Turning Errors Into Opportunities: Managing Malpositioned Dental Implants

Abstract

Dental implants have become the standard of care for replacement of missing teeth owing to their high survival rates, biocompatibility, and ability to restore esthetics and function. However, implant placement is a surgically sensitive procedure that requires precise three-dimensional positioning. Any deviation in angulation, depth, or mesiodistal/buccolingual positioning may result in a malposed implant. Such implants, while still osseointegrated, can lead to esthetic compromise, biomechanical overload, prosthetic complications, and patient dissatisfaction. This review explores the etiology, classifications, clinical significance, and management strategies of malpositioned implants. Prosthetic options such as angulated abutments, customized CAD/CAM solutions, and bar-supported prostheses are described, alongside surgical approaches including osteotomy with repositioning, implant removal and reimplantation, bone augmentation, soft tissue grafting, and decoronation. Alternative solutions like overdentures, sleeping implants, and orthodontic anchorage are also highlighted. Prevention remains the cornerstone, with emphasis on preoperative planning, guided surgery, and interdisciplinary collaboration. The paper underscores that while multiple corrective strategies exist, prevention is always superior to treatment.