2 implants are side by side: thoughts?

We recently vacationed in another country (out of US) and my wife had to see a dentist. She had a tooth that needed to be extracted due to fracture (it was not infected yet, just painful) and we asked about implants having heard that it was good opportunity if everything was healthy to have them immediately placed after extraction.We hoped that we could get it restored when we came back. I was told by all means, that is a great idea. The implants were placed in the root holes, and they cross each other in the bone- like an X, and are side by side. She was fitted with a temporary crown, out of occlusion, but it had a gap in the center- anterior -posterior- that was a food trap and it eventually fell off. I do not have radiographs but i do have photos.

A general dentist here in the US said this is ridiculous and is probably not restorable- but he suggested we see others with more experience before we do anything further. They were placed in December- so maybe they can come out easily. This is upper right 1st or 2nd molar, and it had 3 roots, 2 of which were implanted. What you see in the photos are the abutments that were grinded/shaped as you see them, and then filled with amalgam or resin- in preparation for the impression. They had offered to make and mail a crown to us to (have it put on) seat in a few months. I said we would get it done here- since things change and no assurance it would fit after several months. etc. What do you think? Thanks.

7 Comments on 2 implants are side by side: thoughts?

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Dennis Flanagan DDS MSc

2/23/2016

This positioning is not the usual but it may not be unsalvageable. Have the dentist who placed the implants send you the crown and have it cemented and see if it is successful as long as you understand there may be an issue between the implants. I think it will be OK but I have reservations. Dennis Flanagan DDS MSc

perioprosth

2/23/2016

whenever a type of prosthetic, in this case a simple single crown goes into somebody's mouth, it is a MUST to think logically about its maintenance and cleanliness by patient, NOT by the dentist. in this case it is obvious that notion has not been taken into consideration. NO SINGLE CROWN SHOULD EVER BE PERMANENTLY CEMENTED on these implants. food will stay between the implants and none can get them out. and that is setting the stage for future failure. it was a bad idea to place two implants for one molar. did they charge you for two implants? i once met a dentist who had placed two MINI implants to support a maxillary molar for his WIFE, and he was bragging about it. but he didn't know any better. IF the implants were placed Mesio-distally ( the opposite directions of how they currently are) then a single crown with a wide opening in the middle would have worked. but the way it is, your wife can never keep it clean. i wish you could have posted the Xray too. it would have been an excellent case discussion. if the crown is inserted without cement, and is only being retained by friction, would your wife take it out every day to clean it and put it back. Lateral screws won't be indicated since your wife cannot take it off nor can she go to her dentist everyday for cleaning. I would have placed a smaller crown on ONE IMPLANT ( THE CLOSER TO THE PALATE) and would have buried the other implant.

Dennis Flanagan DDS MSc

2/23/2016

Yes I used to think that way too. I've given some lectures in Europe. There are very different ideas about support there, especially in Italy. There is the Italian dentist who places bendable implants successfully to avoid the mandibular canal. There is controversy about the inter-implant tissue contact. Some believe that the intimate contact of the fired porcelain will cause an epithelial adhesion that will prevent plaque accumulation. I have seen this, but I cannot discount the other view that fears plaque accumulation. Since about 10% of standard sized implants will get peri-implantitis, mini implants may turn out to be the best long term modality in the non-esthetic zone. Dental implants are a relatively new technology and there is a continuum of incoming data. Dennis Flanagan DDS MSc

Gregori Kurtzman, DDS, MA

2/23/2016

Dennis with the implants being aligned in a Buccal palatal direction this is going to be uncleanable once a crown goes on and create perio issues between the two implants. I would love to see a radiograph of this before passing final judgement. am also curious what country this was done in. I lectured in Mexico years ago at an ICOI meeting and a practitioner there showed numerous cases of narrow diam implants being placed into immediate sites with premolars getting two like this case and maxillary molars 3 (one in each root) and mand molars 2 (one in each root)

Dennis Flanagan DDS MSc

2/23/2016

Yes that may be true Greg, but there is some evidence of an epithelial adhesion to fired porcelain surfaces. There are different strokes for different folks all over the world. If these treatments are successful over a number of years of service then that's OK I would think. Dennis

2/23/2016

I posted this- and will get the radiographs from the dentist that we see here in the US. In reference to your comments about the inability to keep it clean- when the temorary crown fell off, I immediately realized that this was going to be a disaster. There was/is a small valley about 1mm deep running between those two implants (on the crown). It gets packed with food, and in her efforts to clean it- the crown fell off. It caused tremendous discomfort and frustration. I will get and have radiographs posted. Thank you. Please see radiograph below (or see the gallery above):

Andris Bigestans

2/28/2016

Totally wrog way of thinking and performing implant placement.You have to remember one saying -If You fail to plan You plan to fail.Take them out , wait , restore bone and finally place 1 implant. Sincerely dr.A.Bigestans.MD.DDS.MOS RCSEd.

2 implants are side by side: thoughts?

7 Comments on 2 implants are side by side: thoughts?

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