Improper implant placement: recommendations?

I am new to placing implants (have only done about 20), but have been following this website for quite some time, and find it incredibly useful. Today I placed an implant in the 46 area (lower right first molar) and my post-insertion radiograph showed that it had gone into the root of 45 (lower right second premolar) by about 1mm. I took radiographs from a few angles to confirm. I took the implant out, grafted, and will bring back to try placement again.
My questions are:
1) Should I have left the implant in? Would it have integrated?
2) I warned the patient that tooth 45 may likely need endo. What is the chance of this, and would this be worst case scenario?
3) How long should I wait to re-enter and place a new implant?

Thank you for your help and insight. What do you recommend? I feel terrible about the way this turned out and am not sure how to proceed.

7 Comments on Improper implant placement: recommendations?

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Peter Fairbairn

10/16/2016

Great you saw your error and removed ....... hope you will check in the future . You have done all the correct things post the placement error ... Depends on what you grafted with..... 10 weeks - 6months ... Mistakes happen , move on and learn....

Mike

10/16/2016

Thank you for the reply, Peter. I have done a number of socket grafts with Mineross by Biohorizons. I have done a number of socket grafts, but have yet to place implants in these areas yet. I have been told that two months should be sufficient for this. What do you think of this time line. Should I wait longer? Thank you kindly

Mike

10/16/2016

Hi Peter, Thank you kindly for the reply. I have grafted a number of extraction sites, but have yet to place implants in these areas. I use Mineross by biohorizons. I have been told that waiting two months should be sufficient. What are your thoughts on amount of time to wait before placing an implant? Thanks again, Mike

Peter Fairbairn

10/17/2016

As Starting out best to leave another month , 3 months when starting no protocols always err on the side of caution ...... you have a long career ahead ..... make it safe and successful . Peter

Dr KG

10/18/2016

45 not likely to have endo. You did alright. Work on reading distances and angles. good luck

Dr.T

10/18/2016

My questions are: 1) Should I have left the implant in? Would it have integrated? No you should not leave it in. You did the right thing by removing it. Yes it would have integrated but at a poor angle and potentially (probably) compromising #45. 2) I warned the patient that tooth 45 may likely need endo. What is the chance of this, and would this be worst case scenario? Since you removed the implant without waiting it is unlikely that #45 is compromised. You say 1mm into #45. Did you actually drill into the root, or just put pressure on the root with the implant? Either way, it is unlikely that the tooth will require endo. No guarantees, but unlikely. This is not the worst case scenario. It is possible (though highly unliklely) that #45 will need to be extracted. That's always a very slight possibility, though I seriously doubt it will come to this. 3) How long should I wait to re-enter and place a new implant? I agree with Peter, 3 month minimum, if everything heals uneventfully and is asymptomatic. Someone with more experience could do it at 2 months, but there's no reason to. You explained to the patient that it happened, and don't feel too bad. These things happens all the time even to surgeons with more experience. From your original post, it sounds to me like you did everything correctly. Please, post a follow up when you've completed the case to let us know the outcome. -T

Mike

10/18/2016

Thank you kindly for everyone's reply. I will keep you posted with the outcome. Mike