Implant touching adjacent natural root: treatment options?

I suggest ,after evaluating the cbct, to remove the implant . There's not a chance of apicoectomy without damaging the implant fixture. If your are right handed be carefull with implant placement in left mandibular region because there is a chance tilting the drill towards the mesial.This is a common beginners fault. Always take an X-ray with pilot drill in place to check angulation. Good luck.

I would do cbct and do rct regardless. Based on your comfort level with patient , you csn inform the patient and monitor. Otherwise explant.

I am very sorry, but if you saw this happened, why you didn't removed this implant at that time. This implant definitely must be removed, and tooth possibly will need root canal. You don't need CBCT for that. We all can see that this implant not properly placed. Second: if you keep it, then you will have difficulty restoring this implant, even if you use custom abutment. You not going to achieve normal gingiva between natural tooth and implant, you will have gingival recession on #22 ( there is no space) 1. remove implant 2. Rct # 22 ( check vitality first) 3. Take a pan ( I think you have enough space) 3. re-install implant in 2-3 month

Refer to an endodontist and get an opinion and if rct is warranted, allow the specialist to do it at your own expense and peace of mind and also inform your defence organization hope this helps

Dear friend..It is recommended to have CBCT image as part of diagnostic steps prior to implant placement along with surgical stent to place the implant in the planned position. Removing the implant is warranted and of course endo therapy must be initiated for the damaged tooth.

I agree completely with Dr. Amayev . Good advice.

Obtain additional radiographs or get a cbct. If in contact with the root, consider removing the implant.

I have a case similar to this case i did it 4 month ago but in upper left first premolar touching the root of upper left canine i left it in place and did rct in canine but still the patient has tenderness in canine what are you expecting the worst scenario will be ??

Looks like a distal curve on the 4 which was a factor in the problem. It might be worth considering losing the 4 and placing another implant at the 4 site or carrying a second crown on the current implant. The reasoning is based on the the amount of distress involved in the options for solving the problem. Best of luck

why are you exposing patient for unnecessary X-ray? what is the benefit of getting CBCT? 1st of all you have to explain what happened to the patient and admit your mistake. You don't need to do anything else other than immediate removal of the badly and deeply placed Implant, Even if you will do R.C.T to the 1st premolar, you have to think about the future of this implant in case the R.C.T will fail. I would not advise to have an Implant close to a root filled tooth ever My opinion to this case 1) Implant removal + R.C.T to the 1st premolar. place an Implant away from the root filled tooth, use shorter Implant if necessary 2) Removal both the Implant and the 1 premolar. Do immediate placement in 1st premolar area and place another Implant in molar area then connect them by 3 units bridge

I agree with Dr. Amayev remove the implant endo the tooth wait to place new implant. This is a problem that could have been avoided by partial osteotomy with pilot drill place pin in hole and take rad to check that would have show the potential collision then redirect the implant osteotomy when you took the final rad and notices the contact the implant at that time should have been removed

I would minimally do rct on natural tooth and evaluate after healing. My bigger question is: if you needed to angle the implant, why didn't you angle it in the other direction. I agree with the other comments that it will be hard to restore and may ultimately need to be removed. Time to refer cases out to a Periodontist or OS!

I would inform the patient....and then do absolutely nothing. Unless of course the adjacent tooth becomes symptomatic, or you see radiographic evidence of a lesion developing. I don't think either will happen in this case. Remember that the body sees implants as inert. I suppose there is some minor chance of bacterial contamination with the initial osteotomy but in my experience thus rarely if ever happens. Good luck, keep us posted with the outcome of this case.

A per surgery CBCT would have identified all vital structures etc and would have helped you plan correctly and obtain a drill guide if needed to angle the implant correctly. I would remove the implant and endodontically treat the canine (socket preserve the site post implant removal). Discuss with the patient if they want further implants placed also if they want you to do the surgery and go from there. The patient may have lost confidence and at this point you need to 100% upfront with them and explain in laymans termas what has happened and what you will do to rectify. Did you tell the aptient at time of surgery that the impant was in contact with the canine and again if you could see it then why did you not (at least) back the implant out 3mm or until if was crestally placed which would have resolved the contact issue (not so much the restorative complications). make sure all your recorde etc and correct and properly documented

Just perform a good rct providing the tooth is non-vital.I think you wait 3-4 months and if no periapical pathosis is developing, restore the implant on a tilted abutment. If the implant was intalled under sterile conditions, then the tooth apex would not be infected and may eanen keep its vitality. See publication by Schmuncler-Moncler.

Explain the issue to the patient. Remove the implant and perpare the site for an immediate replacement the same day, or graft it and regroup with a stent after healing.. Redirect the osteotomy distally a little short of the length of the original as it is a little deep from the looks of the film. This position appears to still be "good" over the mental canal. If doing this the same day, and if you have B-L room, then use the next size implant for good primary stability. You can redirect the oseeotomy easily b/c this is medullary bone and lends itself to easy manipilation, a few turns of the implant burr should be all that you need. You can start the osteotomy after trimming the distal of the original cortical entry point with a lindemann burr so the implant is not so close to the bicuspid and is straight in the mandible Stents help early on in these cases. I would pulp test the bicuspid and look for signs of avitality/necrosis and treat accordingly after the implant correction.

Is the implant restorable? Take a periapical cone beam and see if it is touching the tooth. Know for sure before you tell the patient or you will look like a fool. If the tooth is touching the implant watch for symptoms prior to RCT. If restorable then restore the implant. This can just be an artifact on the periapical, sometimes diagnosed with a distal shift but a localized cone beam should be diagnostic. You can't tell if the implant is to the lingual not encroaching on the root. I had a film like this implant has been in 15 years without problem good luck!

I would have preferred doing root canal treatment for the adjacent tooth rather than removing the implant and replacing it.. it will save time and unnecessary complications.... goodluck

CRS... As the information regarding this case states, the patient IS symptomatic and therefore requires treatment on the natural tooth. I am amazed at the number of responses to this case that have not taken all of the given information into account!

Hi , in my opinion you should take out the implant , take x-ray after implant extraction to see if the apex is damaged , if so do endodontic treatment but your apex will be wider ( no need for apicetomy ) , its a must a CBCT to see more clearly what has happend .

Be ready, but i feel the end result will be implant loss and a RCT on the affect tooth. Been there!

Beside all the comments that each one has one key point and I enjoyed reading, your 2nd permolar implant position is not good enough for restoring with crown. you have a lot of space with next back tooth(as seen in your radiograph). you will get cantilever with crown and too much loading which is not in long axis direction. Also you could not get good emergence profile for your restoration. in addition to most comments because of these factors I mentioned is better to remove the implant and insert another new one, with proper size in the middle of mesiodistal edentulous space to get good emergence profile. Implant Dentistry is a prosthodontically Driven procedure with surgery components. Frist plan the restoration then make radoigraph stent and take CBCT, evaluate it and then make surgical stent and use it for better placement. “Fail to Plan = Plan to Fail” “Knowledge is NOT power Unless you use it in your Action” Thanks

“Fail to Plan = Plan to Fail” I have this on my desk. So true.

The problem should have been corrected at the time the implant was placed. Now even if the implant is removed, the prognosis of the tooth will not be improved. Having a second surgery in the area would not be advisable and will not get you out of the trouble unless you are determined to remove both the tooth and implant or at least remove the implant and devitalize the tooth. But there is the question of whether such an extensive reconsideration is really necessary. I would suggest that you inform your patient and if the implant is restorable and the patient asymptomatic, just wait. After a few months restore the case and follow up strictly. I have seen 2 patients with situations like this asking for consultation in my office and guess what, they perform beautifully for several years.

"The patient is now complaining of sensitivity to thermal changes, dull aching pain and is tender to percussion." This is not necessarily irreversible pulpitis. Take out the implant and give the natural tooth a chance to let the pulp/PDL calm down. Endo may still be needed, but it's not the first response. Remove the implant because it's not angled as well as it should be, but exercise extreme care in grafting the site so you don't make things worse. I'm sorry this happened to you, but its not the end of the world. You did have the patient sign a detailed informed consent that covers this type of scenario, right? Worse case scenario is you take out both the implant and the tooth, graft, let heal, and place two appropriately angled implants --- at your expense of course, as a courtesy to the patient. Good luck to you.

Oops. Just realized the date on this. Can we get an update from the OP as to how this turned out?