Implant close to root canal tooth: thoughts?

This case replaces a failed 5-unit bridge. I placed two implants in the maxilla in the first molar and first premolar implant sites.    I used a guide stent to place the implants.  The implant in the first premolar site is slightly palatal and close to the canine which had endo treatment 2 months prior and has an apical scar.  The implant apex is about 1mm from the apex of the canine.  Both implants have excellent emergence profile.  Thoughts on this case? How would you proceed?

30 thoughts on: Implant close to root canal tooth: thoughts?

  1. Oleg Amayev says:

    How did you plan this case and ended up that close to the root.
    5unit Bridge: implants place in area of first premolar and first molar that makes only: 3 unit Bridge not 5nits. ????
    You can difinitly fit 5 small microscopic teeth 🙂
    Please provide more explanation.
    I will also suggest ( real 5 teeth missing space)never place 5 unit Bridge over two implants that will cause lots of force and implants my fail. I would recommend minimum 3implants and 5 unit Bridge, ideal will be 4 Implants and 5unit bridge.

    • k says:

      the patient had a 5 unit bridge from first bicuspid to second molar this failed and was removed …. a 3 unit implant supported bridge is the plan from first bicuspid to first molar site

      • Oleg Amayev says:

        First bicuspid to second molar still makes 4 unit bridge.

        1st Bicuspid, 2nd Bicuspid, 1st Molar, 2nd Molar = 4units not 5.

        I would remove this implant and reposition in a proper place during the surgical placement.
        Now, after it integrated you must make a choice remove and reposition, or keep it.
        This is very hard to say what to do, its all depend what kind of treatment you want to present to your patients. I think just explain properly to your patient and reposition, it will be better in a long way. If this patient will be seen by other dentist they may say something about that treatment, and i think it will be better if that comes out from you not from someone else. Things happen, just try to explain to you patient and i am sure patient will understand that you want to do good for him or her.

  2. Oleg Amayev says:

    Also possible that your X-ray angulation is incorrect. Check again, you must stay way from natural tooth min 1 mm and implant to implant 3 mm if you in that range then you should be OK.

    • Lukas says:

      This is the old concept of Tarnow paper published about implants with external connection. New rules and new materials are used nowadays. Don’t listen to Oleg, don’t remove the implant, everything is gonna be allright.

      • Oleg says:

        Lukas, did you read all my comments? It says that he’s Xray angulation May not be correct ( two X-rays showing different angle)
        For the record; if I placed accidentally implant into another tooth and I took Xray and I saw that I would remove that implant and reposition in proper space.
        If you as a dentist placing implants into adjacent teeth and you tell your patients that’s OK then you should not place them at all.
        To place a screw anyone can do but to do it properly you will need training.
        Before you saying anything try to read and understand what I was trying to say before you judge.
        For the clinician who placed this implant retake Xray and check you how close you to that tooth and make you decision. Also remember if you very close to that tooth make sure you will have space for proper tooth gingival profile otherwise loss of gingiva may happen.

  3. Matt Friedman says:

    That second image may be deceiving. In the first image I see more inter-proximal bone. I think you should take some additional radiographs at different angles to be sure.

  4. Raul Mena says:

    That risk in this case is not that the implant is to close to the root.
    The problem is that the apex of the implant was placed into a periapical lesion.
    Removed before an independent council comes after you. There is no statu of limitation in this case, since you are aware that the implant was not properly placed

    • dj says:

      This could be just a residual cyst. 50% of healed PA lesions do not “recalcify.” If this is not causing a problem, it is not a problem.

  5. Eric Ruckert says:

    Actually I think it is fine. The first XR is correct and perpendicular to the tooth, the second was taken at an angle, as judged by the over lap and smaller space between the second implant and molar.

  6. ll says:

    look at the first radiograph……………… I see bone between the endodontically treated tooth and the implant. Matt Friedman is correct.

    • KENT says:


  7. FES DMD says:

    It’s the angulation of the 2nd p.a. xray that is deceiving you. I think the implant placement is fine, but obtain a CBCT to verify this.

  8. Tan Sea Hunt says:

    I had a similar case like yours where implant appeared very close to the upper maxillary canine on the OPG. Although I knew before hand this is expected, I took a CBCT which confirmed there was generous distance to the adjacent root.

    Reason for this appearance is the maxillary can root is buccal to the implant placed in the first premolar area on the OPG. For intraoral radiographs it is similar, and will give a wide range of distances depending on the position of sensor at the corner of palatal vault.

  9. Dennis Flanagan DDS MSc says:

    Get a CBCT and ascertain the position of the apex. The apex appears to be infected which may lead to a retrograde peri-implantitis or if it advances to the coronal, a late failure. Consider a revision apicoectomy that removes a wide swath of bone

    • dj says:

      Radiographs do not establish existence of an infection. They only reveal differences in density. That leaves a lot of options in your differential diagnosis, including absence of pathology.

  10. Dr R Y says:

    If patient is complaint free at moment don’t disturb but in future It might be raise trouble to each other like failure of RCT or peri apical infection will definitely disturb the implants osteo integration or on other hand peri implantitis will lead infection to adjacent tooth both are very near so in my opinion better option is repeat implant in order to avoid future loss.

  11. Aziz Amro says:

    I think it is fine.
    We could see enough bone between apical area if implant and canine in the first X-ray.

    Peace of mind

    Take care next time
    Some time you need to take intermediate X- ray

  12. Paul McDonald says:

    We do not know if the apical area on the canine is infected or healing without an xray taken at a different time in relation to the endodontic therapy.

  13. Cynthia says:

    Let patient know implants look good and you are concerned about the adjacent endo. Send to endo that has a CBCT. You will have piece of mind on positioning and you will evaluate the periodical lesion and hopefully have it retreated. Once clear then treat with a 3 unit bridge. I always take a CBCT first and treat any endo lesions prior to implants and always inform the patient.

    • dj says:

      Radiographs do not establish existence of an infection. They only reveal differences in density. That leaves a lot of options in your differential diagnosis, including absence of pathology.

    • CRS says:

      I like this response and I would back it with a CBCT to see if the implant is just palatial giving a skewed result. Treat the patient not the film. If you feel it is restorable go with it. The crestal portion of the implant seems to have enough clearance with the canine. The root should be okay, perhaps a long term temporization to be sure. Not impressed with Oleg’s response.

  14. CRS says:

    I would go with Cynthia’s advice, if the RCT was done with a microscope By an experienced endodontist I think the radiolucency will not be a problem just follow it at recall.

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