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Oral Surgery/Mis-aligned Implant


QUESTION: Hello Doctor,
#19 and #20 have the implants. #17 and #18 are missing teeth.
The implants are in and I am now waiting for my next appointment to receive the abutments and crown/bridge.
Before we started the implant, bone grafting on #20 took place, and the dentist said all looks great and healed well.
I asked my dentist as we were looking at the x-rays of the implants. Why is #20 aligned straight and #19 misaligned? #19 is leaning toward #20 (almost touching at each other at ends where the abutments get attached)? His answer was "well I'm human and there will be no problem".
This answer made me nervous.
Shouldn't the implants be parallel? Aligned straight up and down? And is there a good chance for complications in the future?

ANSWER: Vincent, Thank you for your question. This is a problem when implants are put in "free hand." It is difficult to place implants parallel when a three dimensional (3D) planned surgical guide is not used. Depending on the degree of mis-alignment; this may pose problems at the restorative end. I would ask the restorative dentist to take a look and see if it will be a problem to restore. The best way to ensure that implants are parallel to each other and in an appropriate position to easily be restored is to use 3D surgical guides or place them under navigation guided surgery. Especially when the implants are placed next to each other. For more information about this see:

I hope that helps.

---------- FOLLOW-UP ----------

QUESTION: Thank you Doctor for your quick response. "this may pose problems at the restorative end" Could you be more specific as to the restorative end problems?

Vincent, This is a tough question to answer because I don't know what the implants look like. I would really need to see the angulation and the space. This is why I suggested that you ask the restorative dentist about it. I am happy to take a look if you can send a radiograph.

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James M. Ryan. DDS, MS; Board Certified Oral and Maxillofacial Surgeon


Dr. Ryan's expertise is in the field of Oral and Maxillofacial Surgery. Specifically, Dr. Ryan is an expert in Orthognathic Surgery. He holds uniques experience as the former Assistant Program Director of the Oral and Maxillofacial Surgery Residency Training Program at Washington Hospital Center where he trained residents to perform these complicated surgical procedures. Additionally, Dr. Ryan also has a tremendous amount of experience in reconstruction of the maxillofacial skeleton related to trauma and tooth loss. Dr. Ryan is an expert in 3 dimensional treatment planning for Orthognathic Surgery, Dental Implant Surgery and Wisdom Teeth removal. To learn more about Dr. Ryan, his full profile can be seen at


Diplomate of the American Board of Oral and Maxillofacial Surgery with current hospital affiliations at: Washington Hospital Center Holy Cross Germantown Hospital National Institute of Health/NIDCR

American Dental Association. American Association of Oral and Maxillofacial Surgeons. District of Columbia Society of Oral and Maxillofacial Surgeons. District of Columbia Dental Society. American Board of Oral and Maxillofacial Surgeons. Health Volunteers Overseas.

Journal of Oral and Maxillofacial Surgery Journal of The American Dental Association

S.U.N.Y @ Stony Brook- B.S. in Biochemistry, Stony Brook, NY. Northeastern University- M.S. in Perfusion Technology, Boston, MA. D.D.S.- New York University College of Dentistry, New York, NY. Certificate and Chief Resident- Washington Hospital Center, Washington, DC. Clinical Fellow- The Johns Hopkins Hospital, Baltimore, MD.

Awards and Honors
Dr. Ryan has received numerous awards including: 2006 American Association of Oral and Maxillofacial Surgeons Dental Student Award, Washington Hospital Center 2008 Nurses' Choice Physician Collaboration Award, 2009 Resident Research Summit Scholarship Award, and the 2011 Outstanding Surgical Attending in the Department of Oral & Maxillofacial Surgery at Washington Hospital Center. He has also authored/coauthored and published several journal articles and held several teaching positions,including assistant professor, while at NYUCD.

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