Radiolucency in 25: Prognosis of implant?

That radiographic image does not provide enough information for diagnosis of the problem you are contemplating. It actually adds almost no diagnostic data in this particular case.

The UR as well as the medial UL fixture look to be in significant jeopardy. I also have serious questions as to restorability of the UL fixture given the limited M-D space between the 2 natural teeth

Not to mention this person appears to be a serious bruxer with loss of vertical dimension and most likely group function. I would assume this may complicate matters even more.

This doctor probably should take an implant residency, or certainly have more extensive training before attempting additional cases. I see possible issues with both of the posterior implants, and the proposed restorative “plan” is pushing the envelope. This pano alone is not sufficient information to formulate a sound opinion as to prognosis, but it does show things that look troublesome.

The UL5 implant you need to take a Periapical radiograph to confirm any radiolucency. An OPT is not accurate enough. You definitely need to be careful about the occlusion. The right guidance will need to be on the UR3 (not clever to do it on the UR2, not clever to do it on the UR4 pontic). So yes, you need to have another implant in the UR4 area and splint UR3 and UR4 together (I m assuming you couldn't t put a wider implant in the UR3 position). The narrow diameter implant in the UR3 in a bruxer is going to result in a disaster. Make sure you don't end up with non working side interferences on left lateral excursions.....think about restoring the UL3 to create canine guidance. Look into restoring the upper anterior teeth to create good posterior disclusion on anterior excursions. And very importantly....find out why the patient has so much wear and tear....grinding --- make a hard splint.....acid erosion ---- give dietary advice. Most of all don't panic, admit there is a problem, reassess, discuss with the patient and put things right. The patient has trusted you.

25: what was the diagnosis before extraction of tooth 25 ? how was diagnosis of xray before implantion in site 25 , how long was healing time after extraction? make another single tooth 3x4cm xray, may be this is only an opg artefact, if not i would check if this implant is stable or a spinner, if stable, tell your Patient about your opinion concerning"apex"of implant 25, you should both consider what is good for you and Patient in future. about the other two implants, if considered ok, which i would do so concerning osseointegration, go ahead with bridge, check function not only once and this Patient has to wear brux splint at least every night, if Patient is giving pressure during hard day at work, Patient has to wear a minimized splint then too . good luck regards Stefan

Sorry to say this case is doomed to failure. Look at the occlusion. First you must address the occlusion as obviously the is no enamel on the biting surface of most of the teeth . There are not enough implants their positioning is weak. you will be putting the most ridged material in a mouth that has no stability. Please re think your plan before its too late

How old is the patient and what is his/her physique? If this is a 70 y.o. female weighing 5 stone, then the occlusal attrition could be due to a lifetime of coarse foods, which will have little affect on the implants/bridgework. If its a 30 year old beefy construction worker, then yes its bruxism and time to punt.

She is 28 years old lady .