Poorly positioned dental implant

 What to do with a poorly positioned dental implant?

Poorly positioned dental implants exist for many reasons. These dental implants can end up in really bad positions for various reasons and are difficult for us to try to restore. So, what do you do if you encounter an implant in a bad position? Keeping in mind that sometimes implants in bad positions still work, just don’t count on it.

Steps for an implant in a bad position.

First you need to verify it is in fact in a bad position. I have seen dentists complain about a bad implant from one x-ray. We must remember that the angle of the x-ray highly impacts how an implant looks and can be deceiving.

Angle of x-ray can be deceiving on where the dental implant is.
An example of where the angle of the x-ray can make a dental implant appear terrible when it is in fact fine.

The dental implant is poorly positioned.

If you need the implant in that position then you should strongly consider removing the dental implant and placing a new one in the correct position. The poor position of the dental implant can lead to implant failure. Alternatively, may want to just bury it and not use. A dentist can cantilever off individual implant or make small bar if have room. Using a custom abutment is almost certainly a requirement.

Subapical osteotomy for a vertical ridge deficiency. 12 Oct Would have been better to do a DO first if doing it this way???

If there are multiple implants at odd angles use an open tray.

I have word document of article on this in implant folder called “Implant prosthetic challenges article”

The worst type of poor implant placement is into a nerve.

Bad placement can often still work fine as seen here. Nerve damage from a poorly placed implant is about the worst thing that can happen in regards to placement issues. Again the human body does determine a lot of this. Sometimes the implant is nowhere close to a never and a patient gets nerve damage. Other times the implant is resting right on a nerve and the patient is fine.

Poorly placed dental implant on top of the mental nerve without any nerve damage.
Dental implant placement on top of the mental nerve without any nerve damage. Patient is unsure how old this implant is but does not recall any issues with it.

Anterior implant in a bad position.

A common issue seen from a less meticulous surgeon is a dental implant in the anterior that is outside the bone. We can avoid restoring these by checking the placement as seen in our failed dental implant blog. Some people get lucky and have poorly placed dental implants work.

CBCT of a poorly positioned dental implant that will require removal.
CBCT of a poorly positioned dental implant that we caught before restoring. This implant was from another office and we know from experience to take a scan BEFORE putting a tooth on it if we did not place it.

Implants that fall into a hollow jaw

If an implant falls into an empty or nearly empty portion of the jaw bone it is best to remove but not at the risk for paralysis.

Dental implant falling into a hollow jaw

Implant falling into hollow jaw.Dental implant into a hollow jaw.


Implants that hit a tooth or another implant

The implant success rate does not seem to change when the implant hits or is close to an adjacent tooth Küçükkurt JOI 2022. This makes sense since things like socket shield are showing good success. However, one issue with hitting or coming in close proximity to a tooth is that about 1/5 of the teeth end up needing root canals.

Dental implant touching a tooth is not bad for the implant but can kill the nerve in the tooth.

Patient management of a dental implant that you are not happy with.

Best to be honest and simply say you are not happy with the placement and want to redo it.

Poor placement of dental implant.
Quote from Bill Schaeffer that is really good.