Implant too close to adjacent tooth: how best to proceed?

Dear colleague my recommendation is take out the implant ASAP for healing and recovery, because the adjacent bone tooth is gone and lost. I saw in the picture that you had Intraoral Sensor. I recommend to you when you place an implant use the paralleling pin a take an RX and you can see the trajectory of your preparation. Like this way you can place the implant in Right and safe position. Good luck! Dr. Richard Rodriguez Caracas-Venezuela

Very good advice, it will be simple to remove since it is not osteo integrated . Also use a smaller diameter and line it up with the molar, this implant may not be restorable it is too wide in relation to the adjacent crowns. Also as Dr Rodriguez note there will be periodontal issues, I would place a bone graft let it heal 12-16 weeks then replace. Single tooth implants are not as easy as they look and an intra operative film is helpful. Even though implants can be profitable one needs to place them correctly, it's part of an implant practice to correct this and you'll sleep better at night! Thanks for reading!

As you know, a PA does not always show the true relationship between teeth or implants do to angulation of the cone. I would recommend having a cone beam(3D) image taken to verify there is really a problem. This image will be the true answer as to whether you need to remove it or not. Good Luck, Dr Yates

I'm assuming he can take a pa from the proper angle. Yeah, there isn't enough bone between the premolar and implant. You risk losing the thin interproximal bone you have. You could go from trying to replace one tooth to a failed implant and a compromised premolar. Take it out. Take x-ray of your pilot bur when placing so you can still correct.

I agree we dr Yates. Take a cone beam or separate the implant from the 1st premolars with another X-ray. Confirm you are too close before removing.

How much did you angulate the implant palatinally?? That dimension isn´t of course viewable on x-ray. Your x-ray has been taken from an mesio-excentric angle (look at the molar roots) why I recommend you to shot a new x-ray before panicking. Concercn of course is that first premolar normally has a palatinal root, which reduces the change that your implant didn´t get too close (contact) if it was palatinally angulated. Regards

The implant is not parallel with the adjacent tooth roots which makes me believe that it is too close to the premolar. You can also look at the healing head clinically and tell if it is too close. I think it is too wide and will get caught in the undercuts of the molar and premolar crowns. You don't need to expose a patient to CT radiation for something this obvious, just fix it.

I don't want to sound like a jerk, and I know that you may just be learning to place implants, but you should not have to ask people on a message board if this outcome is ok or not. It is too close to the natural tooth, the wrong angle, and the restorative space looks tight. Do you not believe in taking radiographs to ensure that you are in the correct orientation? Would you be happy with these results if it were in your body? The patient, who is putting his or her faith in you to do a good job, deserves better than this outcome. In the end, this will result in bone loss, chronic inflammation, and poor esthetics. No amount of radiation from PA's or CBCT will change the orientation of this implant. Sorry if I am being harsh, but as a general dentist that has invested time effort in developing surgical skills and who enjoys doing implant procedures, I take it personal when I see cases like this. There are very strong opinions from different specialist that GP's should not be doing these procedures and this is an example of why. It's ok if the outcome is not perfect, but if it needs to be changed then take responsibility and fix it.

always make a surgical guide no matter how SLAM DUNK the case is, just one less thing to think about

You will hv to take the implant out. Say a cbct shows there is half a mill gap between n hope that won't damage the adj tooth, then what? How to restore it? With a heavy cant crown? Just do the right thing, told what happened to the pt, everyone learns from mistakes. Only thing is learn for sure from this mistake. Take orientation PAs, go slow. Finishing off an implant in 15 min won't make you a superman. Doing a good job will. Best of luck.

just one PA in one angle can not tell u the whole story, specially in the cornerstone of the arch.! You may or may not be too close to the premolar. I do NOT say u necessarily need a CBCT, but if u ended up taking one, then a 360 degree survey function on an anatomage software can tell u more if u have adequate cushion of bone around this implant. As a periodontist / Oral Surgeon of 18 yrs , I have placed more than 4500 implant and I have seen enough not to panic unless the clinical assessments match the radiographic observations. By just looking at this mis-angled PA, the restorative space, and restorability issues would not be THAT much different if u take it out and in ur next attempt place it in proper ANGLE only half a mm. more distally!!.. So , although I ABSOLUTELY agree with what our GP colleague (Dr. "B" ) says regarding our due responsibility to EVERY patient, but I would like to gather more info, ..so, take couple of new PA's first.. examine the pt.'s report and sensation on the premolar tooth (pain, percussion, sensitivity, mobility...) , and then make the decision based on ALL those information. It would be nice to report / post those new PA's and clinical issues REGARDING THE #12 responses for ALL of us to learn more here.., as I believe this should be the purpose of this blog. thanks for sharing, and reading.

Could u PLEASE post a pa from medial angulation. Lot of people will learn from it. I think the poster should be involved in the dialogue. I don't know where these posters disappear after posting the case.

In reading these posts I gain insight good and bad, and it is very difficult to bare ones mistakes. It also takes a lot if character to respond to these posts. I enjoy the experienced advice from non defensive folks who can understand and accept constructive criticism vs bravado. This particular case is not the end if the world to start over it only costs another 12-16weeks if that,in the life of a twenty year implant. It seems that some posters loathe that and prefer to pontificate on how wonderful they are as implantologists vs just working the problem. I am encouraged that many of the GPS do show wise judgement and skill, I always defer and respect their restorative skill and hope that they will accept my level of experience and in surgery, I think secretly they do and don't take it personally.No amount of degrees or training can be a substitute in my mind for continuous improvement and doing the best for our patients vs our egos. It is good to play nice in the sandbox but every once in a while I may give an unpopular opinion, it is just that an opinion. I am learning from my wiser colleagues to be more tactful but it is fun to see the passion in these posts! Thanks as always for reading!