Can One Implant Support Two Crowns?

In a case, as seen in the photo below, when you have only 6.4mm of mesio-distal space for two lower anteriors, can we place one implant fixture in the center and implant and have it support two crowns on a single metal-ceramic framework?

25 thoughts on “Can One Implant Support Two Crowns?

  1. Narpat Jain, DMD, FAGD says:

    I have placed 2 mand. incisors on a single implant numerous times with an excellent track record…. it works.

  2. Carlos Boudet, DDS says:

    This is one of those cases that we all get where you may have to choose “the most acceptable compromise”.
    Looking at the posted radiograph, you may want to reassess the condition of the adjacent incisors after periodontal therapy.
    Some of your choices could be:
    1- placing one implant in the center of the edentulous area and fabricating two crowns, which will be a problem if the prosthesis shows when smiling.
    2- placing one implant in the correct position and cantilevering the other central, with better cosmetic results.
    3- Two minis, not my favorite, but it has been done, and
    4- Extracting the incisor on the radiograph with only the apical 1/2 of the root supported by bone and placing 2 implants and a 3 unit implant supported bridge.
    Try not to consider anything other than a small diameter implant (3.0 to 3.4) for these areas.
    Good luck!

  3. Rick Stanley says:

    I have done a couple of these that look great. I have a photo or two if helpful. I like to see a 3.5mm x14mm or longer and have placed temps without occlusion at the time of implant placement. I am typically using Anylos implants and a 15 degree Balance abutment in situaions like this. I allow several months of soft tissue maturation prior to impressing. These anterior teeth have much lower forces, longer implants, greater bone density and minimal incisal edge surface area, all of which lend to the predictablity of these cases.

    • Nazira says:

      Could you please send me those photos as well? I have the same case and would like to see how it will look.

      Thank you in advance!

  4. MEU says:

    You can certainly place one implant to support the two mandibular central incisors. In my opinion, it is better to choose either the 31 or 41 location and then cantilever the other incisor. This has been done very successfully. Looking at the radiograph,( thank you as it always helps) it is apparent that both lateral incisors(42, 32)have lost significant bone support and both may be periodontally compromised. If you find that the perio prognosis of teeth 32 and 42 is poor or guarded, I would suggest that you consider extracting teeth 32 and 42 and ,if possible, place inmediate implants at these locations. Once the implants integrate, then you can easily restore all mandibular incisors with the restoration of your choice. To me this could be a much better long term solution. Hope it helps

  5. dr.chandresh shah says:

    In this case esthetics would be compromised if one implant is placed in the centre with cantilever pontic. I agree with the suggestion of extraction of laterals & immediate implants.otherwise if the bite is favourable in lower ant one implant with cantilever pontic is fine

  6. Dr Phyrum says:

    In my opinion,i would not choose cantiliver as a choice ,please check the mobility degree,if it is in degree one,you can try do the root planning from canine to canine because i can see calculus around those teeth,endodontic treatment if needed . then consider splinting 6 or 5 unit bridges,this works well in my experience .It is economical,esthetic ,long term result,less complication and acceptable for the patients.

  7. Dr Rob Dunn says:

    Two minis have been suggested above, but the sit is two small. Even using two IMTEC 1.8mm implants you would need a mesio-distal space of at least 8mm. Best option here is to extract the lateral incisors and immediate implants to eventually hold a three unit bridge.

  8. Dr. Samir Nayyar says:

    Well you can put 1 implant and give a cantilever and later on, when the adjacent tooth in radiograph, comes out place 1 more implant and replace the earlier crowns with a bridge. I think its not wise to compromise a natural tooth just to give a bridge , if it can serve the purpose for long time after doing periodontal therapy……….

  9. Aslan Gokbuget says:

    After finising Periodontal therapy.Extraction of two lateral incisors and immediat implant in two lateral area and temporary bridge in between…
    best solution..
    good luck

  10. jawdoctor says:

    I am surprised there is no discuss regarding the patient being a poor canidate for implants. LOOK at the calculus, a removable appliance will allow oral hygiene which is not presently important to the patient. An implant with cantilever or bridge reproduce the same chalange to the patient, to keep the implants from being lost due to Periodontitis.

  11. K. F. Chow BDS., FDSRCS says:

    Yes. Definitely yes, because one 3.5mm diameter implant of length 12mm will have as much if not more surface area than the existing 2 periodontally involved incisors. And we all know that an ankylosed tooth/implant is much more difficult to remove than a periodontal ligamentalised tooth, area for area. Probably half the surface area will do.

    And it will prevent loss of the adjacent periodontally involved incisors provided they are root-planed at the same time. Even better if they are splinted to the implant.

    Two 1.8mm diameter minis will also suffice. A removable prosthesis is a no no because it will speed up the loss of the incisors, seeing that they are already periodontally compromised and probably mobile.

    Please… extractions as far as possible. You might as well do a conventional 4unit bridge on the 2 incisors…than to extract them.

  12. K. F. Chow BDS., FDSRCS says:

    We must not subcumb to the hubris of thinking that our dental implants are better than real living teeth with real living periodontal ligaments. They are a very good imitation…….only an imitation..though a damn good one.

  13. Dr Pushkar says:


    I suggest if the patient is ready to pay, removing both 42 and 32, since they are periodonticaly compromised, and giving 2, 3.5 x 10 mm implants immediately after extraction and giving a 4 unit bridge. The patient would be free from trouble for few years.

    Else going in for 1 3.5 x 10 mm implant and giving 2 zircona crowns over it, with pink porcaline to cover up the gingiva giving an esthetic smile.

    If two implants are placed so close to each other, there can be bone loss bw them, and result can be un-esthetical.

  14. K. F. Chow BDS., FDSRCS says:

    Even if the patient is willing to pay, Black’s principle of “Conservation of sound tooth structure” should not be forgotten.

    The two incisors looks alive and sound to me. The conservative option should always be considered first before other options in the name of aesthetics and “patient willing to pay”.

  15. dr sodhi sps says:

    Yes, I too hv placed in such compromised situation one implant with two small incisors , there no space &is good in compromised place. Placing two minis even sometime is difficult. It works . Good luck

  16. Dr. Danesh from Iran says:

    Dear colleague;
    periodntical assessment of this pt. shows a poor oral hygine, so careful scaling & root planing in order to be sure about oral hygine maintanance is mandatory, befor attempting any implantation.
    As a RULL the min. space needed in bw implants is 3mm & 1.5mm bw implant and natural teeth is necessary.
    therefor to keep 1.5mm distance from the laterals, you have only one choice, that is to place a narrow 3.5mm implant in the center .
    To make the crown if the midline is off , u can make only one crown w/c is ideal hygenically, or else make 2 small incisors ,w/ one base [implant] at the center.Donot think about ext of latterals unless those are mobile[3rd degree].
    I hope it could help.

  17. Dr. Amer A. Jasim says:

    in this case you can use 2 crowns with one implant if you have good bone quantity and quality, I mean the fixture length > 12 mm and the bone aronding the implant 1mm and above and always use delay loading.

  18. Dr SenGupta says:

    The lateral incisors are a joke
    Remove them and place a 4 unit bridge on 2 implants
    Standard implants into D1 bone supporting 2 incisors is almost bomb proof ,aesthetics and hygiene access will be better than all other options given .
    However for the sake of discussion lets assume the laterals were sound …two minis would be my preference here, its classic but i do agree that even for that ,the space does appear small.
    A single 3.0mm implant with a cantelevered pontic is likely the best way here
    Although abutments on most standard implants tend to make lower incisors look bulky this solution in this case would be the most predictable..I would do a wax up to ensure aesthetics are satisfactory

  19. gpkaralis dds says:

    I think sure in the anterior region one, preferably larger, implant and a cantilever where there is inadequate mesial-distal space can be a good solution. Particularly where the adjacent dentition is sound and especially where there is adequate bone width for a larger implant. In this case though I want the laterals out of there now to prevent further loss of bone height, especially if there are any esthetic concerns. Look at where the bone levels are now, that’s already plenty of a challenge. Even if the periodontal issues are resolved that little remaining bony attachment is going to succumb to the load. And you have no sound dentition there to provide protection to the cantilevered single implant.

  20. prof.dr.Hossam Barghash says:

    treatment planning is based always on scientific analysis of the situation. one of the point which important considering dental implant is examining the surrounding tooth/teeth condtions this for two reason first prepair the area for implant,seconed to see the survival state,to see if wee can keep it or not,you would not put an implant and after few month discover that you shoul extrat one of surrounding,this is waste of time & money for the patient ,as you will not wait and find your self replacing each tooth with implant. seconed popint to splint the natural teeth with implnat espicially in this condtion is not wise at all, the end result is lossing the implant & teeth.third can we do cantilever in case similler to this with good surronding teeth condtions ? the answer is yes,putting in mined occlusion , direction of force &anterior guidence of occlusion.

  21. K. F. Chow BDS., FDSRCS says:

    Treatment planning is based on scientific analysis of the situation. It is a derivative of basically 3 mostdi considerations:-

    1. The patient’s expectations and budget.
    2. The patient’s oral and general medical condition.
    3. The dentist’s expertise and materials available.

    We all have our favourite modus of treatment, but before we decide on the final treatment plan, it is win-win all round if we run through these 3 basic considerations first.


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