Questionable position of implant: recommendations?

extract a good tooth!!!! never.

I agree. it is the simplest solution and the one most likely to be successful.

Thanks Mike for the encouragement....

Here is the reason why to start over, fortunately you are at a good stopping point since the crown as not been placed. Having that many threads exposed in a bony defect will be a future headache for the next 2 years until the implant fails. It may not look that bad now but it will really look bad after the crown is placed. The restorative cannot make up for a poor foundation. The point being the heroics suggested above are used on an implant which has been restored and functioning for several years not something that is a poor result from the get go. This edentulous space appears wider and there is not a lot of bone from the crest, I don't know what it looked like prior. Now even if by some miracle bone can be grown with a no walled defect the placement is still poor. Remove it and fix it now vs nursing this thing along, I give you permission based on all the reasons you stated in your first post. Next time take a film at placement and simply back it out, place a simple graft and start over, it happens, it's part of surgery. I would also advise using a surgical stent to line this unusual space up. Perhaps two small implants? Now please understand that I am very impressed with you posting this it shows good judgement and wanting to do the right thing. You know the rationale, if the removal is a problem work with a colleague who can help you, I do it there's no shame in that and your patient will appreciate it. I know this may sound harsh but in the long run it is the best vs taking Mike's advice and going down that compromised path and hoping it will work.

Thanks CRS...

I had this happen to me and the cantilevered crown caused loss of the implant, I'm redoing it, so I being honest with you! I got burned since the referring doc didn't send a stent and I tried to eyeball it! In this case the extra time and expense with a new crown could have been avoided. Good luck it happens.

Hi Bhanu... So i should not remove it as CRS says??

Hello Pranav, I am not that experienced to comment whether to remove the implant or not, but I have seen many impantologists boasting of success with even such implants. I think, you can just go ahead with bone graft and cover the exposed threads and hope for the best. I am also eagerly waiting for few more comments regarding retaining the implant and getting a fair prosthetic outcome.

Dr Hughes I have a question in these odd shaped molar spaces is it acceptable to place a molar implant with an open cleansable inter proximal contact to avoid a cantilever in a non esthetic area as a last resort. The implant is not going to drift like a natural tooth and if it is distal to a natural tooth that tooth is not going to drift distally. Could this be used to avoid the traumatic occlusion of a cantilever? Some patients have open contacts with their natural teeth Any thoughts?

looks like it is at the crest and no threads are exposed. although it is placed to distal let it heal have a custom abutment made from atlantis, fabricate a cementable crown with good contacts

Hi Vijay, i placed this implant last sunday, i.e. on 13th. to tell you all that no thread was exposed and this IOPA was taken immediately after implant placement. i am still wondering how come this radiolucency is there around the crest..maybe due to overexposure??? I've read all the comments and have decided to remove the implant. Hope patient understands.

Thanks

I agree to you .There appears to be enough space mesial to implant, so instead of removing this implant , we can place a small diameter single piece implant at later date( ie during restorative phase).

Sounds logical but I would be concerned with the high placement, not covered with bone, and hygiene. If this fails in the future it will need to be removed from under a bridge. It is a tough call. Perhaps removing the third molar and restoring with a cleanseable contact at the first molar. I still would remove and place it better if possible.