Implants too close together: how to solve?

I placed implants in #11 and 12 sites.  After placing them I realized that they are too close together. The mesiodistal space between them at the crest is 2-3mm.  Should I expect significant bone resorption?Can I salvage this case with some kind of restoration?  I will be uncovering the implants in 3 months. What do you advise?

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27 thoughts on “Implants too close together: how to solve?

    1. obviously not ideal,but more damage may be done removing one implant . My concern and I’m surprised no one mentioned it is the rest of the mouth needs some serious attention. this one area is the least of my concern when looking at the overall situation.

  1. Hard to evaluate esthetic concerns without a photo or models, but you might have some trouble properly positioning the canine from the looks of the pa. Definitely restorable but you might have to fudge the abutments and possibly splint the crowns to get an acceptable result. Hard to say without knowing tissue contours. If it’s a really picky patient you might have a problem but definitely not worth another surgery to reposition. You’ll be fine. Good luck.

    We are all learning…..

    1. Precisely. Look at the thick soft tissue. The region is obviously highly vascularised. There’ll be minimal bone loss – if any – platform switch to achieve a better teeth profile – if u must – & scans here are 2-D anyway – blood vessels run anywhere & everywhere – what makes ppl think just bcos it isn’t textbook, it won’t work? Get a CT – one will see bone behind the implants are thicker & will make up for the less than 3mm textbook recommendation in between implants. Sure beats subjecting the patient to a redo just so we feel good abt ourselves.

      1. And notice the implants are divergent – that means it compensates for inter-implant interproximal insufficiency as opposed to 2 totally parallel implants. Restore the implants & it’ll be fine

  2. You might consider using the canine implant and making a cantilever bridge to include #10, at least you will be able to develop better papillae and embrasures. The implant in 10’s site will be fine if left alone

  3. I had a case like this and I chose to remove one of the fixtures….I don’t think it is fair or ethical to put some thing in someone else’s mouth that you would not accept in yours. And to charge them a healthy fee no less…you can remove one fixture, graft the site and re-enter in 4-6 months. I really believe in cases such as this, our first thought needs to be how can me make things IDEAL, rather than how can I “get away with this”.

    1. I agree with removing one of the implants, graft and replant at a later date. Also, I would definitely splint – I’m looking at the 1:1 crown-root ratio and generalized bone loss. Regenerating ideal papillae is not possible since radiographically these are FP-2 . Hopefully the patient doesn’t have a high smile line.

  4. Unfortunately, this shows bad judgment, poor technique and disregard for doing the right thing–a diagnostic workup and guidestent rather than freehanding two fixtures into such poor position. Further why no intraoperative X-ray to confirm placement, especially as these are freehand. At least then the problem might have been corrected promptly. And the idea to let this case just languish, than intervene earlier is even worse judgment. Lastly, the fixtures are so far below the CEj of adjacent teeth, esthetics–even if the fixtures integrate and that is doubtful–will be very poor. Take an in depth implant course and limit cases to more straightforward ones. This one isn’t.

  5. If your implant system will permit the use of smaller diameter abutments on the implants it could allow for better contours and more space for the soft tissue between the implants.

  6. suggestion to restore the premolar only & cantilever the canine if not able to perform further surgery to correct this situation.

  7. The upper left lateral incisor looks to be hanging by a thread. How about removing the implant at #11, extract #10 and place the second implant in that socket, let it all heal, place a three-unit implant supported bridge from #10 to #13. It’s even possible to leave #11 intact and still make the bridge.

  8. Great idea Rodger. Either way, you need to have a heart to heart discussion with the patient. Let him/her know that although the implants “may work fine” the result wasn’t perfect. Evaluate the smile line and discuss FULLY with the patient and go from there. A lot on what’s best in this case has to be decided with the patient.

  9. I will repeat, which echoes pretty much everything that has been posted above…this patient needs…actually this patient deserves a comprehensive treatment plan. And one final comment…in response to all those who have offered suggestions on how to “salvage” this case (I can’t believe this word would be used for a case that has barely been placed in someone’s mouth)..is there any doubt amongst any of us that if this case went to court that the patient would win a malpractice settlement due to operator’s negligence. I don’t know about anyone else but for me, this would keep me up at night, EVERY night until I was able to do the right thing. Maybe this is just me.

  10. Remove the distal, regenerate, replace in 6 mo’s. Do it for yourself so you can feel good the rest of your life about doing the right thing.
    Yes, painful now, but the good feeling of doing it right will live and glow forever.

    Left as is, it will definitely be a huge defect in as soon as two years, no matter what you try. I’m just being truthful . . I even feel your pain.

    Justify all this as your tuition for a great learning experience in the process of being intellectually curious!

  11. I think you can put a small diameter screw between the two implant to separate and leave the screw for about 25 days and after this time you remove the screw …….

  12. Dr. T just a point of information. Poor results don’t necessarily constitute malpractice. We all have cases that don’t necessarily represent perfection. Statement which refer to such results as malpractice make lawyers very happy. Don’t think that only dental professionals have access to this web site.

    1. I agree Osurg that all our cases are not perfect. I am looking at THIS case and just saying that Standard of Care which includes taking digital images after implant fixtures have been placed BEFORE soft tissue closure would have shown the unacceptable proximity of the 2 implants. How then can one explain not removing one of the fixtures before closing the case? I am just trying to understand. There are 2 possible explanations: first, no image was taken (not good); secondly, an image was taken and the decision was made to leave both fixtures in any way (equally not good). Am I missing something?

  13. Poor treatment planning! Comprehensive Tx plan is one of the major issue with this case beside the distance between those 2 implants. Let’s be proud to be a dental surgeon and stop doing patch work on patient.
    Couple of points here:
    – need to address the issue with the rest of the mouth
    – Look at the severe bone loss in that quadrant; the implant platform is located too apical to have ideal restorative outcome. Platform located in the apical 3rd region of the medial tooth (#10). This could have been avoided with a well planned treatment
    – Since this case will need to go back to the drawing board anyway, you could restore those implants as “temporary” or even better just like it was suggested before, restore the premolar (1 implant) and cantilever the canine.
    – This error could have been corrected during implant placement. Why let case like this walk out of the office without immediate action? Need more surgical training and dental ethic lecture.

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