Implant close to adjacent tooth: treatment options?
I had my implant installed about 4.5 months ago. Implant was placed immediately after extraction using what my dentist told me is the socket shield technique. It is in place #13 (I think that’s the correct number, also have another one at #4, it’s ok). But, the implant still sometimes feels discomforting. It is stable, and from the side of the mouth it looks good. About a month ago I was advised by doctor to take ibuprofen for about a week in higher dosage and it did help for some time but now I still sometimes “feel” this tooth. I also had my healing exchanged about a month ago, and it really hurt when it was screwed (especially at the end). Today I had a CT Scan and it shows that implant is near to the adjacent tooth. When my doctor saw a CT scan he said that there’s no need to panic and that we should probably go with root canal treatment of the adjacent tooth.
I really like my doctor, but I would like to get some advise on this case.
1. Is root canal treatment of adjacent tooth appropriate in this case?
2. Is there some kind of inflammation going because of the distance between tooth or is it pressing the nerves in adjacent tooth?
3. For last month I had problems with my sinuses. It was really stuffed. The mucus was transparent. Can it be related?
4. I’m also experiencing for last month some discomfort in chest (while fully inhale), It feels like in breastbone, but more like on outside, bones. It could be because on sleeping on sofa for some time in bad positions or can it be related?
I would be really grateful for your opinion.
19 Comments on Implant close to adjacent tooth: treatment options?
New comments are currently closed for this post.
DrT
5/23/2019
On the CT scan there appears to be an area of infection at the tip of the implant. If the implant can be removed relatively atraumatically this is what I would recommend. If removing it is going to jeopardize the adjacent tooth then I would recommend flapping the area and treating the infection around the tip of the implant. At this time I do not see a strong indication that doing RCT on the adjacent tooth is going to resolve the problem, though this tooth may need RCT in the future
Timothy C Carter
5/23/2019
I personally do not think it is too close to the adjacent tooth but root canal treatment may still be necessary. Sometimes sh&* just happens with no reasonable explanation and in this case the other tooth may have just been waiting to become symptomatic. The sinus issues you have been having could be a factor but I would start with an adjustment to get #12 out of occlusion to rest.
Philip Christie
5/23/2019
I have a strong suspicion that this may be occlusion related but with associated bruxism. A good analysis of the functional and parafunctional relationships would be the first port of call for me.
I have treated this type of pain successfully in many cases over the years.
Best wishes
Dr. A
5/23/2019
I agree with DR. T, there is an area of infection at the tip of the implant. Additionally, the implant position is not as ideal as we would like. I would try to remove, graft and try again in a few months, Ask for a new CT after healing and a surgical guide for 2nd implant. Regarding root canal on the adjacent tooth, this CT does not provide enough info for us. Try a cold test to see if your tooth is alive. Take an ice chip and hold it up to just that neighboring tooth. If you feel cold on tooth it is still alive. See what happens after the explantation and bone graft. Your adjacent tooth could be fine.
Samuel Barr
5/23/2019
When a healing post or some other component is replaced on a seemingly well integrated implant, there should be no discomfort. In every implant that I have placed and this occurs, the implant has ultimately failed. As this has only happened a couple of times with my patients. I can't claim this to be a hard and fast rule. Twice the failures were almost immediate, once the failure occurred after two years, once after four years.
But based on my limited experience with this, in my practice, I would take the implant out, let the area heal, then try again.
AG
5/23/2019
I don't think there is an infection at the tip of an implant. As per patient implant was immediately placed about 4.5 m ago, there is high possibility that implant did not complete osseointegration . Regarding root canal, implant is bit close to adjacent root, but no reason to worry, if #12 becomes symptomatic, root canal should be done. Occlusion should be double check for now, and follow ups.
CRS
5/23/2019
Implant does not appear to be integrated and during placement the adjacent tooth seems to have been damaged.
Paul
5/23/2019
To the patient:
Are you more confused now . This is the way it is with dentists. Each dentist has a different opinion. Why do you think it is? Perhaps they are not following scientific principles but act like craftsman. You decide and consider ... There you got me. By the way, I am a dentist who is frustrated with the system of educating dentists in our country.
kewx
5/24/2019
Dentists are great for forming a circular firing squad. New graduates are first to make something of nothing. The state dental societies are looking out for specialists whilst being funded by generalists......ADA is just the same.
If you think this is bad,.. hospital politics are way worse. There,.. it is not what have you done for me but only what have you done for me lately.......
Symptomatic implant placed 5 months ago has failed.........that is how I see it.
Dr Dale Gerke, BDS, BScDe
5/23/2019
It is inappropriate to make definite comments because honestly, more information is required before an accurate diagnosis can be made.
Vitality testing is required on the adjacent tooth to start with.
However other tests are required on the implant also and probably further investigation of the sinus.
It cannot be overlooked that possibly one problem is presenting as multiple symptoms . So it requires clinical examination and further tests to determine if you have 1, 2 or 3 separate problems. This will help determine if the symptoms are separately coincidental or consequential of the implant. Once known, you can consider the various implications.
The implant apex is not positioned ideally but the question is – is this causing a problem now or will it be an issue in the future.
At this stage, it may be possible to “unwind” the implant if it has not totally integrated. If it is possible (from your description and the CT scans, this is probable) then it could be advisable to do so.
However in truth, my recommendation is to seek further advice from appropriate professionals. Perhaps an endodontist in regards to RCT, a prosthodontist or periodontist in regards to the implant and a medical GP or ENT specialist in regards to your sinus. I think you could leave the latter consult for a while because the first two might solve the sinus issue (or at least provide good advice about it).
I am not trying to avoid your questions but it is important to understand you need a clinical examination before proper opinions can be given.
Timothy Hacker DDS FAAID
5/23/2019
The implant was placed into infected bone. Oops. The adjacent tooth is infected also that may or may not be associated with the implant placement. However, having an adjacent infected tooth will definitely effect the implant.
Remove the sore implant, debride the socket and allow it to heal. Treat the adjacent tooth with endo, or extract, graft and do 2 implants in 6+ months.
Doing 2 implants in 6+ months is definitely more predictable than doing a root canal in the adjacent tooth. At the end of the day you MUST get rid of all infected bone.
Dok
5/23/2019
The implant appears to be too close to the adjacent tooth. We all know the rules and recommendations for spacing between implants and teeth and this implant position appears to break ( or at least bend ) those rules. Also, imagine and try to follow the progression/path that the nerve/vascular bundle would take as it travels to and enters tooth # 12. Now imagine the osteotomy drill bit making a hole that is at least 1 mm longer than the implant ( as is typical ) and there the two shall meet. Severe the nerve/vascular bundle as it enters the tooth and pulp necrosis can occur. Implants shouldn't hurt. This one does so something is amiss.
Ed Dergosits
5/23/2019
The implant is placed too deeply below the crestal bone. When the healing abutment was replaced there was pain because the soft tissue quickly "collapsed" into the space and was "pinched" when the new heling abutment was placed. I personally would recommend removal of the implant and placement of another one in a better position.
Prof. Sehimy
5/23/2019
I feel that the adjacent tooth is endangered by the implant procedure . Check up the vitality of the adjacent painful tooth is advised . Then , RCT is recommended .
Ed Dergosits
5/23/2019
Check up the vitality of the adjacent painful tooth is advised . Then , RCT is recommended . What response to a what vitality test would indicate the need for endodontic treatment of the adjacent bicuspid? Do you think the depth of the implant placement can ever be sustained in a state free of inflammation? It is excessively deeply placed and needs to be removed asap in my opinion. If the adjacent first bicuspid has a positive vitality response how would you proceed and why?.
Dr Tony
5/24/2019
Im sure that Paul is correct .You must be really confused by now.
What everybody has said up to now has merit - but!!!!!!
The bottom line is that an implant should have no symptoms if properly integrated with the bone of the jaw when screwed as you said and you should not be aware or "feel" it.
As Samuel and CRS say - it has not integrated properly and probably never will.
So if the symptoms don't resolve then I guess it should be replaced.
Its close to the adjacent tooth but doesn't appear to be touching it so if there are no symptoms on the tooth then a root treatment is not necessary at this time.
Your other symptoms should not be related to the implant.
Your other implant looks good so your dentist looks like he knows what he's doing .
Just ask him to hold up with the root treatment - wait a while.
good luck.
Dr.Julian
5/24/2019
Yes, the implant is very close to the adiacent teeth, but there are large decays on the adiacent molars. Treat the molars and you also have a big obturaion on the inferior premolar. The pain could come from somewhere else.
Dr Indraniil
5/26/2019
The implant to me doesn't look integrated from the cbct.I would suggest if a smaller x-ray called IOPA can be done to check this for sure and also the stability of the implant on the implant stability meter(isq).In my earnest opinion it will be a weak association with your bone and should be easily removable. After the implant is removed,I would wait and watch the adjacent tooth for a week and then take it up from there .Ofcourse clinical examination with the patient would help but when that's not possible this is the best that I could come up with.
Kind regards
bob F
5/28/2019
Test the integration with an Osstell, then proceed accordingly.
