Positioning and deep implant: thoughts?

I think in this situation I would be inclined to take the deep implant out, graft and replace. I have seen issues with placements like this where the bone level on the mesial of the other implant will want to settle halfway between where it is now and the position of the deep implant due to bacteria colonizing the micro gap. This can lead to a whole host of problems, the worst of which can be dehiscence of bone and/or soft tissue between the two. Won’t always happen, but if it does you’ll have a bigger problem.

I am a bit confused. What is image number 3 compared to the others? The implant, position and adjacent teeth seem different in image number 3. Can you clarify?

You could let the implant sleep and restore with a cantilever. IMO, depth of implant placement (where vital structures permit) should be worked out from the proposed restorative solution. If that means grafting... you graft. This is especially true in adjacent implants where pushing the boundaries usually results in you going out of the frying pan and into the fire.

My concern, if we are talking about the site where there are 2 implants is that these 2 implants have inadequate spacing between them and between them and the natural teeth. As for the single implant, I agree that removal is the optimal approach. I do not embrace the idea that an implant that was just placed is not in ideal position but let's see if it can be restored.

I have a question regarding the planning of the implant before the surgery -what was the mesial to distal width between the adjacent teeth? One thought is to put more energy into planning before the placement . That way there is hardly ever a “what to do ?” thereafter .

I always find it amusing how critical people are of other people's work. It seems like the solution on this forum is always to remove the implant graft and redo. From the information you provided I can't imagine any real problems with restoring this case as restorative dentistry be it natural teeth or titanium screws is always a compromise.

In YOUR mouth?? Fine

‘The enemy of better is best’ logic might apply if this was a borderline satisfactory placement. It’s not. At least in the US, dental boards in many states are getting more and more aggressive with their enforcement. These enforcements are costly and time consuming to defend, not to mention emotionally draining. They can drag on FOR YEARS. It may come as a surprise that dental boards are outsourcing chart review to third parties that scour dental charts for infractions that violate the dental practice act and the ‘standard of care’. Any sanctions by a state dental board that result in disciplinary action must be disclosed on insurance provider enrollment or recredentialing applications, dental employment applications and requests for hospital privileges, to name a few. The negative economic impact can be considerable in today’s world. There is a reason why the answer to so many of these types of questions is to ‘RRR (remove, regraft, replace)’ - the patients deserve our best (they have paid a lot of money for our services after all). And Big Brother is watching...

WELL SAID!!...On several counts. Thank you

Deep will be ok. Be sure that the entire platform is exposed and free from hard and soft tissue when seating the abutment. If the deeper implant can be restored with a screw retained restoration then do so. If it is cement retained then be sure the lab places a collar so that the crown is at the gingiva or slightly sub gingiva on the facial. The first bicuspid implant is converging slightly toward the second bicuspid. With custom abutments the optimal space can be maintained. So deep it self is not a problem. If the implants are platformed switched then all the better.

thank you all so much for taking the time to answer me and sharing your knowledge. i deeply ( :P ) appreciate all your input and i dont feel great about this situation and i ll assume every responsability..... please do continue to comment . in the situation i m in i cant remove and graft because i m an employee and it sucks and i can tell you i lost much of my sleep. the restoration will be certainly a screw crown. i ll be always grateful for taking the time to help me . thank you.

The one thing that need to be considered here is the crown to implant ratio. I think if it's a single implant probably you will need to remove it but as long you can do a bridge over the two implants there is no need for any invasive correction. Plus, I think it's a good idea to give a two years guarantee to the patient and if possible to do an Xray every six months or so.

I hear the term crown to root ratio come up a lot and I am not sure it is relevant when discussing an implant supported crown since there is no root. What about short, <8mm implants, they would almost always violate this imaginary ratio which was defined for natural tooth supported crowns