Suggestions for Case with Implants Too Close Together and Periodontal Issues?

I suggest following treatment plan: There is enought vertical bone to place implants 1. remove second implant simply with pliers - it will go out without any problems, or use pliers to screw it out. You may keep first implant but prognosys is no good for this implant also. 2. In remaining socket from implant 1 you may place implant imidiately. Second socket must be filled with bone chips and left for 2,5 month to heal. After that you may place another implant there. 3. Do soft tissue management with temporaries to compensate vertical bone loss Any more ideas? Thanks.

I would also look at the remaining teeth in this area as they are very questionable. I would remove them prior to placing implants and then spread the fixtures accordingly. You may actually end up removing the existing implants and the teeth grafting the sockets and planning implant retained bridge with aid of the surgical guide

I would suggest removing both implants. Let it heal for a few weeks to get soft tissue closure and a little bone fill. Go back in and place with a guide. The bone cannot be predictably regenerated around either implant. It's more predictable to start clean and not have to deal with a headache later. Make sure you use a CT scan to evaluate the area. Do the CT after you remove the implants so you can plan what to put in properly

The treatment plan depends on the patient's healing and surgical skill of the operator. If the patient has poor hygiene or other systemic issues that would preclude ideal healing, take both out. If you take out only 1, you will need to do significant coronal positioning of the attachment apparatus at the same time that you either remove the distal implant or place its' replacement 4 - 6 months later. You will need a lot of skill and luck if you are to maintain one of them.

Upper natural teeth are rather powerful and two weakened implants in molar area will be able to withstand mastication forces for a short period of time only.

I think you need to remove both of them now, and also decide if you keep the teeth in this area. After, place implants in the good position, depending on the decision.

Removing dental implants that have been placed 8 months previously may not be so easy to reverse torque out. There is bone loss around the two Siamese Implants, but if it is possible, attempt to remove the more mesial of the two. Placing abutments on implants #1 & #3, an orthodontic jig could be simply made to drag distal the natural bicuspid, therefore allowing the distal implant to have a more normal sized crown, and the mesial implant to have a proper crown in a healthier periodontal environment. Sometimes.....you have to go with the flow!!!

Again, I believe intraop pa films are " standard of care ". It is such an obvious issue, I have never asked the question . But how does this happen, in the first place. Maybe the bone loss has reached it's " steady state ". If so restore it with a single molar. This is a mess ! Bv

Agree with Bv. First inform your patient of the problem and likely need to remove the implants. Bone loss may have reached the "steady state". If the patient agrees, you could try platform switching the distal implant and placing a well made long term temporary crown. Leave the adjacent implant unrestored putting it to sleep so to test if the situation an be maintained in this state. Watch closely if it apears to be a problem implants must be removed. You do not want to see agressive bone loss because you waited to long to remove the failing implants. If it looks good the temp crown could be replaced when it fails. This can be done with minimal cost and risk. If the case fails your patient will probably thank you for trying.

I don't think bone lost will stop on this case. Already many treads are out of the bone, on an 8 months un-restored implant. Trying to " save " the situation is not a good way to go. You need to think 20 years of service for an implant. We are learn from our mistakes, and removing the implants may be the best way to save the bone, so you can start again with better outcome.

It is clear that you can't live it the way it is. The best option is to remove both implants and regenerate and go back again with two new implants. If not possible, as an alternative treatment plan ( and probably the easiest one) it would be to remove the mesial implant and restore the wider one as single tooth.

What about cutting the mesial implant to bone level , bone graft, "sleeping " it that way?

Remove the distal implant. If one cannot place it distally at the time of removal, than place it latercafter regenerating the bone in the distal osteotomy site. Work on the crestal bone loss later. These things can happen, none of us are perfect.

Ed's comment might have some value. Cut the mesial Siamese implant bone level and put it to sleep. Extract the pre-molar and fit a bridge between the two remaining implants.

Remove and start over using a surgical guide.

Remove both implants, graft, allow to heal, and replace with one implant to support a single molar.

Again, would anyone care to elaborate the downside of cutting the mesial implant to bone level, sleeping it that way. Clean the exposed surface of the remaining implant, Bone graft and allow area to heal. Seems like it's worth a try?