Incorrect positioning of implant in distal socket: recommendations?

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The implant was placed in the distal socket of 46 immediately after extraction and is nicely healed. The problem is that it is in the wrong position, being too far to the distal. Do you recommend that a second implant be placed in the mesial? The total space is 14mm or little more. What do you recommend?


29 Comments on Incorrect positioning of implant in distal socket: recommendations?

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Boris karloff
1/25/2018
Why not try placing another 2 infront of it?
Gregori Kurtzman
1/25/2018
I would place another implant mesial to the current one due to the space present
OMFSTX
1/25/2018
Unfortunately not only is there a spacing problem but there is apparently violation of the distance recommended between a natural tooth and an implant leading to periodontal issues longterm. Be upfront with the patient and recommend removal of the implant and place another implant in the correct M-D position. OMFSTX
Dr J
1/25/2018
That's the problem with immediate implants...Is always safer to extract the tooth (with or without graft), wait, and place the implant in a much easier condition. Remove the implant and place in the ideal position.
Montana
1/25/2018
Head of the implant looks pretty suspicious, like hoop failure?
Samer
1/25/2018
I would just try to restore it as is!
Montana
1/25/2018
It looks to me like it was restored and the mesial walls failed. Anybody else see this?
Montana
1/25/2018
Buccal wall actually
Perioperry
1/25/2018
Looks like the proximity of the implant to the adjacent molar will compromise the interproximal tissue health once a restoration is placed. A second implant could be placed mesial to this one, but the interproximal deficiency with the existing situation would remain. Also, the mesial of the molar appears to be pretty well deteriorated, necessitating a full crown, which would further deminish the already minimal interproximal space. It would be best to remove the implant, graft the site, and later place a single large diameter implant, or two smaller diameter implants situated to allow for a proper restorative outcome. The adjacent molar should be restored before re-implanting.
Dr. Gerald Rudick
1/25/2018
It appears that a portion of the crestal wall of the implant body is fractured off...and this implant cannot be successfully restored....the fracture probably occurred at the time of installing it under very high torque....I hope it is not already integrated...... when you go back in again, you can use a single wide body implant, or two narrow implants to restore with two narrow crowns to fill the space.
Matthew Osepchook
1/25/2018
I agree with Montana and Perioperry. The radiograph may a bit burned out but I would plan to remove the implant due to position failure and plan to crown the 7 and bonegraft the 6 site. Place a new implant later. Something is strange about the fixture collar on the mesial.
Peter
1/25/2018
Return back to sender!
H. Ryan Kazemi
1/25/2018
Atraumatic reverse torque explantation followed by site graft if necessary; allow to heal, then 3-D computer assisted planning and placement of new implant with guide.
Craig Wright
1/25/2018
Best course of action: Expant, graft and place one implant in the proper position. You could try to place a second implant but why make patient pay for two questionable implants when one would have been sufficient if properly placed. I place immediate placement implants regularly in 1st molar site but place it in the middle where there also just happens to be bone on the buccal and lingual wall-then graft root spaces! Ready to restore in 3 months! I am not sure the implant in question is damaged or whether that is a natural thin area that is burned out in xray. This is a good example of restorative based implant placement being ignored. We used to just place implants where the bone was and then let the restorative dentist take the rap for a failed case in 2-3 years due to improper bio-mechanics!
Carabelli
1/25/2018
The posted radiograph is pretty dark so it is difficult to see the mesial contour of the molar. Is it decayed or burn out on the MO? If it's decay and you have to restore it that will make even harder to restore the implant. A space of 14 mm is pretty wide since I think most molars are about 10 mm wide mesial distally. A pre-op dx wax up could have help you decide if one or two implant crowns would be better in such an irregular space. Should've considered 2 implants from the get go. Even if this one implant was placed perfectly center you will likely have a "tomato on a stick" for a crown. I agree with the comments above that it is too close to the molar and that the head of the implant appears fractured. It also doesn't look like the implant was placed deep enough from the adjacent CEJ. Given all that, you might save yourself some stress by re-doing the case and have that diagnostic wax up done. If you decide to keep this one and place a second implant who is footing the bill since the patient probably only signed up for one? That's an uncomfortable conversation to have...best of luck.
Dr. MarioAG
1/25/2018
The Xray is very dark , but this is my insight about it. The implant is not restorable with a good prognosis, the patient will have lots of problems. The implant is too distal, and also I see the implant is not deep enough in the bone. Due to how dark is the xray it looks like the top of the implant is fractured, and that there is no bone on mesial of the bone. I would strongly suggest to remove the implant, do bonegraft. And start over.
Dan
1/25/2018
Explant ,graft, plan for better position . Do not go further restoring you might or most probably will encounter more problems. Good luck!
Dr AG
1/25/2018
I find so curious that doctors provide very little info on the cases presented recently. Missing info on the case, not great xray, never a picture, etc. This implant in not in the proper position and adding another one will not help. Also the colar look damaged. A new implant or even a bridge will be better than leaving this implant in.
Anthony
1/25/2018
Using a guide and not like a blind man.
Dr R Y
1/25/2018
I would like to restore .
FES, DMD
1/26/2018
If the collar if the implant is indeed fractured, as it appears on the lone radiograph, this could lead to another problem. If the implant has osseointegrated, trephining it out, will likely lead to loss of the distal molar tooth. Not a good situation here.
Ozzi
1/26/2018
Give two premolarized crowns with mesial cantilever
Dr Saad
1/26/2018
There are 2solutions Keep the implant and restore it with a crown that touch the premolar in a wide contact area to reduce cantilever force on the abutment _implant screw otherwise loosening of the screw will occur eventually Or put another narrow implant in thd mesial socket and make another tooth and this is more successful on the long term
Horia Aldea
1/27/2018
Do the endo on 47, remove the implant, than a provisional bridge on 45 and 47. Wait for 6 months for the bone to heal because is a loss of bone on distal 45. The mezial socket looks empty, but the x-ray is not the best.
Timothy C Carter
1/27/2018
Screw retained restoration with a mesial cantilever. Stop trying to create new problems.
Dr Steve
1/27/2018
I would have treated the molar with a crown first. Would have done a cantilevered temporary bridge with distal rest on the medial tooth. Let this set for 3 months. Place the implant in the proper place. Then restored the implant and molar at the same time. Same treatment if present implant is removed. This case reminds me of someone poring a foundation for a house never having looked at the house plan! Well at least we got an implant fee that day. This case is a loser for the patient, the dentist and the practice. Get some more education!
Matt Helm DDS
1/27/2018
We place implants in single-tooth edentulism in order to spare the adjacent teeth from the invasive dentistry required to construct a bridge, based on the conservative doctrine. However, in this particular case, the typical conditions are met for a bridge indication, because the molar needs endo and a crown, and the bicuspid needs the crown replaced. Since this implant is so poorly positioned (and there are questions regarding the integrity of its collar), I would unscrew it and just do a bridge after doing the molar endo. The problems with this implant are just beginning, and will not be worth the headaches – or the bad reputation – in time.
Timothy C Carter
1/27/2018
Unlike others on this forum I will give you the benefit of doubt and assume that you have assessed the integrity of the neck of the implant. Rather than criticize you or the one who placed the implant I will give my honest answer to your original question. Simply restore as a single unit or two with a mesial cantilever. Dentistry, at least what I have seen, is not always perfect. You can correct a future problem if it actually occurs.
Oleg Amayev
1/28/2018
Coronal part of this implant is fractured, and needs to be removed. This implant can not be restored.