Can Dental Implant Placement Be Modified After Healing? (photo)

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.

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

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.

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

Dr. T

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.