Will close proximity of two implants cause future complications?
Implants in #9 and 10 sites [maxillary left central and lateral incisors; 9, 10] were installed one year ago. They are very close together, but are well integrated without complications. Will the close proximity cause future complications from this point? Should the implant in #9 site simply be left to sleep?
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13 Comments on Will close proximity of two implants cause future complications?
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CRS
6/22/2015
Hard to tell on a panorex, do they line up with the surgical guide?
DrT
6/23/2015
The proximity of the 2 implants to each other and to the natural teeth is not a good situation for all 4 of them. Explanting is going to be extremely difficult. Ideally I would put one t sleep and, I would leave the implant that is farthest away from the adjacent tooth
yalda sadeghi
6/25/2015
t sleep?
Francis
6/23/2015
Proximity less than 3mm may lead to resorption of interimplant bone and hence loss of interdental papillary.
DrPaulNewitt
6/23/2015
As CRS has mentioned. hard to tell on a pan due to the distortion and magnification. Understanding the research and bone physiology will go a long way to helping understand why implants are kept a specific distance apart. 3mm between the two at the crest is ideal for many reasons but again. you can't get an accurate measurement on the PAN
CRS
6/24/2015
Here is a thought, could it be a contributing factor that implant companies set these guidelines due to the space requirements of the fixture mounts and abutments. Remember that patients are custom. Also laboratory requirements for restoration. Since implants are restoratively driven surgeries this is a practical viewpoint which can be lost when placing the implants a combination of surgical anatomy, what will work, and technical requirements. I wonder if a surgical guide which not always easy to use was available during placement. The central incisors need to be centered in the midline and the lateral implant is too wide. A clinical photo would be very helpful to evaluate. It is tough to evaluate on panorex and I often cringe when reviewing my post op panorex, the placements can look really weird. If these are well integrated good prosthetics can save the case and there are a lot of options out there.
Laz S
6/23/2015
Leave the mesial one buried and restore the two - that should be sufficient to hold four anterior units. The buried one won't cause a problem unless you uncover it and try to restore it
joe
6/23/2015
DO do a single thing TIME is in your favor. (Speaking from experience)
Dr. Gerald Rudick
6/23/2015
Situations like this do arise from time to time.... well integrated implants placed too close together, which will lead to a prosthodontics failure.
However, an esteemed collegue of mine in Montreal published an interesting paper on this subject in one of the dental implant journals a while back, where he described technique to separate one of the implants in a vascularized bone block, and move the implant to a more desirable location.
I will leave you his internet address, and he can be contacted to share this technique
For information, please contact: Dr. Gilbert Tremblay
Dr Bob
6/24/2015
I do not know what implant this is. If it is one that will allow for platform switching, then abutments that are a smaller diameter than the implants may provide space for healthy gingiva between these implants. There may be more bone between these implants than what appears on your x-ray. If enough space exists for the gingiva and it can be cleaned even if it is over the implants in a platform switching condition it should hold up.
Dr. Shet
6/25/2015
Though the panorama showed very closed, I can guess, bone between no #10 Implant and no #11 tooth is enough . But bone between #8 and #9 is really unexpected. I think your plan is very good Just kept the no #9 implant silent to avoid load and subsequent bone loss. It will also help you to make a acceptable result of prosthesis. Hope you don't need to be worried about long time survival but regular followup is necessary for immediate action in any situation.
You have more choice but all are complicated and expensive. Think also from the patient point of view, how he/she will be happy.
Richard Hughes, DDS, FAAI
6/26/2015
This is not an ideal situation. Yes a vital segmented osteotomy could be performed or putting the #9 implant to sleep is an option. A periapical radiograph of the area would be helpful. Probably nothing will happen to the bone. The papilla is a different story. It will be a little challenging to restore. You may need custom abutments for the mavillary left implants.
Jali Sadr
7/15/2015
Hi,
Thank you for all comments
1) You could do your job with a single crown on #7 and three connected implant crowns for # 8, 9, 10. By the way, how much is the space ( mesio - distally) for this four units? It seem it is large/wide to make nice restorations. perhaps patient has had space between # 8 and 9 before. Why you can't make three single units on # 8, 9, 10 instead of three units bridge. I would like to know other friends ideas in this regard too.
2) In case you are going to sleep an implant, that is # 10 Not #9 (as you mentioned) because of # 10 proximity to tooth # 11. then you could make a bridge for # 8, 9, 10 which left lateral (#10) is cantilever. This is much better from aesthetic point of view. What do you think?
3) It seems that implants are not parallel to each other, especially #9 and 10. How do you close impression coping for taking final impression? Even you may not able to close those for impression. then what do you do? What impression techniques for two almost kissing implant exist? Could every body shear his way for very convergence implants with photo please! Kindly appreciated.
I hope I could give some hits and asking some questios.
Good Luck
