Long story short. Have had recommended bone grafting, crown lengthening, and gingival modification all to place implants for # 8,9,10. 8 and 9 implants appear too far apart and sculpted papillae is not lined up in center of upper jaw making placement of #10 difficult. Dentist would prefer to not have #10 implant placed as he feels outcome will be more cosmetically pleasing with a bridge. Appears there will be no papillae between 9-10 and 10-11. Future bone loss concerns me. Any comments?
Can Dental Implant Placement Be Modified After Healing? (photo)
Doctor Answers (7)
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Implant placement position and papilla formation
The position of the implants can not be changed. Their position should correspond to the position of the planned teeth, which would have been predicted by having done pre-operative models and work up by your restorative dentist and surgeon. It is best not to place implant #10 for cosmetic reasons- so a crown will be made as cantilever off #9. Soft tissue (papilla) can be designed through temporary prosthesis fabrication and specific surgical techniques that your surgeon can provide. Bone loss should not be a concern if implants are integrated and healthy. I hope this is helpful.
Here are some links that might be of help:
Dental Implant Changes after Placement
Unfortunately, implants cannot be moved once placed. To remove it would require surgery, healing and then having another implant placed. There are, however, many creative ways to make less than ideal implant placement cases work. Your best bet is to find a highly competent dentist who can work with an excellent lab to do some "artistic implant dentistry"
Perhaps write back to us with suggested treatments to get further advice prior to doing treatment.
Ronald W. Konig DDS, FAGD LVIF
Implant Modifications after Placement
There a number of concerns you should have been aware of including why we do not usually place implants next to each other! When implants are placed next to each other, there is usually no papilla present because the architectural issues are different than when an implant is placed next to a natural tooth when the papillae is present due to the bone from the tooth. Next, an implant can be relocated by reopen inf the gum and performing an osteotomies to move it where you want if the implant is healed or in solid bone. It would be better to let #9 sleep and have your dentist create a tempory bridge with ovate pontics to form a better gum sculpture.
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Implants cannot be moved unless you take them out and re-do them.
Unfortunately your pictures are a bit out of focus(looks like they are mirror shots?) Hard to tell from this if they are place properly or not. However, once implants heal they cannot be moved. They would have to be surgically taken out, let the bone heal/graft and re-do them in the correct possition. There is the risk of lossing bone and gum by doing this.
This type of work needs to be planned very carefully between the surgeon and the restorative dentist, and both need to have proper training and experience or things could end up very bad. A diagnostic-wax up should be made to see the anticipated size and possition of the teeth, based on this, a surgical guide is made so the surgeon can place the correct size implants and in the correct possition. Even with a guide, the surgeon needs to play close attention to the agulations and depth.
Also, as a general rule, you should not place implants placed side by side in the front teeth. This is because it is not very predictable to get papillae between implants. You will get a better esthetic result if you place two implants(not side-by side) and make a bridge with a fake tooth in the middle. An exception may be in the front teeth (8-9) because the incisal papilla (bump) can remain even if the teeth are lost. So in your case, you could make a brigde--two teeth on 8-9 and bridge #10 (this is a cantelever).
I would NOT recommend 3 implants in a row in the front teeth. Looks like you show all the gums when you smile, if this is not handled properly you could end up very unhappy.
At this point you need a very good restorative dentist or prosthodontist. A temporary bridge should be made to see what things will look like. This can be modified to sculpt the tissues. If you are not happy or it is not possible to work with the current implant possitions, then you will have to start all over and risk lossing bone and gum in the process.
Hope this helps
Can implants be changed once healing has occurred
Once your implant has healed (fused to the bone), change is only possible if the implants are removed. . It is best not to place implant #10 for cosmetic reasons- so a crown will be made as cantilever off #9. Soft tissue (papilla) can be designed through temporary prosthesis fabrication and specific surgical techniques that your surgeon can provide.
Can IMplant Placement be modified after healing?
Upon looking at your case but haev never seen you as a patient, it seems as thuogh your case was poorly planned from the beginning. It is possible to move implants but it requires removing thema dn bone grafting and then upon healing placing new ones. This process will take about a year or so. You probably do not want to go through that.
If possible a smaller diameter implant can be placed in the open area. I would see a periodontist to have the imlant placed. I would also have the dentist and periodontist to confer with eachother and have a plan prior to having any further treatment completed. I would also have a diagnostic wax up of the potential final result prior to having further work completed. This gives the periodontist and dentist a guid to go by so that placement of the implant can be in an ideal postiion. Planning a case such as thi sis crucial to outcome and success. It is a very expensive procedure and should be handled with an extreme amount of expertise and care. Your front teeth are th emost visible therefore the most esthetic.
Dental implants don't move
Once osseointegrated (fused to bone) implants stay put. If the placement is not ideal, then removal and replacement is needed, which will take considerable time. In this situation, having #10 cantilever off of #9 is an option. The soft tissue, the papilla, can be developed in the provisional (temporary) phase of treatment, but may not turn out "perfect".
Bone stays put pretty well under tension, meaning with teeth or implants present, bone stays. When teeth are lost, bone shrinks (this is why dentures can be so problematic). I wouldn't be overly concerned with future bone loss as the implant will help.
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