Implants placed too close together: comments?
I placed two implants in the posterior mandible in the first and second molar position. Since the patient could not open very wide, I could only place the second molar implant this far posteriorly and still have the implant placed parallel to the axial load plane. I used a surgical guide, but the second molar position could not be achieved ideally due to patient constraints. At the time of placement, I measured the inter-implant distance at the crestal level with a probe and it was just shy of 3 mm. Just wanted opinions regarding the long term stability of such implants that are placed just at the minimum distance apart? I understand I might get a little loss of crestal bone and therefore the lack of a papilla. However, this not being in the aesthetic area, it should be clinically acceptable. Please comment with your opinions/experiences . Thank you.
18 Comments on Implants placed too close together: comments?
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rsdds
4/4/2016
they look ok to me .. most of my implant failures have been in the lower 2nd molar area so be glad..
DrDave
4/5/2016
These will be fine from an integration standpoint.
A good lab custom abutment will help, but your restorative will be a bit funky. Keep an eye on the occlusion.
LANCE
4/5/2016
that is a nice job! as the excellent surgeon Dr. Ziv Simon states.......... you are treating the patient, not the radiograph. that is a nice radiograph and continue on! let the clinical situation fold out over the months and years with keen observation, probing, and oral hygiene reinforcement . actual in the mouth results will be the standard and I think you have done very well my friend!
mwmrjohnson dds, ms
4/5/2016
You'll be fine. Tarnow did a study, I think it was 2009, where he compared implants placed 4mm apart and 3mm apart. They were straumann bone level implants with the platform shifting. There was no crestal bone loss even when placed 3mm apart. Fortunately you used implants with platform shifting so you shouldn't have any issues. these implants are actually quite well placed.
Dr. Gerald Rudick
4/5/2016
You did a great job...nothing to be sorry for.
When you do the crowns, they will appear as a platform switch situation, and you can open the space and have more than a 3mm speacing...plenty of room for a healthy papilla.
Marc Hertz
4/5/2016
Looks fine to me. Not every case can have textbook parallelism. It is very likely that this will have a good outcome.
Seyed Jalil Sadr
4/5/2016
Dear Friend
Looks ok and fine in radiograph. Since it is platform switching system, then it is ok for papilla formation even is not so critical in posterior region.
By the way, you said that you used surgical guide. How was your guide? Do you have any picture of it to show?
if you had metal tube in guide for 2nd molar so you could not go wrong way unless you did not use it because of your patient limited mouth opening. sorry for my comment.
Anyhow, you did great job and good like.
John Kong
4/5/2016
I agree with everyone on this thread. The dental implants will be fine and it does not look overly close to me.
The fact that they are platform switching implants will also help.
LAnugget
4/5/2016
My only question would be why you didn't place the first molar implant closer to the second bicuspid? That would have given you more space between the implants.
Dr Nehal Sheth
4/5/2016
Looks fine and no issue with distance apart from little prosthetic issue. You can go for platform switching if available in ur system and little lab support.
Best of luck.
CRS
4/6/2016
I think the spacing is restorable. I would not have placed subcrestal. Check in a year with a periapical to see if there is bone dieback. It appears the platform switch is still at the bone margin. It's all about the maintenance. Second molars are tough!
Jawdoc
4/6/2016
My only comment would be to use the open tray technique during impression taking. Non-parallelism of the transfer copings in a closed tray technique may cause the tray to be stuck in the patient's mouth (not a good situation to be in) due to significant undercuts between the non-parallel copings.
Dr. Knowles
4/14/2016
I have done that (with a closed tray impression of 18, 31). And you are right, it is not a good situation to be in. I ended up using a handpiece to open an access hole through the tray while it was stuck in the patient's mouth. That provided access to one of the impression copings and I removed the screw. The impression came out fine after that.
Phenomenal patient, she called me at home that night and apologized for causing me so much trouble. I almost always do open tray impressions now.
A follow up question to the case presented: I don't see the second premolar in the x-ray. Will this be two single freestanding crowns, or part of a more complex framework? If you are placing individual screw retained crowns, I would seat the second molar crown first. That will leave you a straight path of draw for the first. That slight angulation (which is well within clinically acceptable parameters) may cause an interference if seating the second molar with the first molar in place. I had a situation where I adjusted away the contact while trying to place a screw retained crown on an angled implant. This will not be a problem if you are cementing to abutments.
Look at that, I just fessed up to three mistakes, and the poster didn't make any.
dr Sunil
4/7/2016
Looks OK with the spacing between implant Restoring it will be little tricky lab person should be able to manage it without a problem because of platform switching
Phil Mendelovitz
4/12/2016
Looks like you fortunately placed them just subcrestal which will help develop a good emergence profile!
Alexander Gerbakher
4/12/2016
Great job, Doc, Two thumbs up.
MAS
4/17/2016
Like most comments, I am sure you will not have any problem with supra-structure fabrication. I am not sure how far is first implant from Natural last tooth (2nd premolar?). It may be little too far from it as this tooth is not visible in radiographs.
r.mirmooji
4/18/2016
The distance between implants is controversial and the data has been changing. The distances allowable between two implants is dependant on the implant system , from what i remember for 3i it stands around 1.2mm, biohorizons tapered plus 1.6mm, and for bone level implants such as straumann, or biohorizons tapered 2mm.
on your x-ray it looks great to me and as someone else stated with platform switching you will be fine.
