How to repair a failed implant site?

I am not half the surgeon some on here are, but that implant really looks like it dug into the root of 11. Could that have been the issue? Could you cantilever off 13 now?

You should have known from the guide pin that the angulation was wrong. Also,, too big of implants for area,,, review space requirements, you can measure on a model..and make a splint.

implants are too close together first off.

don't feel bad the distal angulation of the upper canines can be a pain in the a.. remove graft and retry. Did you measure m-d space you need min.. 13mm it looks kind of tight...

Can we get a post-op CBCT to confirm the impingement on #11 and measure the actual distance between implants and implants to teeth?

all too often, without a cone beam, angulation issues both positive (more room) or negative (less room) can be misleading. From a study model, the arch width can be assessed and if needed, mesial of #14 can be shaved to gain prosthetic space of 1-2 mm if needed as well as any distal bulge of a cuspid can be reduced. I agree that the prosthetic space between the implants are slightly close together. My advice, explant #12, graft, evaluate #11 for any untoward apical issues. Be sure of the space constraints for replacing #12 more parallel to #13. Out of curiosity, do you know the width of the space between #11 and #14? Good Luck

Check vitality of #11 may be necrotic. #14 may have a cracked root. If #12 was a failed endo there may be residual vegetative planktonic forms that colonized the implant. Debride the site and place a new smaller diameter implant if the facial wall is intact, if not graft and wait 3-4 months and revise.

Don't place a removable denture on non buried implants. That would be step one. It may have been Bette to splint them then to place healing abutments and they let a rpd ride in them. Since it was not the goal to load them right away, I would have submerged them. At any rate. Let the area heal now and explore to reimplant in 8 weeks. You may have a problem with 13 too. Bury them and let them heal.

As stated above, give yourself more clearance to adjacent teeth. You can use a Lindeman bur (side cutting) to change the angulation of your implant osteotomy when you see it is too close to the adjacent tooth with the parallel pins. You can also move an osteotomy buccal or lingual as necessary before you go to the final drill. I actually don't think you nicked the canine but it's too close for comfort. I do think the cause of the failure was from the removable appliance. I would rather immediately load the implants with non-functional temporaries than use a removable appliance. If you have to... relieve the heck out of it. Then the patient complains of a food trap. I use under prepared osteotomy condensed with osteotomes or Versah implant drills to prepare for immediate implants or implants in soft bone.

Too many implants. should be 3 mm minimum between the implants and 1.5 mm minimum from adjacent tooth. If they are failing, it would best to remove them and regraft. The longer you wait the more bone will breakdown and it will make the situation much worse to deal with.

I've made this mistake before but never have I left an implant like #12 in place because It looks really bad. If the pt. goes for a second opinion you are in deep trouble.. We all have bad days.

How to fix the case would be to do it right the first time. Angulation off, implants need to be 3mm from each other and at least 1.5 from adjacent teeth....I would regraft, let it heal, and replace the implant at a better angle - only if you have space. Just because someone has two teeth missing does not mean you get to place two implants. Measure....you need 1.5mm from each tooth, so 3 automatically and 3mm between implants, so 6mm total of empty space, not including the implants. you placed two 3.25mm so 6.5mm. Do you have 12.5mm of space? Then you can do two implants. My other hesitation is that the molar site is where lots of 'heavy lifting' occurs, so placing small diameter implants may not be a good idea. Good luck.