Implant Placed Too Close to the Natural Tooth: What Will Happen?

Answering Dr. OB question: Who has the real truth about dental implants. In my experience, nature is going to give you the answer. I have placed many implants, never so close to a natural tooth, and I have had 5% failures but when the implant is not placed properly, leave it, have the patient examined frequently and the patient´s system and nature will give you the right answer. Don´t run before you begin to walk¡

Dear Dr.Ob What is the fundamental of implatology states to place and implant? You need studies cast,clinical X-Ray,surgiGuid,adequate bone,minimum 1.5 mm bone on labial aspect,1.5 mm bone on ligual aspect and 3mm between implant and implant or implant and adjacent teeth,so if you fail one of them,you will be in trouble,furthermore, your job woul NOT be an academic job.However, at this point,what do you need to do? 1-If you placed an implant VERTICALLY closed to adjacenttooth 0.5 mm

Sorry for disconected.Follow mention Dr.Vaziri 1-If you placed an implant VERTICALLY closed to adjacent tooth 0.5 mm,you have to removed an implant as soon as possible and grafted the sit with AlLOGRAFT(NOT easy graft) to enclosed an EXTERNAL root resorption in adjacent tooth in the future. 2-If you placed an implant OBLIQUE closed to apical 1/3 of adjacent tooth and adjacent tooth is NON-VITAL, it would be possible leave an implant and you do gently an EPIEOECTOMY retrograd filling on endodonticaly adjacent tooth to solved the problem. Good luck to you. Dr.VAZIR-Iran

I disagree completely with above comments. I have seen plenty of cases with implants very close to teeth with no problems. I place a lot of orthodontic implants (TAD's) and have inadvertently engaged cementum and had no issues. Yes you should check the vitality of the adjacent tooth, but by no means do anything now. Unless you really hacked the tooth with your drill it should be fine. Just keep it on your mental list of things to follow. However, realize that your papilla will not form in an ideal shape. It will be short, or maybe even non-existant. If this an esthetic case you will have trouble. You did not mention which tooth you replaced. This is why I keep telling beginners to take check films, 3-4 if necessary while placing implants. I have done thousands of these things and I still take at least two. Submit an x-ray with more info and you'll get better advice.

SB Oral Surgeon, I agree with you. I have had zero problems.

Dr. Hughes comments said it all. The odds of a problem are very low. Learn from the case and improve. We also take several intraoperative x-rays along with a simple easy surgical guide. A surgical guide will give you ideal placement for the restorative platform. The x-rays will be keep you in the straight and narrow from a mesial/distal angulation problem. Then just pay attention to buccal lingual principles of placement. We've all seen x-rays of implants very close to teeth and rarely do we see problems.

@ Dr Hughes: sir i had a similar issue - replacing 27 the surgeon placed the implant (nobel biocare groovy) very close to the mesial of 28. Was not able to engage the impression coping fully - but with difficulty the impression was made - can you please let me can we grind the impression coping a wee bit to make it fit easier? also thinking about gold adapt custom made abutment.. what is your thoughts?

After doing implants for 27 years and have seen all types of problems, do not remove the implant! I have had implants referred to me that have accomplished apico's on the next tooth, and no problems resulted. If you need a surgical guide to place a single implant, then just possibly you should not be placing implants?

I believe Dr OB did not maention anything about damaging the adjacent tooth/root structure. I agree that you can get away placing an implant too close to the adjacent tooth. The placement might not present a surgical or healing complication, but it will definitely be a prosthetic problem. A longer osseointegrating period, as you mention, will solve nothing. If you are willing to settle for a situation where there will be no interproximal papilla and where your best prosthetic effort will be a failure esthetically, then leave it. If you need a decent esthetic result, then consider removing the implant, grafting and returning months later for a second attempt at corect placement. Do not underestimate the importance of check films. Good luck!

leave it, it should be fine.

In regards to the question about grinding on an impression coping, I have had to do that many times. You need to make sure the coping is not touching any adjacent teeth or you'll get an inaccurate impression. Grind away until you can see space between the adjacent tooth and the impression coping. More than likely you'll need to make a custom abutment to retain the final restoration.

Dr. JL I am desagree with you.... Why not to use surgical guides for a single implant ? For begginers is the best way not to have this kind of problems. Not every one knows everything from the first step... In our friend´s case, he never sayd anything about the next tooth.... If the next tooth is ok, the problem that he may have is refered to the papilla formation and also with the impression and final restoration. As SB Oral surgeon sayd, if is it an aesthetic zone, you are gonna be in trouble....

In response to drjl. Doctor, I feel it serves no one to diminish the role of a surgical guide when doing a single tooth implant. I am a GP who has restored implants since 1985 and placed since 2000. I use a surgical guide on almost every case. It takes me 10-15 minutes to make one using Straumann SS sleeves and a Biostar. Why would I not want to use one? I recently took impressions on 3 maxillary implants placed by an outstanding oral surgeon. One of them was off about 30 degrees into the palate and came out during impressioning. We have a whole host of responses to these web comments about how cone beam scans are the 'standard of care'. Assuming that were the case, why is a surgical guide a lesser option than free handing as in the case of the oral surgeon mentioned? The goal of our treatment is to insure proper placement of the implants, not to toot our horns about how cool we are not to need ancillary aids. We need an absolute minimum of 1.0mm of facial bone, or we get die back of the buccal plate and esthetic compromises at best. As a GP I would not accept a lab that missed a margin by 1.0 mm. Why would I accept an implant placed by a specialist that missed placement by 1.0 mm to the facial? It integrated, they got paid and now I have a restorative compromise at best (started to say nightmare). We serve one another best by not belittling the extra steps taken by other practitioners to insure a successful outcome. Just because you think you can nail an apex every time doing endo doesn't mean you don't take intraoperative x-rays to verify length. What's the difference with implants? These posts often get too full of egos and forget the patients.

With respect to impressioning and abutments, read Mike Johnson's comments above. He is exactly correct. His impressioning technique should always be followed. And I began implants by always using stock abutments. My own learning curve has brought me to using 100% custom abutments now (Atlantis). I can take a round implant restorative platform and turn it into a rather square molar in a short distance. This helps patients not get such large food traps. And I nearly always order 'ideal' emergence profiles. If I have to cut to tissue to allow placement of the abutment, so be it. A little tenderness for a day or two vs. food entrapment for life? You decide what you would want for yourself. The largest molar implant is still way narrower M-D than a tooth. I'll do whatever it takes to get that distance filled in with metal and porcelain and not thin air. I feel emergence profile is a VERY big deal.

If adjacent tooth become tender or sesitive do endodontic treatment of the offending tooth, otherwise no problem relax.

just relax, wait for sometime , check vitality of the adjecent tooth, i am sure nothing will happen

Hello You don't need to remove the implant, just wait for osseointegration period and then check the implant also if needed you just need to do RCT of the adjacent tooth.......

I have had and seen about a half dozen implants in contact with natural tooth roots over the last 22 years. Even saw one recently where the adjacent root had been damaged along the apical half of the root. These have caused no problem with the natural tooth. Usually the problem is in prosthetically restoring the misaligned implant. That is all part of the challenges of implant dentistry. Don't sweat it.

I once placed a maxillary bicuspid implant a little too close to the cuspid - less than or equal to 1 mm of bone between them, and a portion of the crestal interproximal bone necrosed and sloughed. It left a defect in terms of the esthetics of the interdental papilla that proved ultimately to be acceptable to the patient - but it was a guy and he was not that concerned with it. In a woman, in an anterior region, this could have been a serious problem. Maybe you're not as close as you think since film angulation has something to do with it. I would wait it out and see. Also, I see nothing inappropriate about single tooth surgical guides, they are especially helpful in the second molar spots since it is difficult to get direct vision of that area during implant drilling.

I suggest waiting and see I also have placed impolants close to the root of many teeth deliberately at times and have not had any problem if I have not damaged the root. the biggest problem may be a restorative problem. If you cannot get an impression coping on the implant you will have to remove it and start over. I might suggest using a surgical guide system to avoit this problem one that is available is Guide rightBy DePlaque.com Using this type of guide allows one to determine where them osteotomy and implant will be placed prior to placing it. They now have a new device that allows one to pre-determine the placement in two dimentions if a cone beam X-ray machine is available. you make a template and evaluate it with a Peri apical radiograph and then change the angle of the guide sleeve in either buccao- lingual or mesio-distally by bending the guide post in two dimentions and remaking the template correctly .

Agree with the majority. Should not be an issue! Have seen it many times. However also as mentioned, it may be a restorative challenge if the implant is also that close to the adjacent tooth coronally. Good Luck

Sir, if you place your implant as close to the adjacent tooth that the distance between the threads and the root is about or less than 1mm, then, you have violated the borders of the adjacent tooth's periodontium.That is to say that a man made longitudinal bony pocket has been created, since ,the bone will never get formed between the threads of a fixture and the root of a neighboring tooth in such a short distance.It is mostly because of the space occupied by the periodontal fibers."Et vous-meme pouvez l'essayer pour decouvert de la verite.Merci.

Hi dear dr ; in my opinion is depend 2factors; 1;If u have been placed in esthatice zone;i am agree with dr vaziri and u have to remove it.,but if it is not in esthatice zone . ,if u think uwill not have any problem to get impression and adjacent tooth has not any problem with usual visit u can keep it And another important factor is cantilivering distance and locatoin that u will create.

you should not worry . if you had a limited space mesiodistaly to insert the implant you should inform the patient that he may need root canal espesially if roots are not parallel.today i had a similar case. platform exactly in the middle but apically im 1mm close to apex

It will integrate just fine. Advise the patient about what may or may not be a problem down the road, ie. endo on the adjacent tooth, and make a note in the chart so that if it needs it down the road, the patient won't be surprised and feel that you are making an excuse. The challenge that you are facing is restoring it. Good luck and don't lose any sleep over it.Learn from this one so the next one will be better.

I agree with SB Oral Surgeon and Mikd Johnson completely. One other caveat. There is danger of compromise of the periodontal ligament due to the close proximity of the implant. This can lead to 3 possible outcomes. One: nothing happens. Two: damage to periodontal circulation and ultimately to apical circulation problems causing strangulation of the nerve and requiring endo. Three: stimulation of the Rests of Malassez in the PDL ultimately leading to cyst formation. Recommendation is still the same. Leave the implant, observe over time, follow Mike Johnson's suggestions re prosthetics, and MAKE SURE YOU LEAVE AN EMBRASURE SPACE IN THE CUSTOM POST AND FINAL CROWN PLACEMENT so that you do have a chance at forming a papilla.

dear doc I too believe that only time will tell the out come.If it is not in the aesthetic zone do not remove it.Surely making an impression will be a problem but it can be sorted out.taking an x ray with the starter drill would have solved the problem.guided implant specially single tooth is not only expensive but also involves radiation to the patient.I am sure making prosthetic stent & taking due precautions in future would be really good

Are you indicating that the implant is 0.5mm from the natural tooth? or that it is slightly closer then you would ideally like it to be? one needs at least 2mm between the natural tooth and fixture to be able to maintain bone between the two and also to be able to fit an impression coping on the fixture. If it has not been in that long I would suggest backing it out and graft the site and return in 2 months to place a new fixture in the proper position. This also is a good example of need for use of surgical stents.

Implants placed too close to each other three months ago ,went well but what is going to happen with supra construction ?