Distance between implants considerable: long-term success?

I placed 2 implants in the maxillary right posterior quadrant using an indirect sinus lift without bone grafts. The implant in 16 is 3.5×11.5mm and the implant in 17 is 5x10mm. The buccolingual bone width was sufficient.  I am concerned about 2 potential problems:

  1. Do you consider the implant in 17 site too close to tooth 18?
  2. The distance between the implants is considerable.

Can you recommend options for prosthetic rehabilitation with the greatest chance for long term success?

20 thoughts on: Distance between implants considerable: long-term success?

  1. Gregori Kurtzman DDS says:

    Distance to the natural teeth is fine. i would restore this with a 3 unit bridge as doing that with 2 crowns will create a food trap under the contact between them that can be remedied with a bridge and how the pontic contacts the ridge.

  2. Zev Kaufman, DDS says:

    Excellent placement! Restore with a Three unit bridge and when delivering a provisional, anesthetize the patient, make a small mesio/distal incision and create an ovate pontic into the edentulous site. In two weeks you will have a wonderful ovate pontic site that will not impact food and will feel natural to the patient as if there is a tooth in between the implant crowns.
    Best of luck,

  3. malcolm miller M.D.,D.D.S.,M.Sc.H.A., MSc Perio. says:

    The longterm prognosis for integration of the distal implant is uncertain.
    It has been shown in the literature that any less the 2.1 mm – 2.5 will result in breakdown of the bone height and loss of integration over time. I KNOW that many people on this site refer to their own experience and discount the scientific evidence based research , but having almost 9,500 implants in function over 12 years I think it is important to look at the research. Terms like “this works for me” or “in my hands ” are not terms we should use in any discipline anymore
    but I see this on this site frequently.If there are questions people have , we are here to help each other , but only data from properly researched journals should be used – in your office and on this site. I will answer any questions people have but some of the silly answers posted here are not viable in 2018.Again , Let’s use the proper research to help anyone looking for advice.

    • Anon

      I totally agree with you Dr Miller.
      I think if we rely on our personal experiences only,we are going to be in a situation of juggling clinical evidence and emotions .what one dentist sees as an appropriate way of treating this situation with might differs from another .Literature and clinical research are very important tools to use for more predictable results.

  4. Dr.Alan Amin says:

    I agree with Dr.Kurtzman in short term, but scientifically talking , I am with recommendations of Dr. Malcolm Miller,if we really wants to help each other in right way not decisive one, also I notice few shallow thinking advice from some of this website which were most of them expressing little personal experiences in dental implantology,.
    DR.Alan Amin,Oral Surgeon &oral Paleontologist

  5. Zev Kaufman, DDS says:

    Dear Colleagues:
    Please remember, this IS NOT a scientific forum! This is a practical question and answer, social networking site. Kudos to the doctors who post questions, that many others might have, and kudos to those who take the time to post answers with, hopefully, practical solutions to the problems.
    For over 20 years of teaching the subject I have seen excellent work from clinicians with very limited experience and at the same token, I have seen NOT-so-excellent work from people who can quote research and write text books. As you all know, Dentistry IS a combination of Skill, Knowledge, Expertise, and Experience. One can learn a great deal from others’ mistakes!
    Everyone has an opinion and their own clinical experience and they are absolutely entitled to voice their opinions. If the only people to do work were the MOST qualified and educated, most of the population will go untreated.
    Let’s keep our advise to our colleague practical, professional and non-judgmental.
    Wishing you all a Prosperous, Happy, and most importantly, Healthy New Year!

    • Anthony Johnson says:

      The reality in 2018 is to always plan implant placement in 3D and guided. Anything else is like a blind man navigating a busy road all by himself.
      We must remember that implants are prostheses with surgical components. Therefore planning should be from the restoration to the root and not the other way around.

      • Munish Kumar says:

        I did get CBCT as pre op planning . I did follow the prescribed guidelines except the surgical guide. I think the problem was with my inventory. I should have placed 4* 10 in #17 but unfortunately that wasn’t available so the next option I went for 5*10. That created the mess. It not only ended close to #18 but also increased the inter implant distance. The lesson plan I have learnt from this case is never to be overconfident that makes you ignore the finer details integral part of implanvology. All went as per plan except the site. I have thought of extracting #18 and 15 degree abutments or castable abutments for the long term success. I welcome every comment for or against my treatment, so was the intent.
        Thank you everyone for taking out time to help me and the profession at large

  6. Bülent Zeytinoğlu says:

    Yes implant 17 is too close to tooth 18 which I think will cause some trouble during the prosthetic work. Distance between the implants I think is good enough for a 3 unit bridge .I am not certain about the prognosis of the mesial implant because of the bone resorption at the apex . It willbe better to fix the bridge with a temporary cement for a while .If the angle af the x ray is correct implants are not perfectly parellel to each other that may need extra attention during the prosthetic porcedures .Good Luck

  7. malcolm miller says:

    I want to clarify something here.Dentistry is described as an art and science, so clinical experience is valued highly.When we were talking about the distance from an implant to a proximal tooth there are some scientific truths we all adhere to.We know what is involved in maintaining bone health , not only in distance but in how we prep the bone ; health of the proximal tooth; thickness and density of the bone etc..That is what I meant by scientific truths learned from research.Everyone has great examples of successes even though compromises may have been made.The point is one’s best chance for success in any surgical procedure is in respecting the biologic parameters that we learned in basic science. That is what we can all agree on and still feel great about our cases that succeed even when we compromise some principle . We should rejoice in our victories.One question – when an implant fails and we did compromise , what do we tell the patient?

  8. Ricardo Righesso says:

    Perfect Dr. Malcolm Miller. Let us use only evidence-based dentistry. Clinical experience helps a lot, but it is not possible to replicate to all professionals. It’s just something personal.

  9. Dr. Bill Woods says:

    We’ve all had successes and failures. The real question in clinical Dentistry is – can we can figure out what went wrong as we see what goes right? If we do this, which is in my opinion why this forum is here, then that is the best any of us can offer up or to each other. When we do this, it’s a win-win for all situations, even those that may be no so ideal. We are all the better for doing so. I haven’t been in this site lately but I’m happy to see the collegiate atmosphere still at work. Bill

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