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Poor dental implant placement with respect to the adjacent dentition can lead to a variety of potential problems (Figure 3.5). An erroneous location of an implant may cause an esthetic issue with the need to alter the shape or emergence of the crown, as well as potential compromise of the periodontal health of the tooth and adjacent tooth. The etiological factors involved include poor surgical planning, incorrect placement and/or improper angulation, direct damage to the adjacent tooth due to placement of an implant with an excessively wide diameter into a narrow interdental space, and indirect tooth damage due to the generation of excessive heat in proximity to the teeth (similar to thermal injury from proximity to the IAC as discussed previously) [21]. As a consequence of violation of the periodontal ligament space, devitalization of adjacent teeth may occur, as well as external root resorption, resulting in the need for additional treatments such as endodontic therapy, apicoectomy, tooth bleaching, crowns and bridges, and/or tooth extraction. To avoid damage to adjacent teeth, a preoperative clinical and radiographic evaluation is of utmost importance. Radiographic analysis should include measurements between the natural teeth, and determination of the presence of root dilacerations and inclinations of the teeth adjacent to the planned implant site(s). The minimum recommended implant to tooth distance is 1.5 mm, and the minimum interimplant distance is 3.0 mm in order to respect the periodontal ligament spaces as well as biological width. Implants placed too close together may lead to a compromised periodontium and interimplant bone loss (Figures 3.6 and 3.7).

Fig. 3.4. A closer CBCT view of an implant violating the IAC.