Is this implant too close to canine tooth 23?

Remove it the implant is on an angle and will be difficult to restore. Did you use a surgical guide? A cone beam would give a better view but based on this film the implant is not aligned with the adjacent tooth and there is plenty of distal bone.The implant is crooked

They are right you could restore but it will never be ideal it may be difficult be re-placing and grafting the site will put your mind in an easier place. Peter

What was the initial prosthetic plan? Insertion of only one implant in this area would resolve neither cosmetic nor mastication problem, even though it had been perfectly placed.

Next time make a vacuform radio graphic stent with barium at the implant site.That way you will have an accurate position for measuring the implant size.Then drill a guide hole for a surgical drill guide. Also when you drill the osteotomy have an assistant stand at the patients feet and help you line up the implant and not pull it towards your side.Taking a cone beam without a stent in place makes it impossible to transfer the position to the mouth. Some cone beams have treatment planning software but you still need a surgical stent lab or computer generated. It's just good treatment planning very simple!

To Dr. way You’ve meant a cantilever but not a “bridge”, which has at least 3 units

Youa re right to point that out , what was the plan , i know that economics are important these days but if you are uncomfortable about sinus augmentation ( this should be an easy case ) the maybe 2 implants would work one angled for two teeth the 5 being mad larger to effectively be a 6 .Distal cantilevers in a compromised dentition like this can be testing. Regards Peter

IMHO you are asking for a lot of trouble and for future failure even if implant was in ideal position with a distal cantilever, especially if it is opposing natural dentition. Mesial cantilevers are more predictable and have a better long-term prognosis. Maybe you don't have enough bone for an implant to be placed more distally, but I would recommend removing the implant and based upon cone beam, place one more distal and cantilever mesially if possible. If not, remove implant, graft and re-implant after proper healing.

I'd take several more films before considering removing the implant. Possible overlap due to angulation, easy to do.

Don't think twice , remove implant immediately , fill socket with alloplastic/ resorbable graft material , leave alone for 4-6 months , start again , but this time do a diagnostic wax up using radioopaque teeth or wax ,then take cone beam and a surgical stent/ drill guide to accurately locate the implant/s. Its hard to say there may just be enough bone to place both 24/ 25 implant. I won't recommend a 2 unit bridge, with Distal cantilever. Best lessons are leant the hard way. Good luck

If it is asymtomatic and already integrated, I would warn the patient about your concerns and keep it. (You might do more damage to the adjacent tooth to remove it). If it is not integrated, you can try to reverse it out, graft the area. wait a few months and try again.

Regardless if a surgical guide is used, get used to taking sequential films. Also, start with small drill, and only to a shallow depth. Keeps even the most experienced and seasoned surgeon out of many problems. For 15 years, I have always drilled and placed a pin in a study model, that is present in the operator at time of placement. Always.

You have breached 2 rules here. First - treatment plan BEFORE you place the implant/s - this includes wax-ups guides etc Second NEVER EVER EVER think about cantilevering off a single implant - all you are doing is creating a level arm.

This is the second case posted where the fixture was placed very close to the adjacent teeth. I am concerned with the lack of judgement people are exhibiting. A little preoperative planning like CRS was mentioning could have prevented this. Also, are you taking radiographs during the osteotomy preparation? In addition, it would be nice to think implants do not exhibit crestal bone loss but I ask you this, what if there is bone loss? In addition to compromising the implant, you are affecting the pristine tooth. Remove the implant and plan the case correctly!

After using the surgical guide, confirm the alignment with a film of the 1.0 mm pilot drill. If this is not perfect use a Lindemann drill or re-prep site. Do not compromise the osteotomy.

Remove it asap its contacting the natural tooth and will cause issues with that tooth. The angulation of the implant does not parallel the natural tooth and a good reason to always take a radiograph after use of the pilot drill to check angulation. also good idea to use a surgical stent. in this case the implant should have been placed further distal maintaining at least 2-3mm between it and the natural tooth

If the patient is asymptomatic then it is most likely an overlap issue. I can't believe only one other Doc said this. And cantilevering one tooth, especially a lateral incisor off an implant, is absolutely fine. Please remember the rules of crown to root ratio as well as aspects of angulation do not, DO NOT, apply due to the lack of a PDL. I am both a placing as well as restoring dentist and can tell you that an angled abutment will not only allow you to restore this implant but will yield a good and long lasting result. I would leave this implant in and inform patient that is not "ideal". Even say that you could redo the implant but believe it will be fine. I guarantee they will say "we'll, lets give it a shot. It doesn't hurt." And there's nothing wrong with that!

Hello!it's about the 24 region,this radiography is not adecvate to appreciate an implant.use an cbct before and after.from my oppinion the angulation and thevcantilever is a problem

TWO IMPLANTS VERY CLOSED TO EACH OTHER AND WITH SAME ANGULATION WHAT IS THE CHOICE TO LIVE OR TO REMOVE .THEY ARE BOTH WELL INTEGRATED

if patientis asymptomatic i'll leave implant there.you can have a lot of prostetic solutions for restoration.

Are you joking ? Refer your patient to an implant specialist to remove this harmful, irrestorable implant and to perform an external sinus lift

The film does not look heavily angled to me, only slightly, the contact point between lateral and canine are not greatly overlapped. so i guess the implant-root is very close. I would take a better radiograph first before deciding however to make sure I assume the implant was placed angled due to anxiety over the sinus position. Its better to explain the complication to the patient and deal with it.

So I think that you need to make better x-ray ,preferably with cone beam .If the tooth canine is asymptomatic so leave the implant ,and try your best to put another implant near by this one ,then to make a bridge of two premolars and a cantilever 1st molar ,my opinion that there is enough bone to put another implant !!!!!!!!.in the next time when you are going to put implant ,always you should take an x-ray simple one,after the first drilling with 2.0 mm drill to see the pathway of drilling and the expected site of implant then continue to fix the implant !!!!!!

There is risk leaving this implant in place. Just take it out and do it correctly.

If the implant invaded the periodontal ligament the colleague will not post this case and wait our advices. About the angulations it is not only inclined mesiodistaly but it is inclined buccopalataly and it is inclined palataly because the labial plat is too thin to insert an implant labial to the canine in such a manner , so the abutment of the implant is severely inclined labialy. So implant with severely inclination in two plane and platform in a level about few mm under the level of cementoenamel junction of the adjacent tooth in addition to esthetic problems with severely inclined abutment labialy in a severely apical level what kind of prosthesis will be result and about what kind of cantilever we are talking about, let us not forget the effect of few mm of angulations on the crestal bone resorption imagine this with this complicated angulations and cantilevering.

There are 2 main issues here (and a few secondary ones such as the use of cantilevers which is best left for another discussion): 1. Will this implant, once it is restored, have a predictably good long term prognosis? 2. Is the adjacent canine being compromised in any way? My answer to these questions are: NO, this implant, even if it could be restored, will have a poor long term prognosis because of the bone loss that is already evident mesially, and also because the eventual direction of occlusal forces will most certainly not be along the long axis of the implant; second, the canine is already showing involvement of its bone on the distal, and additional bone loss on this surface is inevitable. I think in cases such as this (and we have ALL definitely had them), the question that we ought to be asking ourselves is not what COULD we do, but rather what SHOULD we do. We have all deviated from the ideal, not only in implant dentistry but most likely in our practice of general dentistry or in our speciality. IMHO, we need to try to keep these instances to a minimum, and each and every time we do this, we ought to ask ourselves if this is what we would want in OUR mouth. Thank you. DrT

I wouldn't want that in my mouth. Why such poor planing? If you can't do a lat. wall sinus lift then honestly you just should stick with the basic cases. 1. No educated surgeon/dentist would treatment plan a distal cantilever premolar. 2. No experienced surgeon would create this type of situation. Where is your conscience?

dear colleagues who never ever makes a mistake, blessed is he who among us has never failed ... here there is a problem but I think that few are sincere at all and I still think that most of us would leave the implant where it is asymptomatic right now.

To remove it, you better do it within the first three weeks. Once the implant is well integrated, you wont be able to torque it out. A trephine of a slightly larger diameter than the implant will have to be used. In such instance ,you will surely run a great risk of damaging the adjacent tooth even in an expereinced hand.Take a ct , it's an acurate way of determining exactly how close it is, PAx could be misleading. This implant maybe just fine if symptom does not arise. As far as crestal bone resorption on the distal of Canine, if the pateint has a thick gingiva biotype, chances are low . Live, love, and Learn !