Remove Implant or not?

Hi, You are close to the other tooth but I think you are safe. Especially if Pt doesn't have any issues with #9 i.e. discomfort, "numb feeling" etc. We can see with the PA that you are not encroaching on PDL of #9. Now what could be an issue is restoring the implant. If it's too close to the #9 then you could have an issue with contour of the crown. However, I am sure with a custom abutment, it could be done. My $0.02

it is a hard case to judge. Different People may recommend different approaches based on their own capabilities and skills, which does not necessarily mean you can achieve the same results. my concerns, for removing the implant is, how atraumatically you can remove it, how well you can graft it without altering the mid-line pappila and if you loose more bone on the mesial upon removal of the implant how compromised the aesthetic outcome will be. on the other hand, if you leave it as is, there is a chance that the implant survive but #8 required RCT, but even worse, if you get bone loss on the M of the implant then it will go all the way down to the apex, due to compromized blood supply and regeneration in that case is like regeneration of a Class III furcation. Not easy nor predictable. whatever you choose to do, you need to shapen your skills and knowledge about possible physiological changes that may happen and how they can be dealt with. My most important comment for you is, don't place with implant without taking a verification Xray and Take an Xray after your 2mm Twist Drill to check the orientation. if you skip steps, or cut corners, you will face more complications in your practice. i have been placing dental implants for 10 years and i still practice like that. And i learnt it from and Endodontist whom i was assisting before going to dental school. he had more than 15 years experience and was working 5 days a week at the time. Not once i saw him, cut the GP before taking the Final Xray, even when he was running late. "Practice Safe" and don't try to be a hero, Try to be good in what you do.

If it was me, I would take it out. After only 2 weeks it should reverse screw out easily. I would then graft with CS and CP and wait 3-4 months. I agree with the other comments that you cannot predict exactly, but you can put a percentage prognosis on probable outcome in cases such as this one. My best guess is that there would be about a 50% chance that the interproximal bone will suffer (probably complete loss) followed by the usual consequence of infection and loss of (or at least severely compromised) adjacent tooth as well as the implant. The question then is what is your moral and legal duty of care? Can you defend you lack of action if the adjacent tooth is damaged (and of course) the implant is also lost? You have a responsibility to mitigate potential damage. As such I do not think you have an option. I suspect you know this or you would not ask the question. As a profession we have to live by the motto “above all else, do no harm”. In regards to why this happened, it was always going to be difficult for you to place an immediate implant in the existing socket without ending up too close to the adjacent tooth. In this case a surgical guide would help (I am not sure if you had one) but even then trying to drill more centrally would be difficult since the drill will always want to follow the line of the socket (especially since the bone looks reasonably dense). I would have probably delayed implant placement for 3-4 months to allow healing (or perhaps tried placement with a surgical guide but not proceeded after a check radiograph of my drill angulation if it was not centrally located). The good news is that I would expect a good final result with no consequent permanent damage should you remove the implant, wait, then re-implant (preferably with a surgical guide) at the appropriate time. Although annoying, this would be a cheap learning experience.

I agree with Dr Gerke in philosophy. When this happens to me (and it happens to us all, even when I do the PA 2mm drill ), I'll have my assistant take multiple PA's to see exactly how far away from the tooth the implant is. Often a small angle change will show a greater distance. Dr Gerke's philosophy rings true for me in that when I make a mistake and correct it the first time I make that mistake, I am less likely to repeat that mistake. When I give myself "a by" -allow the mistake to fester, I pay the price with a failed implant, explaining to the patient how I didn't give them "the best" AND I am much more likely to accept the same stupid mistake NEXT time I make it and it takes more energy for me to correct it the second time. Consider all the tuition that you've paid, expenses for equipment etc to get where you are: This is a cheap learning experience and if you are careful with your words your patient will appreciate that you want for them what you want for your mom.....that is if you like her:)

If the incisor is not symptomatic I would leave it alone for now. This is a good learning experience for you. Always look at the apical half of the tooth being extracted on these immediate case. See how it dips to the mesial? The implant is going to follow the path of least resistance so it went in too close to the incisor root tip. Next time use a 702 to cut a new start site where you want and pa X your way through the osteotomy . In these anterior cases one mm may be the difference between go or no go.

I cannot fault you for the position of the implant, because you took out a root that was positioned too close to the adjacent tooth; and you followed that path...… wait and see, if there is no pain in the central incisor. and the implant integrates...then you were successful....."watchful waiting"

Thank you for your comments. I also had the same ideas but can make up my mind. The literature is also 50 -50. But more often they leave it and follow up. Funny it is that i saw the minimal distance between central and lateral. Center it more to the canine. I belive that one can see the osteotomy on the x ray, which is more central. But when inserting the implant , it sliped away in the alveola. I will talk to the patient, removal is more safe.

Hi. Leave the implant until osseointegrste. No problem . Good luck.

hi the xray is not telling us all the truth i think to leave it since the tooth is asymptomatic every think will be fine

I have seen many osseo-integrations like this from colleagues, friends and one from myself. I had no issue with pt's pain acceptance or post op infection even after restoration. What I would have done myself in retrospect is back it out immediately re prep osteotomy and re position implant with bone graft of patients harvested bone from site prep.

I’d leave it in personally. the X-ray is a 2D image that shows the widest part of the implant (diameter) so hopefully it’s a little further away from the tooth than it looks.