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Justin posted an update
Hello,
I recently placed an implant that I’m worried about the prognosis. My previous cases have all been free handed. I had my lab make a guide for this case. I ended up relying too much on the guide and placed the implant too close to the adjacent tooth (0.8mm). Has anyone else placed one this close and had it fail or be successfull? Im wondering what my next steps should be? I informed the patient it was closer than I would have liked, have her planned back for a follow up in 2 weeks and plan to leave it buried for 4 months.
dtberat_dds, Jedediah and 5 others9 Comments-
Anecdotal Suggestion
While this situation can be super stressful, it doesn’t necessarily mean disaster.
Anecdotally, I have at times, and many others have placed implants closer than we wish we would have to adjacent teeth. It’s happened once or twice. And aside for a few sleepless nights, I (and the patient) have had zero issues from it.Literature
Long term clinical result of implant induced injury on the adjacent tooth
A study that followed patients for over 10 years found that even when implants directly injured nearby teeth, 90.6% of those teeth remained functional long-term. Only a few needed root canal treatment, and one implant failed in cases with direct root invasion. But overall, the implant survival rate was high at 96.9%, and the stability even improved over time. So, immediate extraction isn’t typically needed, and the implant can still integrate well. https://pmc.ncbi.nlm.nih.gov/articles/PMC8041840/pdf/41598_2021_Article_87062.pdf
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Appropriate Next Steps?
In my humble opinion, the first thing is to take a step back and not stress too much. Thing will be okay.
Now, here are some potential options:
Option A: Take the implant out and re-do the implant placement. You still have time if you wan to do this.
Yes, it does feel stressful to explain to the patient why you want to redo it
Consider if you believe this will make the patient better or worse off
Option B: Leave it as is, and monitor the adjacent tooth for any pulpal changes. (You might be surprised to find that nothing happens.)
Honestly, in this situation, to me it does not look like there is a clear right or wrong. There is no negligence here. You did the best you could. Now navigate what you feel would be best for you and the patient.
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@ivan-chicchon I met a case with the demand of restoring a failed prosthetic (10 years ago), the patient came to the office with 2 one-body implants and a splint prosthetic, but one implant neck was broken. When I took the CT, I was also surprised that the implant was so close to AN IMPACTED WISDOM TOOTH. and the implant is still good after 10 years.
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Thanks Ivan this response is super helpful!
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how was the torque when you place the implant, if you place with high torque it means more pressure on bone may transfer to adjacent tooth, if moderate torque, i think just follow up for vitality of adjacent tooth
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Here’s the pic that @nguyenanhduytrung was posting. He said it’s been in 10 years and no issues @jmsdds
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Agree with @ivan-chicchon . Typically will do fine but just learn from it and take that knowledge and experience to your next case. This is a great example of guided doesn’t mean better and more accurate. A lot goes into it and they can be great but the digital plan needs to be executed as if you were doing the surgery right then and not just sign off on the lab proposal which is rarely good enough. Not that this was the case but I’ve seen these type of cases too often as we have taught fully guided cases to doctors.
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I’ve seen implants in the PDL of adjacent teeth that have zero issues. It will be just fine.
While not ideal, my understanding is we can get closer to adjacent teeth at the apex than at the crest of the bone.
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