“Dental implant screw not centered properly between teeth?”
Can a dental implant still work out ok if the implant screw was placed somewhat off-center? I realize if it's extremely off-center it won't work but what if it's only slightly closer to the tooth in front of or behind the implant? I got a dental implant in my upper left-hand side for a missing back molar and it's closer to the tooth behind it than the one in front of it so I'm concerned it may not work out but I won't receive a crown for a few months. He just did a sinus lift and bone graft and put the implant screw and abutment in.
Male | 35 years old
7 Answers
Implants are placed where the proper bone is present. Which unfortunately is not always in an ideal position. Let it heal and your dr will evaluate.
An unfortunate occurrence in dental implant prosthetics is malpositioned implant placement. In fact, a large percentage of my dental laboratory business has been restoring “rescue cases,” which are usually either new cases or remakes of seemingly unrestorable implants.
Premachined angled abutments work wonderfully for poorly angled, yet somewhat reasonably placed implants. A large span bridge with many implants where one or two will have the screws coming out of the buccal can be easily corrected. This applies only if the implant manufacturer makes angled correcting abutments. Nobel Biocare, Straumann Bone Level Implants, Biomet 3i, Zimmer, and a few more make these abutments.
A custom abutment with a milled lingual screw hole is an option when the manufacturer does not make an abutment or the position is too buccal or too deep. In this situation, the custom abutment can be made in the traditional way as any cementable prosthesis with a labial chamfer or butt. After finishing the abutment, a lingual screw hole is tapped with a specific-sized tap that corresponds to a screw. A plastic waxing sleeve and screw is attached to the abutment, and an over-coping is waxed. When completed, the coping is now screw retained.
A milled mesio frame acts as one big custom abutment when all of the implants are malpositioned. A bar that attaches to all of the implants is made with either tapped occlusal or lingual screw holes. The bar, when placed in the mouth, will have the implant screw holes pointed in many different positions. In many cases, the cylinder and screw will be away from the bar. The one piece over frame will lay on top and be screwed into the mesio frame.
An overdenture works in many cases. The angulation of the implant is not as crucial in an overdenture since the overdenture covers everything up. A clip bar acts in many ways like the mesio frame, except the overframe is removable by the patient and, in most cases, the overframe of a mesio bar is not. A one-piece solid bar with attachments—such as ERA, Locator, Hader, and many others—is made and a denture snaps onto it.
Screw holes coming out of the buccal are not the end of the world. In the posterior, the only ones really concerned about the screw holes are the dentist and the lab. The patient really has no expectation of where the holes are. Once filled with the composite, the case is done and the patient goes home—no wiser to the screw hole issue. Sometimes the implant is so far buccal that it comes out of the gingival-colored ceramics of the bridge. This comes out nicely since a pink plug in the gingival is more esthetic than on the mid-facial of an anterior.
Premachined angled abutments work wonderfully for poorly angled, yet somewhat reasonably placed implants. A large span bridge with many implants where one or two will have the screws coming out of the buccal can be easily corrected. This applies only if the implant manufacturer makes angled correcting abutments. Nobel Biocare, Straumann Bone Level Implants, Biomet 3i, Zimmer, and a few more make these abutments.
A custom abutment with a milled lingual screw hole is an option when the manufacturer does not make an abutment or the position is too buccal or too deep. In this situation, the custom abutment can be made in the traditional way as any cementable prosthesis with a labial chamfer or butt. After finishing the abutment, a lingual screw hole is tapped with a specific-sized tap that corresponds to a screw. A plastic waxing sleeve and screw is attached to the abutment, and an over-coping is waxed. When completed, the coping is now screw retained.
A milled mesio frame acts as one big custom abutment when all of the implants are malpositioned. A bar that attaches to all of the implants is made with either tapped occlusal or lingual screw holes. The bar, when placed in the mouth, will have the implant screw holes pointed in many different positions. In many cases, the cylinder and screw will be away from the bar. The one piece over frame will lay on top and be screwed into the mesio frame.
An overdenture works in many cases. The angulation of the implant is not as crucial in an overdenture since the overdenture covers everything up. A clip bar acts in many ways like the mesio frame, except the overframe is removable by the patient and, in most cases, the overframe of a mesio bar is not. A one-piece solid bar with attachments—such as ERA, Locator, Hader, and many others—is made and a denture snaps onto it.
Screw holes coming out of the buccal are not the end of the world. In the posterior, the only ones really concerned about the screw holes are the dentist and the lab. The patient really has no expectation of where the holes are. Once filled with the composite, the case is done and the patient goes home—no wiser to the screw hole issue. Sometimes the implant is so far buccal that it comes out of the gingival-colored ceramics of the bridge. This comes out nicely since a pink plug in the gingival is more esthetic than on the mid-facial of an anterior.
Yes, it can. Since I do not have any clinical records of your case, I am unable to give you a definitive answer. If you would feel better, I suggest you seek a second opinion from an implant restorative dentist in your area. Form and function of your implant restoration and longevity of the implant and restoration do rely a great bit on the placement and location of the implant body but, there are many other factors as well. You should also have a frank discussion with the person who placed the implant about your concerns. Placement of implants can be quite challenging, and precision, though strived for, is really not guaranteed. In most cases, the implant will survive with good home care and regular dental visits.
Hi. Keep in mind that When looking at the position of an implant abutment or cover screw in the gum area, you are really looking at the tip of the iceberg. The implant is placed between the roots of the teeth and the abutment lines up with the root. In summary, a fair assessment considers the xray, and path of the access screw, the bite, etc when determining if an implant is well placed. Hope this helps.
Usually, the implant can be restored without problem as long as there is space between the implant and both adjacent teeth. The surgeon places the implant in the best bone and the restorative dentist makes it work.
Well that depends, but most times it’s not an issue. Usually has to do with the anatomy below the gum. Upon placement, the plan to place them exactly centered doesn’t always work out perfectly. Of course, centered is the ideal, but that is dependent on anatomy of bones and sinus. So, you place them where bone is and compromise on exact center in some cases.
Ideally, it could be okay, but check with the dentist who placed the implant. Ideally, it should be placed with the implant vertical to the ridge of the jaw bone, but anatomical considerations need to be considered as well.
