Implant overload: do I need to worry?

I would have gone longer and centered the implant instead of using what appears to be the mesial socket. I think you answered your own question. However the emergence profile on the second molar crown looks pretty good, with a regular platform in a wide space I worry more about emergence profile and hygiene.

Make a bridge with the other implant and will be ok.

Should be fine. Just like a cantilevered bridge make sure there is no excursive contact on the mesial distal aspect and only light Icp on the long axis.

I concur with bogdann

No Problems here not ideal but fine , just make a bigger crown as to the effects of forces resultant from this off center and efffects on the bone read the research by Anitua Antigua of BTI Implants . Keep it simple there are many non-ideal situations , it will be fine Peter

An occlusion rest from the future restoration is desirable on the premolar crown.

Understanding concepts on bio-mechanics , the properties of TiAl V etc is important ,thinking about why we do things , splinting to another implant merely reduces the capacity of the implants stress riser to not cope the the forces effectively and can lead to co-axila forces on an adjacent Implant . Just restore it, the proerties of Ti in this situation will cope with the forces better alone ( yes I have read Mischs book but disagree here ). The main issue may in fact be something we cannot see and that is the soft tissue or lack of attached gingiva in this area . Peter

First remember that original implants were 3.75mm and a 4.1 platform with external hex in plain g4 titanium, and you know what? they worked ok in cases like this for years and years..... my mother has the exact case with a 3.75*11.5 shinny original branemark, installed as my first implant in 1993, the crown is still there, the implant is still there and where Im going with this rambling.... get good gingiva and have a correct occlusion and you will be more than fine, Implants today are much better so dont really need to worry. cheers Alex

You should have the crown replace the full distance from the 2nd premolar to 2nd molar, othewise you will end up with a food trap, and all the probelms associated with that. You can minimize occlusal load on the implant using the above mentioned suggestions, where the implant occlusion in centric will be light, with the natural teeth acting as stops, and no contact in lateral excursions. That said, eventual prosthetic failure is a possibility in this case, since the implant platform is narrow for the distance being replaced (a 5.0mm would have been a better choice), and the off axis load due to the current implant angulation. Splinting to the existing implant is an option, but then oral hygiene gets tricky.

This case needed to be waxed up and tx. Planned more thoroughly. I'm pretty certain you have more than 10mm of M-D space. One option may be, to place two narrow(3.25) fixtures and restore them with premolars. This advice is coming from a guy that doesn't restore implants, but I do provide fair advice at times. You've got to scan this patient, in my opinion. B Vinci

Baker and CRS have given good advice. I would wax up, make a guide. Graft the socket and revisit later with a longer and wider implant. Another option, M-D space permitted, place two 3.75 mm implants and restore with two bicuspid crowns but first graft and let turn over.