Thoughts on slightly angulated implant?

The other implant is not splinted to the other tooth . The space from the mesial edge of the healing abutment to the contact point of the adjacent tooth is 4.5 mm . The centre of the implant to the adjacent tooth is about 7 mm.

Yes I agree the angulation is not that big of a deal, but isn't the whole idea of platform switching for crestal placement. Why the deep placement I see dieback in these cases, but we could be looking at the lingual plate vs buccal on a panorex. I think things will get dicey when that natural tooth needs to be removed between two restored implants especially if the crowns are cement retained. If that natural crown was old I would have removed the tooth and placed an implant supported three unit bridge from my perspective. Hopefully I'm wrong.

you are right you are seeing the buccal vs lingual place on the panorex in fact on the buccal the head of the implant was maybe a half mm supracrestal and the lingual was crestal or a half mm sub crestal at the most.

its a platform shift on the other implant and it IS fully seated, note that this is a panorex that lacks precise detail

Raul could you give a good rule of thumb regarding implant spacing between the molar and the natural premolar. I usually use a guide for the crown bulk but when you remove the guide how many mm are ideal? Implant to contact point on the other crown? Thanks

a wax up was done prior to surgery and this was used to create a surgical guide, for a lower first molar the centre of the crown to the contact point of the premolar is 5 mm ; in this case the centre of healing abutment to the adjacent tooth is 6.5 mm ; this means that we are of by 1.5 mm of course this is not ideal but after all we are human and can't always be perfect

Instead of defending the human imperfections re read these posts and perhaps correct it. Remove the non integrated implant and redirect the pilot drill and go deeper to correct the angulation so that the crown won't be so far from the natural tooth. Place the platform shifted implant at the crest and thank the posters for the help. Next time use a parallel pin and take a film to check. Don't blame the sclerotic bone for the poor placement, this is a better way to go. Otherwise don't bother to post the case if your mind is already set you are wasting the posters time or you may just want to be reassured vs correcting your work. A large bulky crown cantilevered will be at risk for failure and you were advised by several posters very politely. Even fudging the natural crown will help. This is good advice from several posters, take it. Learn.

CRS This is a brief answer the question you addressed to me regarding implant spacing: There are many factors that control the spacing between implants and between implants and natural dentition. You are correct most of the time the mesio distal dimension of the crown should be one of the factors that control the position of the implant. Another factor that some doctors adhere to is a minimum of 2mm rule between the threads of an implant and the root of a tooth or between implants. That is a good rule of thumb for implant placement and I try to adhere to it, at the same time I have placed many implants within 1mm between implants and also between implants and natural dentition. The implant design that I use provides that benefit to me, to my referring doctors and more important to the patients.. I don’t want to get into the Implant system, at this time my intention is not to promote our implant system. Another placement option is when restoring a molar with a large mesio-distal dimension, I may place 2 narrow implants and restore with 2 splinted bicuspid. These options allows for better emergence profile, and a restoration with stronger support. Fee wise I may charge regular fees for that extra implant and crown, or half the fee for the implant and the crown and in some cases I may not even charge for one or the other.. I am looking out for the benefit of the patient, and the long term healthy condition of the hard and soft tissue. With our Technic we routinely see bone growth instead of bone loss. I have not been in this forum to long, but I belong to another implant forum and the members sign with their full name, it gives us a chance to know each other and get a better understanding of their postings. Where is your practice? Are you doing orthognathic or basically implantology? Raul R. Mena DMD Oral-Cranio-Maxillofacial Implantolgoy Diplomate ABOI-ID Private practice Plantation FL President Quantum BioEngineering, Ltd.

Thank you for the insight my technique is similar in the spacing I just want to make sure the implant is restorable with good emergence. I sometimes use the fixture mounts as a guide but I pretty much remove them at placement since I need the room and like to see how the implant sits in the bone. I practiced full scope Oral and Maxillofacial surgery in the first half of my career but now have sub specialized in implants with appropriate regenerative grafting. I practice in the western suburbs of Chicago and will think of you Raul in the beautiful Florida weather during our harsh Windy City winters. Thanks for the feedback!

In my experience the patient would prefer to have the non integrated implant redone correctly and know that their doctor did their best. Blaming sclerotic bone and an X-ray after the fact is not the way to go. However Carlos you are very kind and polite. Two things learned, splints while a good guide do not predict a perfect placement and use a parallel pin with a check film during surgery. This is a case it seems with adequate bone and planning but the execution was off. If it were me I would fix it since my restoring doctor would not be pleased.

Oh absolutely a good fix but my advice was trying to explain a better standard in placement. This is assuming the implant has not yet integrated. If it is integrated then your solution is best and perhaps this can be a learning experience vs a compromise. I do not restore hence I offer surgical advice!

So what are your criteria for "success".? I just had a patient in this AM who had an implant placed which was closer to a natural tooth than in this case. She says that she hates the space and does not chew on that side of her mouth. I personally have an implant which also has less space between it and the adjacent natural tooth, and I am here to tell you that the food impaction is dreadful. So when I look at a case such as this, in which the patient probably spent upwards of $4,000 and most likely had the expectation that he would feel comfortable chewing on it, then I really have difficulty asking him to accept a compromise result, when a more optimal result could have and should have been achieved. I think we sometimes lose sight of patient comfort when we get involved in discussions such as this when all we are considering are the "technical" aspects of the case. I remember that the 3 major goals of any dental tmt are Comfort, Function and Esthetics.

THIS IS A FIXABLE CASE WITH A CUSTOM OR ANGLED ABUTMENT!!!! Focus on the case please. Not one of your gone-south cases.

Will check the post

Yeah but God did those natural angulations😊

Cortical cancellous human bone. Sometimes mixed with PRGF if volume is needed. I will add some Bio OSS in my sinus lifts as a radiographic marker. I have been doing this a long time and have found that this is the best product for regeneration.