Dr. S. asks:
Recently I placed a dental implant in the mandibular premolar area and inadvertently hit the mandibular canine. The periapical radiograph shows that the dental implant has penetrated 2mm into the distal wall of the canine. Should I immediately remove the implant and drill a new path and properly align it? Or should I leave the dental implant where it is and see what happens?
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Dear College ! If the canine is asymptomatic don’t do anything. I experienced, twice this about seven years before and the implant and the tooth are doing great ! To avoid such things place tapered implants and don1t forget, canines are mostly inclined !
actually you should not do a single thing if there is no sympthoms. I have seen it a couple of times and in both cases the implants were integrated.
good luck
Dr. S. I agree with not doing anything if the canine is asymptomatic. I would advise the pt. and document the violation of the canine and also bring the patient in for peridic evaluation of the area. Another suggestion to prevent this is to take xrays at 6 mm, 10 mm etc to check for any anatomy as you penetrate the bone and check angulation. Yes, it des take a little longer but it could help prevent alot of worries. Good Luck.
In my opinion, placing an implant into the root of a tooth does not meet the standard of care. I would re-direct the implant.
Hello. I experienced the same thing. But the patient felt his canine “moved” and uncomfortable.
So I have decided to remove the implant after two weeks. After another five weeks I have placed an implant in a new location. As the bone was thin the implant turned into the canine during placing it. But it did not touch the canine. Since then I use an X-ray during the operation if I have any doubts.
After 16 years of placing implants I still adopt the policy of taking a “check” x-ray with the pilot 3 or 4 mm in to asses the angles. And you know it sometimes saves you.
The question is , Is the cuspid symptomatic? the other concern is that implants need a minimum of 1mm of bone for intergration.You encroached and invaded the biologic width if the cuspid. Therefor there is a possibility that the implant may not fully osseointegrate and may fail, and or the cuspid will become symptomatic , need a rootcanal and now there is a potential problem with you and the patient. I follow one rule in my OMS practice, Be opento your patient, if you comprimise your work , you comprimise your integrity. Would it be that much of a problem to remove it and replace it. I know a patient would want their doctor to be the best, and that is how you handle it, I have been it that same situation, what I say is that after careful review of the x-ray, I feel that I can get it into a better position for the restoring dentist and for the patient.You will be suprised the patient will appreciate your honesty and tell everyone what a perfectionist you are.I always tell my residents that other Dentists will eventually see an x-ray of your work, and critique it, I know you would want a fellow colleague to say, that’s a nice implant
Hi,
I agreed 100% with Dr.Como. I am a periodontist and always have to send report of my procedure to colleagues. When I make a mistake, I would tell patient and redo it immediately since our work is constantly judjed by another dentist and we don’t want to compromise our reputation and integrity as well as patient’s well-being.
Few weeks ago I was helping a resident at NYU.He was placing a 3.25 mm 3I in very tight place between No.11 and no.13.
We had to keep taking Xrays many times with 7 mm pin to have correct angulation and not to damage adjacent tooth particularaly no. 11 as its root was distally curved.
Finally after 1.1/2 hours of haggling we were able to place implant in perfact position.
I believe whenever implant enchroaches upon adjacent root,implant shloud be removed and redirected in proper position,even tooth is asymptomatic.
What happens if so called asymptomatic tooth becomes nonvitalised in future and develpos PAP.
Where would you go then?
Is it not easier clinically, medico-legally and professionally to remove implant now?
Joshi,
Haven’t you heard of bonded bridges at NYU?
What’s the point of removing an implant that has penetrated a tooth – the damage has already been done?
Mongey
ofcourse damage has been done to tooth.
How about possible future damage (failure)to IMPLANT itself because of failure of integration of implant or pathology from tooth?
Also if you leave 2 MM of implant lying in the body of root and if need arise to get tooth extracted in future, how would you manage it?
REMEBER 2 MM OF IMPLANT IS INSIDE OF ROOT.
And of course not only I have heard of bonded bridges I do bonded bridges.RESIN AS WELL AS CERAMIC.
What bonded bridges have to do with this case?
can you explain it please?
I think dr.joshi is right.If in future tooth develops endo involvement,accessary canals may contaminate implant.
If patient needs extraction of tooth and be replaced by implant,then you will end up with shorter implant or no implant at all.
even i agree with dr.joshi, if the implant has penetratd the canine , it is safe to remove it and reposition it , better not to wait and watch for the canine to be lost ,ther is no wait and watch, we are not here to do trials , but to rectify our mistakes immediatly if we have gone wrong and when we know it .
I have seen a couple of cases, not direct injury but implant apices were very close or overlapping with canine roots, and there was no sign and symptom.
But after several years, apical abscesses suddenly arose from the affected teeth. In either case, endodontic treatment was initiated and there wasn’t any deterioration of tooth or implant.
I placed a premolar a few months ago and it was very close to the canine on x-ray. Advised pt and we decided to wait and see. After a few months pt presented with a lot of pain on canine and we did endo. It was in fact infected but implant was fine. Noted that I could feel implant with file as it left root end. Pt was advised of circumstances again but returned a month later with pain again and upset saying canine was originally perfectly ok. Noted crown fracture of canine and we needed to extract it. Upon extraction noted a small dimple on side of root where implant drills had hit root. The fracture of crown was due to very high bite forces of this pt but it did not matter. I am now doing a socket preservation, IV sedation and implant/crown of free. The cost of coming to close to the root. While originally I would have left it to see how it developed, I would not remove it and maybe endo tooth at my cost before pt changes their mind and gets upset.