Implant very close to mesial root: long-term prognosis?

You need to remove it if it is less than 6 weeks (non-integrated) back it out and redo it in 8-12 weeks. You won't be able to restore it. What's the point of taking a post op film and not correcting the problem? Also you can place a narrower implant.

You may get away with the distance to the molar but possibly have difficulties restoring it given the narrow mesio distal space and angulation of the implant

This is as simple as 1-2-3. If it is not integrated remove it, place it in 0,9% sterile saline, curette untill blood comes out, redo the osteotomy and when placing the SAME implant give a bit of angulation so that the implant does not go to the previous site. You should do that by the surgery day. Hope the surgery was a few days ago. Let's not complicate easy stuff.

Dont worry. I recommend close observation, pa xray and clinical. If there were healthy periodontium before implantation. It will be osseointegerate without complication.

The standard of care is to back out the implant, place a socket graft, let it heal a few weeks. Return the implant ,get a replacement (the company lets you switch it out). Replace the implant probably narrower (measure your film) and replace it in a sterile manner. The implant surface will not be compromised. If you use the same implant it will no longer be sterile and the coating will not be pure. If you don't remove it you won't be able to restore it. You will violate the implant warrentee. If you try to re-drill in such a narrow space you'll drop into the same spot, doubtful getting primary stability. It happens, do the right thing for your patient.

the only challenging procedure i can see here is the prosthetic part of the process, the implant position is fine and it will osseointegrate hopefully , subjecting the pt, to further operations in a risticted area close to the mental foramen is not the heroic act now. its fine go ahead .

HI If it is integrated, use angulated abutment and load the implant Should not be a problem.

I am not worry about the succes of the osseointegration but i am worry about the prolong prognosis of the this implant after the fabrication of the prosthetic crown with a distal bon of thickness about 1 mm. In addition i am worry about the hyogenic preservation of this implant which appear to become very difficult to clean with the distal narrow embrasure. I hope you can remove it and reimplant after 2-3 monthes with my best regard

This implant should be placed in the center of the empty alveola. To avoid that kind of misplacement of the implants please do a wax-up and a surgical guide, even in simple cases and especialy for beginner implantologists. Dental implant is the surgical part of a prosthetic treatment not a goal by itself, so the respect of the gingival margins is mandatory. A 1.5mm for the interdental papilla is the minimum space to be respected. I advise you to remove this implant asap , graft the bone and after 3 months try to re-implant this site following the right simple golden rules. Elie DDS

Again, if you take a post op film and don't correct the problem what's the point of taking a film. Do the right thing and fix it.

A 3-4 mm deep, 2mm wide pilot hole and pin PA X-ray would tell you right off where you are heading at the start. Also, you have to look and measure the initial start point with some technique like a guide stent or even a Boley gauge would find the center of the space. Finally, if you are new, or questioning the position, you can place a bone spreading plug into the implant prep and x-ray it much like an endodontic trial file. Implant preparations should always be measured twice or thrice, before you even open the implant body package. Also, one must be aware that any root remnant or calcified bone defect can deflect the reamers away from it, so stop and look and measure often as you prep. My old bay instuctor, Dr. mills, over 40 years ago kept repeating, "It doesn't cost a thing to stop, step back, and reevaluate a procedure."

Please just answer one simple question: Would you want this in YOUR mouth? Thank you. DrT

I would remove it even it has ossteointegrated. This case has long term hygiene issues and crestal bone remodeling, especially if the implant doesn't platform switch. As previous colleagues had mentioned, I would follow it up with grafting, healing time and.... Dr. Vassos out of Alberta, Canada has a nice implant placement kit which is a series of different sized rings with holes in the center of them. This case is a good reminder for all of us to always follow the protocals

I would not touch anything unless the patient is very young (less than 30 years old) or he or she really has a bad plaque control, otherwise the implant is only really close on the middle part of the mesial root. Nothing will happen. just tell the patient that has to have very good plaque control. In fact this is more or less the same distance that we live on the anterior teeth, and they work fine. Definitely it is not the ideal position, but, as Tarnow has describe, 1 mm and a half between the tooth and the implant (and that is more or less what you haveI there) is fine.

I would take some PAs and see if the position is actually better than what it seems. If it is Id put a plan abutment and see if I can tackle the prosthetics. If I cannot visualize a good prosthetic outcome only then would I consider removing. If I have to explant Id change the position of the implant and do a graft same time. All this has to be executed ASAP. Best of Luck.

surprising, when some of the comments advised for leaving this implant as it is? also surprising is the fact that most of the comments spoke about hygiene issues etc, but nobody spoke about the lateral forces, if this malpositioned implant was to be loaded prosthetically! this implant definintely needs to be corrected.

Is nobody concerned about the fact that if this implant was upright and centred, it would be awfully close to the mental foramen? I understand why one would want to place the implant distal and canted, but I think it is a bit overdone. Perhaps planning a shorter implant would have given you more room to work. If this is integrated then explanting it would cause more harm than good. It will be difficult to restore well and it's long term prognosis is guarded. It's ok to freehand these, but you need to take intraoperative radiographs and correct as you go along. Learn from this one.