Two Dental implants almost touching: What are my options?

I am a patient. I have had two dental implants (Nobel Replace tapered) done and the plan was to have them apart enough to allow a bridge of 3 crowns. Unfortunately, they were installed too close and almost touching. I am reluctant to go through options that may result in more complications. At this stage aesthetics and perfection is the least of my concern. I am looking for ideas that involve minimal reworking and minimal risk for further complications. The installation was carried out 3 weeks ago. What are my options?

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23 thoughts on “Two Dental implants almost touching: What are my options?

  1. Based on the OPG and sticking to the site of concern, I would recommend:-

    Have a chat with your dentist and discuss about getting one implant removed and place bone particals at the site of defect. I would have the sinus lift done at the same time for the same side after getting the sinuses assessed by the ENT specialist..

    I would also advice you to discuss with your dentist about placing implants at 15 and 16 site in6-8 months and option of delayed implant loading . You can use temporary denture at the site of missing teeth during this time.
    ( make sure denture is relieved at the site of 14,15,16)

    I like to stay away from immediate loading but it varies from dentist to dentist.

  2. It makes perfect sense for you to minimise further reworking and risk. As you are, sensibly, looking for a compromise rather than perfection, here’s a simple idea. Keep the implant further back buried and just use the front one. Have a molar put on that one which will fill in the corner of your smile and give you significantly improved function. Just live with a gap further back. This would require no further surgery and will be straightforward to do. Hope this helps.
    Dr Andrew Shelley, England

  3. At 3-4 weeks, osseointegration (bone forming around the implants) is at its weakest so removing the implants will be simple. I wouldn’t delay as implants this close together will ultimately become problematic and their removal may be more destructive to the surrounding bone. There should be a minimum of 3 mm from implant edge to implant edge.

  4. At this point I think a good lab could make custom abutments joined over which crowns/bridge could be cemented. The only way to know for sure is to get your dentist to take an impression and send it to the lab to see if this would be feasible. I think any attempt to remove one implant will lead to the loss of the other , due to their proximity.
    If custom abutments are possible then you can go ahead with the bridge as planned

    1. Disagree…after 3 weeks it should be quite easy to remove the rear fixture and graft the site…the alternative of leaving both of them is setting up this area for inevitable problems in the future and very possibly loss of BOTH implants…but you need to act quickly. I would also strongly suggest after you deal with this issue that you discuss with your dentist the other teeth in your mouth as I see from the enclosed x-rays that there are several other concerns in your mouth. Finally, second opinions are always an option

  5. I applaud your desire to seek consultation from a group of surgeons rather than lawyers. This is a pretty straightforward situation. Judging by the surgical result you dentist was trying to avoid the sinus graft procedure. Unfortunately if you want to correctly restore this area it’s a necessity. The process is simple.
    1. Remove posterior implant, graft site and place membrane.
    2. Sinus lift and simultaneous place implant site #3. Lateral wall sinus graft not internal osteotome lift.
    3. Restore in 5 months.

    As the other dentists have remarked please have your dentist inform you of the other dental issues that are visible to us in your panoramic radiograph.

  6. Dr. G makes a lot of sense. Unfortunately judging from your current surgical result your dentist does not have the requisite skill to perform Dr. G’s simultaneous implant/sinus lift procedure. The procedure is very simple in the hands of an experienced surgeon. My patients generally go to work the next day and sometimes the same day. Find a periodontist, oral surgeon, or implantologist who routinely does these. I would flat out ask the doctor how many he or she has performed. The answer should at least be double digits. Do it soon because once you get past six weeks healing it starts to become difficult to remove the implants. Not impossible mind you, just more difficult. Good luck to you and post again with your new results. I think I can speak for everyone when I say we are rooting for you.

  7. As a patient, you are a very decent person….sometimes things happen that are not planned for……yes the implants are too close together, and yes, it is a simple matter to simply unscrew the distal (rear) implant at this stage, because it is not osseointegrated ……. so have your dentist remove it by simply revere screwing, and I am sure he will give you a full refund for that implant, or you could leave the finances as such, and he could plan to place a posterior implant in the proper space, at no cost to you.

  8. I agree that removing the back implant as soon as possible since it is easy to do now and very difficult afterwards. I had a patient who came to me with implants placed similar to this and her previous dentist had tried to restore the case, but she couldn’t clean between the implants and the area was constantly bothering her due to gum disease. We finally removed the crowns and let the back implant “sleep” while we restored the front implant and the area finally healed.

  9. A good restorative dentist can manage this situation without problems. I have done it and seen it done. It requires paying attention to the abutments and contouring the final crowns properly. If your dentist believes he can do this let him have a try. IT IS NOT DIFFICULT. if it becomes a maintenance issue (the only real concern), then the distal implant can be covered or left as an overlay abutment and another implant could be placed further back. If this was my mouth or a loved one’s I would not remove the distal implant. Best of luck.

    1. DJ: How can you not see the MAJOR perio issue between these implants? Perhaps you are also not seeing the perio disease throughout his mouth. I am a periodontist and this makes me feel so sad that so many dentists these days either ignore or are ignorant as to the BASICS of periodontal health.

      1. Agreed. It’s the old story of comprise to suit the dentist instead of doing what’s predictable for the patient.

        We are all given a standard of care to follow. We all know what is correct and what is not. Clearly this is not. At what point do we as a profession represent the ideal instead of the compromise?

        Read between the lines in the comment above,
        If that doesn’t work then try this.

        It takes 5 minutes to remove an implant. It will take multiple surgeries to fix the bone loss on the front implant if you can’t keep it clean.

        The current implant placement is surgically and restoratively unacceptable. I would never want that in my mouth. Why in the world would anyone suggest to try it? It indicates a disregard for the value and wellbeing of the patient.

      2. This is an xray and the implants are not exposed. That’s why you can’t see the periodontal issue here. There is none. Give it a chance. I have seen it work.
        Do not condemn based on aesthetic or pre-conceived notions and “theories”. Do you simply extract every molar furcation? The vast majority of these will be fine. Read the full post.

        1. I would venture to say that if you showed these images to 100 dental educators that ALL 100 would say to at least remove the distal fixture, if not both…this is what I learned when I was in dental and perio school. Please tell me what principles of optimal intra-implant distance you learned wherever you went to school…This is EVIDENCE-BASED dentistry…not let’s just wing it and see what we can get away with. I can site you hundreds of scientific articles to support the need to remove at least one of these fixtures. Would you kindly cite references to support your approach. Thank you

          1. No need to get rude. If you do not think you can manage this situation that is fine, refer to a dentist who can. I have with excellent results.

      3. Agree, the second implant should be remove. Trying to restore the case is a very bad idea and will lead to more problems.

  10. Dear Patient,

    This is a resident level mistake or error. Most literature now states that implant fixtures should have a minimum of 3mm in distance at the platform level, here the xray shows its closer to 1mm. Since they are buried, there are no periodontal issues, once they are uncovered or restored, may lead to periodontal issues (bone between the implants will slowly disappear and chase all the way to the apex). This may cause repeated infections and sensitive gums and recession of the gums and exposure of the implant surface. Read up on peri-implantitis for more details.

    Both implants appear to be 3mm too long on the panorex, not sure since the anatomy of the sinus does vary, but a CT scan would be a better imaging study to verify this. May be of no clinical significance at this time, although it may affect the health of your sinus. I would still get a CT scan to document post-placement of these implants.

    Placing 3 teeth on these two implants will be prosthetically challenging (normal components may not fit well on implants this close and will need customized components) and may run into implant or prosthetic fracture, screw-loosening over time. Ideally, the anterior implant could have been closed to tooth #5 and the distal implant closer to tooth #1.

    Solution: At minimum, as some have already recommended, remove distal implant (the one closer to the rear of the mouth). Replaced the defect with bone and place another implant closer to tooth #1. A 3-unit fixed bridge is feasible with good long term longevity. Keeping both implants may be the easier thing to do now, but it will put your entire prosthesis at risk, no matter what anyone says. I can understand that it has been done before and is successful but there are too many variables to account for success from one patient to another. Anecdotal dentistry is valued too high, and we as clinicians should always adhere to evidence based dentistry as much as possible.

    Advice: To be honest, your dental surgeon is borderline incompetent. As i’ve stated earlier, this is a scenario in which this result may be possible for a dental surgery resident (doctor in training) who was unsupervised, but not an experienced clinician. I would seek a second opinion very soon so that reversing the implants out will be simple and easy rather than having the implants removed after they have integrated. Your situation is unique, and although there are varying opinions on your case in this very forum, there is a majority consensus on what you should do. Time is of essence.

    Good luck.

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