture just slid up there while giving the torqu.
I should have waied much longer before placing the implant. Should have let the adjacent lesion heal.
pierre
8/18/2016
remove implant asap,bonegraft if necessary.......ensure no pathology around mb root for 3months .....replace implant in ideal bone and position
