Loose implant during abutment loading: thoughts?

No, I don’t think it’s OK. It looks like the #8 implant has failed. I would remove it, curette the site and graft with bone of your choice. Then replace the implant in 4 months. Best do it before the bone loss worsens and you have a compromised site

I am assuming these were immediate implants? You need primary stability to load the implant. Without primary stability you are setting yourself up for failure. At the very minimum once you noticed you did not get primary stability, you had the option of placing the cover screws and bury them for healing - create an Essix with absolutely no pressure on the implants and allow 6 months of healing.

Is that a PARL at the apex of #7? An implant that is mobile is a failed implant possible due to periapical infection from #7 or lack of primary stability. Remove the implant, treat #7 with endodontic therapy and start over in that area.

Thank you for the post. Are those immediat implants ? Are the abutments torques same day ? The aesthetic area is a difficult area, may I ask what is your experience in immediat implants ? Any mouvement is not good, may need to remove graft and wait. Assuming position is good (we have no picture and bad quality xray as info) need to burry the implant if you have not 30 to 35 ncm of torque.

We could certainly use a little better radiograph. If you have invaded the PDL on medial of 7 that can produce excessive tissue fluid and if you proceed with loading this one you will have a failure. You should either back out and graft or bury this one for six months and try to check mobility then. During the six months take monthly X-rays to make sure there is no deterioration of the site. If it looks like a lesion is developing....then get it out if there immediately. If the site looks good on radiograph and no tissue pain in the area, then you MAY come out ok. Many times in these narrow spaces, we can get good healing even if the PDL is slightly compromised. Patience is the key. You can always get by with a removable temp for 4-5 months and having an immediate loaded implant is not worth it unless you have excellent stability from the start.

These both implants must be removed. They are both improperly placed. Remove it, grafted, take CT scan, use guided surgery and place implants. On these X-rays: invasion of incisol foremen, damaging adjacent tooth, less than 1 mm space between implant and natural tooth, improper angulation, comprised esthetic due to all these issues. Just remove it and use guided surgery and you will never have to deal with it.

No, it's totally not ok. A mobile implant clearly is a failed implant! How can anyone even ask the question, specially with that very clear (and huge) radiolucency on the distal. Remove, graft, and wait 6 months before placing another implant in that site. Other than that I completely agree with Oleg Amayev's critique and will add that the good implant is also not burried enough as the last collar threads are exposed.

Sorry for my misspelled words due to my really smart smartphone

I totally agree with Matt and Oleg. Raul

What was your torque at insertion? Should have at least 35Ncm to even consider immediate loading. I'm not aware of any implant system where the provisional abutments are seated at 35Ncm, so if there was in fact mobility noticed at abutment placement, immediate loading was contraindicated. Looking at the radiographs, I don't believe you were anywhere close to an insertional torque of 35Ncm.

I have to assume these posted cases lately are bait from a scientific study to see how much dental colleagues will amuse or condone malpractice. These implants were pathetically placed and a disgrace! The anterior-most implant is basically in the PDL of the tooth mesial to it. The posterior implant has basically no good chance of being restored considering its placement relative to the next tooth. I could make an argument for only one implant to replace those two missing teeth to optimize esthetics and implant success. You took a pilot drill PA and still couldn’t get them semi-straight? How do colleagues with any sense of ethics even consider giving someone placing these deplorable implants constructive feedback? Quit practicing on people unless these cases are being done for free. I always hold on to what my surgery chairman once said: “the first 50 cases of something new you do you should be paying the patient, the next 50 you should be doing for free and the next 50 you can start charging for them”. Good advice.

Remove bothe , improper angualtion, graft and rrepeat after 3 months

This is a very difficult , and unforgiving area... smack bang in the middle of the aesthetic zone... Not only are their issues of osseointegration, but prosthetic considerations with implant angulation , to be able to restore and have an aesthetically pleasing result... There seems to be a consensus for implant removal and if the patient allows , re implant. I would consider a prosthetically driven implant guide, to help stay on track.

I'm afraid I must agree with the harsher of the commentators above, and you don't help yourself or us by giving such a brief history coupled to sub-standard radiographs. I must ask what is your experience of immediate implants, because from what you've said in the history "one implant seemed to be slightly mobile" and then to nonchalantly ask "Is this okay", paints a picture of someone who is quite inexperienced in this technique and arguably implant dentistry as a whole. If you're really a dentist (which I'm beginning to doubt) and this is really what you've done then 2 things: 1) Please seek the advice of a colleague proficient in implantology and (in no small part) managing complicated cases because, just from what you've given us here, I concur with the majority of the previous professionals on this forum that you'll need these fixtures removed, the site grafted and then consideration given to fixture selection and placement a few months later after a CBCT and with either CT or prosthetic guidance. 2) If you're planning to go into this field, please invest in some proper training and mentoring because evidently you're not ready for this. I know the above is a bit harsh and its not as if I haven't had my share of failures in >25 years but it is meant as genuine collegiate advice as patients are (rightly) becoming more demanding, lawyers are soliciting our unhappier cases in record numbers and even our own colleagues will act against us as they've usually invested (financially and time wise) in their skill set and so sub-standardness is understandably frowned upon.