Implant very close to natural tooth: remove or wait?

I have treatment planned a case for 3 implants in the maxillary right and 3 in the maxillary left.  In drilling the osteotomies on the maxillary right, I noted that the 14 site (maxillary right 1st premolar) the buccolingual bone width was thin, about 4mm.  I attempted an osseodensification procedure in the 14 site.  When I installed the implant, I fractured the buccal cortical plate and lost primary stability.  I changed the implant angulation and achieved 35Ncm stability, did a bone graft and covered with a membrane and sutured.  In the final periapical radiograph, I noted that the implant was very close to the apex of the canine.  Should I remove the implant?  Or should I wait and see what the response is?  What do you recommend?

19 thoughts on “Implant very close to natural tooth: remove or wait?

  1. Tim Hacker DDS FAAID says:

    The safe thing to do is plan on removal soon. Even if you leave it, the residual periapical lesion on the canine may be problematic. There is plenty of bone distal to your placement. Waiting 3-4 months should not be a deal breaker.

  2. Gregori Kurtzman DDS says:

    Remove that implant as implant wont have any intergration to the spot on the tooth its contacting and this will develop an issue given time leading to failure of that implant and possibly the tooth. If you cant place an implant distal to this then graft and place one in a few months

  3. Dandachi says:

    leave it , I have seen many similar cases with fully integrated implants and clinically good ,
    remove it if failed ,, that is it .

  4. Z says:

    Based on the other implants you are obviously a competent clinician. Although this one may be successful given enough time, this implant makes you look terrible. I would remove and graft and wait several months. What if the canine starts to fail and the patient seeks a second opinion? God forbid you have to justify this to your state board of dentistry you will not have a leg to stand on.

  5. Dennis Flanagan DDS MSc says:

    The apparent PA lesion will probably infect the implant so reposition it now and then it won’t interfere with the time sequence of your case.

  6. GYzag says:

    Your best option is to remove the implant and hope you did not damage the canine. As professionals, we must give credit when credit is due and constructive criticism when it is warranted. If you took that Pa BEFORE you closed up the site, that in my opinion is irresponsible. And if you closed up the site before checking your placement and noted the malposition later is also irresponsible. We owe it to our patients to do the best treatment possible. When posting, please provide CT view so that we also can better help you doc.

  7. Sorabh Jain says:

    Why not to do a apicetomy of canine to avoid approximation, hereby curetting the area also to prevent any periapical lesion possibility. Just an suggestion?

  8. Anthony Johnson says:

    There has been an error in the whole scenario from the beginning. Doing implants in 2017 without planning and a guide should never be considered. You can only tell the position of that implant by utilising a CBCT. Therefore I will ask that you do that before any action is executed because it is like asking a blind man to navigate a roadway all by himself. That is exactly what you did during the placement and you dont want to do that again trying to correct a perceived error in an erroneous way.

  9. Manjunath Sati says:

    leave it if any problem we can remove it later,manytimes it looks very close to tooth in the x-ray but cbct will give better result.

  10. Fotis Roilos M.Sc.Impl.,M.Sc.Perio. says:

    If there was a periapical lesion in the canine and the implant was placed in the lesion… then it needs to be removed… If the patient feels discomfort due to the violation of the PDL of the canine… then it needs to be removed! Otherwise, wait and see!

  11. Sean says:

    Your question “Remove or wait” arises because you have assumed the implant is close to apex of 13. Which might not the case.

    Verify with CBCT first.

  12. Dr.Gerald Rudick says:

    Don’t beat yourself up, or allow others to do it…..none of us have 3 D xray vision….my advice is to get a CT Cone Beam scan now and see where the implant “landed”, and if your graft to correct the labial defect was well placed and effective…… then you can decide if it is necessary to remove the implant and start over.

  13. Manuel says:

    Remove the implant and graft. Wait 6 months and take a CBCT and figure out the ideal position of the implant and valorate during this 6 months the canine. You loose time but the rehab will gift better result.

  14. Hashm says:

    hi because the canine was endodontically treated you can remove the apex of the root until you separate about 1.5mm from the implant

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