How should I Manage the Implant Near the Root of Adjacent Teeth?

I have a patient who lost #28 [mandibular right first premolar; 44]. Â #27 [mandibular right canine; 43] moved distally into the #28 site. Â I installed a 3.5x14mm implant in the newly vacant #27 site due to the distal movement of #27. Â The implant tip is close to #27 but has not penetrated the lamina dura. Â I installed the implant in #27 site lingual to #27. Â The bone density was D3. Â Patient is asymptomatic. Should I remove the implant or wait and see if any problem develops? Â She feels a little pressure sensation on the teeth adjacent to the implant.

(click to enlarge case photos)
Before Surgery

![]before surgery](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/06/P-001.jpg)

In the Mouth

![]](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/06/P-003.jpg)

XRAY Film

Healing Cap Cover

![]Healing Cap Cover](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/06/P-005.jpg)

15 Comments on How should I Manage the Implant Near the Root of Adjacent Teeth?

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Dr. J

6/21/2012

What was the mesio-distal space in the edentulous area? Maintaining 1.5 to 2 mm space between the implant and tooth is a good idea. Although the implant does not seem to be touching the adjacent tooth. The concern here would be a too narrow space mesially distally. You can expect some amount of bone loss crestally. a preoperative planning, wax up and measurement would have given you a good idea for the placement of this implant. Take an x ray from another angle you may be able to see some new things.

John Kong, DDS

6/21/2012

It'll work, although the angulation could have been better. Glad to see you used a platform-switching implant. Just one critique, why use a 14mm implant? Unless it's an immediate implant and you're trying to get primary stability, 10-11.5mm is what I usually shoot for.

Dr Chan

6/21/2012

this is an Ankylos CX A14 implant. It is indexed and platform switched. Leave the implant in there. It is fine. The pressure sensation will pass. I tend to use a compact sulcus former with the one-stage procedure. Good job and thanks for sharing.

Dr. Alex Zavyalov

6/22/2012

After going away pressure symptoms, I would proceed. Correction of abutment angulation is necessary to achieve good prosthetic result.

tomobooth

6/26/2012

i think that looks all good, a itlong buthey it works!!! You could have used a really narrow implant ie 3.0mm astra tech

Richard Hughes, DDS, FAAI

6/26/2012

This will be ok.

Shyam Mahajan

6/26/2012

Good case. Good photographs. Looks no need to worry.

dr aalhaio

6/27/2012

good work my friend but next time u can use anarower implant for aresticted mesiodistal dimention

dr. dan

6/27/2012

Restore and watch. It looks good to me

pranav sharma

6/27/2012

It is close but not touching the adjacent tooth.seems fine to me.wait and watch. Regards.

dro

6/27/2012

The implant and adjacent should be fine. My preference would have been to move the angulated cuspid back to its normal position first and then replace the bicuspid instead.

Baker vinci

6/27/2012

I see no problem with this. As far as implant, you are spot on! Bv Vinci Oral and Facial Surg. Baton Rouge, la.

Baker vinci

6/27/2012

Implant length bv

Dwayne Karateew

6/28/2012

There is no need to worry about the implant or the adjacent teeth. No need to have placed a narrower implant in light of the recent publications by Tarnow et. al. regarding acceptable proximity to adjacent teeth when using a platform shift implant (in this case the Ankylos A14). Whenever I have a situation where there is funky angulation of the adjacent dentition (pt. declines ortho correction) or root proximity issues I will plan my case with CAD/CAM guided surgery in mind such as SimPlant. Food for thought for the next case where you may not be so lucky. dk

Sam Jain DMD

6/29/2012

No need to do anything. Looks fine. Got lots of cases like this w/o any problems. Enjoy Sam