Radio-opacity interference with implant success?

I have a middle aged female patient who wants to replace missing #13, 14 with implants.  My treatment plan is for 1 implant in the the first molar site with a cantilevered second premolar.  There is not enough space mesiodistally for 2 implants.  There is a radiopaque lesion in the site that a radiologist has diagnosed either as an enostosis or a retained root.  Will this radiopaque lesion be a problem for the implants?  Your thoughts on this case??

18 thoughts on: Radio-opacity interference with implant success?

  1. Benjamin Selden says:

    The lesion looks suspiciously like a root tip. You can almost visualize the canal space and even possible resorption around it’s apex. If the extracted tooth was ankylosed that would be a likely result.
    If it is to interfere with implant placement, it’ll need to be removed, and grafted appropriately.

  2. Denture Guy says:

    Looks like a root tip to me and it should be removed. If not sure and it is a root tip you run several risks . One of them is the PDL soft tissue creating a softissue encapsulation of your implant
    I’m not sure a cantilevered pontic off an implant in the functional zone is a good idea You would be better placing 2 undersized implants and connecting them. You can create space with C&B, ortho, enameloplasty

    • Craig Wright says:

      I agree-Biomechanically, mesial cantilever would be unpredictable. Better two smaller implants splinted. Remove rt and graft.

  3. Doc Lock says:

    Sure looks like a pair of palatally impacted cuspids. Remove and graft for most predictable results. Consider ortho consult to see if they could be brought into place?

  4. John Burch says:

    This is my take. If the cuspids have not caused trouble in 30+ years, leave them alone. As for the radio opacity, you can probably leave it also. Place two narrow implants, not one. Then make sure you have a comprehensive treatment plan, to manage, financially and biomechanically, the failing alloys on the lower left, possible failing C and B on the lower right, future endo on 18 and 19, and missing teeth on the upper right. Also, you had better get on top of this lady’s hygiene or the implants will fail and you will have to do them over at your expense.

  5. Ben Selden says:

    I encourage those diagnosing the “ canine impactions” to enlarge the radiograph and note the red arrow demarcating the lesion in question. The canines are clear enough, and could be an issue, but not the one the original poster is questioning.

  6. Andy K says:

    Don’t wake up sleeping lion. If the root tip is not bothering patient, leave it alone. Plenty room for 2 implants ( # 13 & 14) without touching the root tip.

  7. Dr R Y says:

    Impacted canines can be seen clearly, if patient have no issue leave it or refer to orthodontist advise,2 small implants are pretty good option with cantilever


    The radio opaque area is distal to the canine obviously an area of sclerotic bone (perhaps condensing osteitis) had a similar case biopsied it and took FOREVER to heal these areas tend to not be well vascularized my opinion avoid implant into area go mesial or distal to it

  9. Dr, Mario says:

    I would suggest 2 implants on the right side. And one implant on the left one on the premolar area, then do a bridge from that implant to the molar on the back.

  10. CRS says:

    I would address the impacted canines the anterior dental work is poor and failing. Ignoring a future problem is not wise. So going forward if you let the anterior work fail then address the canines? The patient would be better served to fix this with a good plan vs a piecemeal solution for a premolars implant with a cantilever. When the bridgework fails you would have just kicked the can down the road, the patient will be older and the surgery more difficult. Hopefully you will address this with the patient.

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