Is this implant restorable?

If it is freshly placed, I would simply remove and prepare a deeper osteotomy and insert a new one. Provided that there is safe distance from the IAN and that it is not perfing to the lingual.Easy to fix now . more complicated after you made a crown.

Implant was placed 6-7 weeks ago according to the patient

Take it out it will be easier than other solutions , will integrated already ( Sasaki et al Jomi 2008 ) so will need Neobiotech to reverse out ... Peter

Where would I find these kits?

That implant looks too shallow to me. If it's not integrated yet, I'd advice replacing it.

You could restore the implant but it would be best to remove and drill a little deeper. There is ample vertical bone. The threads may irritate the gingival . One could prep back the threads and place an abutment . Restore with a cemented crown that has a finish line on the prepped threads.

Absolutely agree with these great posts very very informative! Fortunately you are in the "golden time" (I made up the term) to remove 6 weeks is sort of a rule if thumb for the start of osteo integration. By replacing more in the middle you can prevent a cantilever. Good Luck!

The implant is not placed deep enough and will create a problem developing any emergence profile add to this the implant design calls for a placement level with the crest or slightly above it this will lead to a long term problem. Best to remove and place an implant at the proper depth.

The real question is why in the world you would even try to restore it? Loose the fixture (I use the Neobiotech) place a new one and restore when its suitable to. Cheers Alex

depends on the esthetics,yes it could be restored

If it is integrated I would restore it but I would make sure the patient is advised and acknowledged in writing that this does not have the best prognosis. If it fails you can replace it then. I would also try to smooth out the threads above the bone.

This reeks of insecurity. This guy shouldn't be placing implants if he is scared. I agree . Take it out and place an appropriate fixture, unless it is integrated. If you aren't getting scans on these cases, you and your patient are going to get burned. Bv

It is restorable. However, if you wish to remove the implant, this is the best time to do it. You should be able to just unscrew it. It looks like the implant was placed into the mesial root space. Would have been better to graft and place after a few months. No wonder it is placed shallow. Weigh the pros and cons and explain to the patient before going in.

what's the crown to root ratio? it looks like those teeth are short, stubby crowns....if you grind the exposed threads and drop the margin on to the implant body and leave it in lite occlusion, it should work.....provided there's enough vert. height for the abutment. what's opposing it...a full plate or a porcelain bridge or a single tooth?

Hello I think that restoring it as it is will further lead to crestal bone loss. So it should be replaced with a new implant with proper placement level. Thanks and have a nice day.....

If it was placed around 6 weeks ago then it should be fairly easy to remove, just reverse it out, I would not jump to buying a removal kit without first trying to simply back it out, if it is an internal hex then its probably a Nobel clone so if you have a nobel or 3i implant inertion tool try that and apply counter clockwise pressure by gripping it with artery forceps.

If the dentist who placed the implant is a local doctor I suggest that you involve that dentist in this process. At the least determine why this patient is requesting that you do the restoration instead of the doctor who placed the implant. Perhaps the surgeon will remove and replace this implant without additional cost to the patient. Removal and replacement in an ideal position will result in a better looking restoration. This implant is restorable, it will not be an ideal restoration but it will work.

A scan is not required for this case. Simple PAs or Pano is sufficient for diagnosis and treatment. This could of been taken care of at the time of surgery. One can take simple yet fairly accurate measurements with 5mm ball bearings and a PA. The use of drill stoppers will give one depth control.

Yaron ...... regardless what has been stated research shows that it will be integrated , but these kits make for very easy removal I suspect you will need 100- 150 NcM reverse torque to get this out . I had one removal where the bone was down to the last 2 threads through PI loss and it required 400 Ncm ......... possibly due to the re-moddellling and stress forces leading to a denser surrounding bone . Regards Peter

Hi Yaron , Again as always depends what you are comfortable with , my standard protocol for lower first moral IMplants , is to split the roots remove , leave 3 weeks for soft tissue closure then place the Implant into the inter radicular bone and graft both root sockets adjacent with a fully bio-absorbable synthetic material........ but after hundreds it gets easier ( Yes CRS like Golf ! or maybe not ) so the key to placing at removal if you are comfortable with more difficult placement. Maybe best to leave to heal or even graft the site . Yes you could restore but there will be issues later Good luck you will be great . Peter

I do agree with removal, letting heal and replacing deeper and in the centre of the space. However, one important thing to find out before proceeding is why the implant has been placed shallow in first attempt? One reason for such a placement could be that patient was feeling pain during implant placement despite receiving ample anaesthtics as block or even into the ossteotomy. This can be due to accessory branches of IAN or mental nerve present in the way. If that's the case, CT scan is recommended to carefully trace the nerve and be aware of it as you may need to have a shorter implant handy if you end up with the same problem during surgery.

To remove I can suggest to warm the implant to 50 degrees Celsius and remove it in two-three days without any kit and extreme torque.

Follow up to previous post. Used implant removal kit to torque out implant. Worked like a dream, I hardly had to use any force and it came out. Area grafted with irradiated cortico- cancellous bone chips. I will follow up with an image when I place the new implant in 4 months. Thanks again for all the comments and helpful advice.

Give your patient all the information on the compromise that has to be made in prognosis and esthetics and let HIM give the answer .

Looks like the implant was possibly placed immediately after extraction and as pointed out into the medial root of the 46. It also appears in the film that there is adequate room to go deeper vertically, based on the zone of safety rule. measured from the 47 to the 45. From a prosthetic point of view you are now dealing with a less than adequate platform to begin with. The implant is angled such that you are going to end up with a cantilever effect and you may see bone loos associated with that on the distal of the implant with time. one of the things we can't see in this film is how much vertical you have for restorative. As it appears, the implant is not seated to the crest and seems to be above the crest by several millimetres. This may compromise your restorative options. I think if this was in my mouth i would want it removed and placed in a better position, with prosthetically driven criteria. What would you do if this was in your mouth knowing what you know about an implants?