Implants Too Close: How to Proceed?

Why do you want to remove an implant which is not causing any problems?Leave it,and if you need an additional one for the prosthetic,then go in and place one.

may be there is no complication in this case there for keep all plant in position ,distance between implants we needed for more blood supply for osseointegration

i have put some implants were the case was similar to what you described...i got some bone resorption at the head of the implant and in other cases i got nothing...Implant distance is important for bonne blood supply, if you have a good blood supply you don't have to worry much...

I assume you are worried about the difficulty in restoring the two implants, more than osseointegration. One or both implants may fail due to proximity and lack of blood suppy. Both may integrate, without complication If you remove one you may lose the other one as well. If both integrate, you can put one to sleep by leaving a flat cover screw on it and restore the other one. By adjusting the transfer coping with an implant level impression, you may get a situation that the lab can make custom abutments as needed to give you a restorable situation. The other possibility to get a restorable situation would be to place the abutments on the implants and prepare them as required and take a direct impression after the abutments are torqued down. To give better advise, we need to know how long the implants have been in place and what type of restoration is planned. The obvious comment is to be more careful in the future, but sometimes we make errors in judgement under stress, especially when trying new techniques. Best of luck, Ben

Ultimately, it's hard to determine without seeing radiographs, but I would seriously consider removing one of the fixtures. If it is just angulation of the radiographic beam, then that's one thing, if its a true measurement of the bone remaining between the 2 fixtures, that's not enough bone to maintain an adequate blood supply. 2mm is the minimum distance between fixtures, 1.5mm between tooth and fixture. The shape of the implant fixture also plays a role, if its tapered, you may be ok, if they are parallel walled implants, not likely to improve the situation. As the periodontal inflammation increases around the the neck of the implant, the compromised blood supply of placing 2 fixtures so closely together, will greatly accelerate bone resorption and compromise both implants. You will lose both bone and tissue and have increased gingival recession with show of the fixture surface. It is certainly not an immediate surgical complication, but a delayed complication. It will certainly not be evident until many years have passed, but I guarantee you, once you've told a patient that implants last many years, they will not be happy if both implants fail after a few years.

remove one and replace it in the same surgical event, and you will have a happier and easier life. (if they integrate , it will be a real problem to restore them, and if you wait you will have to use a trephine which will probably damage the other during the removal) think about the future and the best for your patient best of luck

If the implants are integrated,I wouldn't even attempt to remove one of the implants as you will need to trephine one of them out.This will likely damage both implants and you will need to remove both.I would put one of them to sleep(using a cover screw)and I would have my Lab to fabricate a custom abutment and an implant PFM crown with a cantilever pontic to replace the adjacent tooth.

It is very difficult to make any suggestions without a radiograph and the timeline. If they are so close together, that they are both unrestorable, then I would sleep one of the implants. Trying to remove an implant could get complicated for both the surgeon and the patient. Osseointegration could occur as early as 6-8weeks. Removing an integrated fixture generally results in marked bone removal and could compromise the adjacent implant as well as make future implant procedures cumbersome in that site. You could also get an ICAT and evaluate the situation in 3 dimensions. I hope it works out, keep us posted.

I think the good doctor is anxious about the prosthetic phase. Talk of the prosthetic phase with him.

Remove it before it´s to late, the problem will be when you don´t have soft tissue between them. I had to restore several implants in that condition, and belive me is really a nightmare the absence of adecuate soft tissue between fixtures.

I have in the past had a similar situation...not proud of my placement obviously...learned and have not done it again....but I would not remove a fixture because you might loose both of them...solution is custom abutments to minimize flaring from the implant body or sleep one of the implants and don,t use it ....tough call without radiographs

Are these 2 Implants in the aesthetic Zone? If Yes you may run into trouble.In that case You may Load only one. Do not remove !! If not in Aesthetic Zone Besides the bone loss ,and the lack of Papilla formation you may not be able to record an Impression.You may need to select a proper colllared abutment and prepare it intra orally and record a Direct impression like Crown and Bridge.I hope this helps. Email:info@drashish.com Web:www.drashish.com

i think the problem you will face in the future is the bone resorption between the two implants that are close to each other. so if you get osseointegration ,wait and follow. and its better to splint the implants together.

Ciao it depends on the location of implant and type of prosthetic project: cemented bridge or screw full arch rehabilitation. before the hypothese of implant removing , very invasive approach, you can evaluate to not connect the implant to abutment and submerge one of them. very easy . the less favourable remain under the mucosa. bye bye form italy

Is hard to say anything without a radiograph and are these Implants in the post or ant area?? If they are solid i would not remove one of them, you might be loose the other one. If you have problems with your prosthetic put one to sleep. But now you have a big problem, you have to many different opinions. Try to make the crown and bridge work in this area out of occlussion, no force in any direction. good luck Uli

How did you get into this predictament anyways? Was there no treatment planning or stents? I know everyone gets in a tizzy when it is only said that specialist should place implants but the more I read these blogs the more I wonder if that should be true. Or at least have a major amount of training. I think it is only a matter of time before the dental community is scrutinized by major news networks expose and/or lawyers looking for cases that have gone bad and it is going to bring the whole industry down. I am not a specialist so please dont responsed in that it is only self serving

I have restored implants placed very close together (by a highly respected specialist) and angled into each other. He did two implants for #19 both roots. I had to take to separate impression with one transfer coping each time, then make individual custom abutments, do a resin pick up in the mouth, solder them together and then make a coping over that for the final crown. I would not want to do it again yet it is 6 years later and the crown, implants and patient are apparently fine. The surgeon happily no longer tries to replace each root.

If the implant was just placed, I would just go in and back it out of the osteotomy. If the implant has been in longer I would leave one burried. This is assuming that there is no problem with integration or bone loss associated with the close placement. Eat the cost and out another in if needed for stability.

Sorry for your stressing re this case, it is part of the learning curve. Make sure your patients know your skill level at the time of placement cause if poop hits the fan it will come out quickly (no joke). Be very up front and do not above all say something is wrong or that complications MIGHT happen. Show them why you are concerned and have a very frank discussion on the next course of action and why. Get one of those fixtures out unless you don't believe in the establishment of a biologic width from the implant/abutment junction, which if a very long junctional attachment forms, might lead to a source of chronic inflammaton and eventual loss of both implants . Remember surgical stents are invaluable even in single implant cases. If "poop hits", the first line of questioning will be Doc, did you use a surgical stent? If no, why not?

Even with a surgical stent implants are not always placed perfectly, even by experienced surgeons. Especially in the posterior quadrants where it is hard to see and there is very little room. Just look at the x-rays shown in lectures and printed in journals. Don't beat yourself up because this. Do what is best for your patients and learn from the expierence.

Dr. C. there is no need to worry much , actually atleast 1.5 - 2.0mm of bone is required between two implants to survive , it happened in my few cases but only in two cases in lower ant. region and i lost one of the two implants so there r many ways to procced 1.you just wait and watch till the uncovery of implants and before that if patient comes with any pain and swelling take an x-ray ,look at any radiolucency present around any of two implant remove that implant and leave the site to heal.you other implants will osseointegrate and if you want to place the implant at the same site place that after 2 months and use less dia. implant and 2mm. away from adjecent implants. 2.if you donot want any complication and if have recently placed these implants remove one of the two implants which is less important by prosthetic point of view and graft the site with the graft material and and place the resorveble memb. over that , by doing so you will get the good bone formation at the site as well as good osseointegration of the other implants. if you want to place the implant at the site place that after atleast 5-6 month.

Explain to the patient that you have very little training in implant surgery and although you did not tell them so initially, you are learning on them. Admit to yourself that it is more than just drilling a hole and sticking an implant in. Take this as an opportunity to reflect on what you are doing before your lack of training really hurts someone. Learn some good treatment planning and case presentation skills so that you can have a successful practice wthout being a jack of all trades and a master of none.

timing is very important to discuss what to do. these might be unrestorable. if you can back out mplant withi first 3-4 weeks better. long term postioning could be aproblem. maybe move your practice befor the pt experiences the long term perio problems

As a GP I surgically place and restore implants. I always make surgical guides. A surgeon I referred a case to did not wait to receive my guide. He did the surgery and placed the two implants about 1.5 mm apart without my guide. To take the impression, I had to slice the impression abutments so they would go into place without contact. Even surgeons make poor choices sometimes. We are all "Practicing".

If you can restore them leave them to osseointegrate. if they had primary stability they most probably will osseointegrate. Post opt, if Pt is experiencing pain for more than a week then you can expect problems

Dear Dr It depend upon whether your implant was in the mandible or maxilla if it was in the mandible ,then the situation could be more critical bexcause the blood supply is much less and the possibility of bone necrosis to the THIN part of intervening bone is qiet high ,removal of one of the implant for sure will not improve the situation but you can wait ! and follow up you case