This landed in my lap on Thursday, patient is seeking a better smile and wanted the missing teeth filled in somehow. He is from Riyadh, Saudia Arabia, where the implant in question was placed almost three years ago. I have sent him for an endodontic consult first on the premolar and molar on both sides, but especially here to see what course of action we may take. The patient tells me that the space was larger three years ago and has been slowly closing up. We immediately extracted the retained roots on the palatal and grafted with CaSO4 and RCT to follow on the first molar in that area as well.
My concern is treatment planning this case. The Nobel implant is in very close proximity to the canine and the premolar has drifted to about up against the implant making restoration very difficult, certainly not a fixture level impression?!?!?
Any ideas I would love to hear them thank you.
Periapical radiograph of canine showing superimposed implant
Periapical radiograph showing implant and adjacent teeth
![Mirror shot of the palate intial pic]https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2013/10/IMG_5233-e1382473010555.jpg)Mirror shot of the palate intial pic
Front shot with teeth apart
Side shot of mouth closed
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