Will close proximity of two implants cause future complications?

Hard to tell on a panorex, do they line up with the surgical guide?

The proximity of the 2 implants to each other and to the natural teeth is not a good situation for all 4 of them. Explanting is going to be extremely difficult. Ideally I would put one t sleep and, I would leave the implant that is farthest away from the adjacent tooth

Proximity less than 3mm may lead to resorption of interimplant bone and hence loss of interdental papillary.

As CRS has mentioned. hard to tell on a pan due to the distortion and magnification. Understanding the research and bone physiology will go a long way to helping understand why implants are kept a specific distance apart. 3mm between the two at the crest is ideal for many reasons but again. you can't get an accurate measurement on the PAN

Leave the mesial one buried and restore the two - that should be sufficient to hold four anterior units. The buried one won't cause a problem unless you uncover it and try to restore it

DO do a single thing TIME is in your favor. (Speaking from experience)

Situations like this do arise from time to time.... well integrated implants placed too close together, which will lead to a prosthodontics failure. However, an esteemed collegue of mine in Montreal published an interesting paper on this subject in one of the dental implant journals a while back, where he described technique to separate one of the implants in a vascularized bone block, and move the implant to a more desirable location. I will leave you his internet address, and he can be contacted to share this technique For information, please contact: Dr. Gilbert Tremblay

I do not know what implant this is. If it is one that will allow for platform switching, then abutments that are a smaller diameter than the implants may provide space for healthy gingiva between these implants. There may be more bone between these implants than what appears on your x-ray. If enough space exists for the gingiva and it can be cleaned even if it is over the implants in a platform switching condition it should hold up.

Though the panorama showed very closed, I can guess, bone between no #10 Implant and no #11 tooth is enough . But bone between #8 and #9 is really unexpected. I think your plan is very good Just kept the no #9 implant silent to avoid load and subsequent bone loss. It will also help you to make a acceptable result of prosthesis. Hope you don't need to be worried about long time survival but regular followup is necessary for immediate action in any situation. You have more choice but all are complicated and expensive. Think also from the patient point of view, how he/she will be happy.

This is not an ideal situation. Yes a vital segmented osteotomy could be performed or putting the #9 implant to sleep is an option. A periapical radiograph of the area would be helpful. Probably nothing will happen to the bone. The papilla is a different story. It will be a little challenging to restore. You may need custom abutments for the mavillary left implants.

Hi, Thank you for all comments 1) You could do your job with a single crown on #7 and three connected implant crowns for # 8, 9, 10. By the way, how much is the space ( mesio - distally) for this four units? It seem it is large/wide to make nice restorations. perhaps patient has had space between # 8 and 9 before. Why you can't make three single units on # 8, 9, 10 instead of three units bridge. I would like to know other friends ideas in this regard too. 2) In case you are going to sleep an implant, that is # 10 Not #9 (as you mentioned) because of # 10 proximity to tooth # 11. then you could make a bridge for # 8, 9, 10 which left lateral (#10) is cantilever. This is much better from aesthetic point of view. What do you think? 3) It seems that implants are not parallel to each other, especially #9 and 10. How do you close impression coping for taking final impression? Even you may not able to close those for impression. then what do you do? What impression techniques for two almost kissing implant exist? Could every body shear his way for very convergence implants with photo please! Kindly appreciated. I hope I could give some hits and asking some questios. Good Luck