First implant case: Does size matter?

This is my first experience placing an implant since I graduated 6 months ago from dental school. I extracted the mandibular left first molar 3 months prior and the site has healed.  I placed a 4.6x9mm implant, instead of a 5.8×10.5mm implant, because I was concerned about hitting the inferior alveolar nerve and destroying the buccal wall. But, now I think I place too small of an implant? I am wondering if this implant will suffice or if I should explant it and replace it with a 5.8×10.5mm implant?  I am also wondering about the impacted mandibular left third molar, casuing a problem for the implant later?  Right now the implant is immobile and the tissue has healed well and there is no pain.  Do you think this will cause problems in the future and should I extract it now and should I have extracted it before I placed the implant? Just hope it all works out for my first case.

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23 thoughts on “First implant case: Does size matter?

  1. I second that. Good placement. Restore it when it’s osseointegrated. Review patient every month or so to check that there’s no infection etc

  2. I’d leave the 3rd molar alone unless it has a deep pocket communicating with #18 distal or if it becomes symptomatic– otherwise, I would leave it alone and monitor it closely with a better PA x-ray.

    Having a CT Image prior to surgery should have given you the information if you could have placed a wider implant to start with. Having said that, I’d be proud of having placed that implant; Congratulations!

  3. The scan looks great!! Nice
    I don’t know what your concern is. However, If you are worried the post can’t handle the load and can be fail because the forces will take on molar, ask your lab to do light occlusion, or even take it off occlusion slightly.
    If it’s not your concert, congrats on the first implant!!! Nicely done
    David Mai

    1. Can i tell the lab to make the occlusal plane (buccal to lingual) smaller than normal? Will it help? Thanks for ur advice my friend

      1. I think keep the size the same. Small will make look weird even molar, Make sure the CEj Bring out to match with all natural teeth. All my implant procedure is no contract with lateral contract movement and light on oclussal. If you concert about the force, I would do no later contract movement and slightly no contract on occlusal. If you run 0.5 contract check tab, it should slightly smoothly but still feel little resistance.
        I hope I can help;
        David Mai

      2. Having a smaller buccal- lingual occlusal table will reduce the forces. These forces are the most prominent in this situation when compared to mesial distal forces which are somewhat braced by the anterior and posterior teeth.

  4. The implant placement is good and well done.
    The only small issue that is good to keep an eye on at your next implant placement is to have the implant platform (top of the implant ) at the same level as the marginal bone. It looks that currently the implant is perhaps located 1-2 mm above the marginal bone. The x-ray is a 2D view but I suspect there could be some dehiscence on the buccal cortical bone.
    Currently this implant placement is something between a bone level and tissue level implant.
    If the implant that you use is a bone level implant and you do place it above the marginal bone level, you will risk plaque retention and implantitis over the time (plaque sticks easier to the rough surface of implant).

    I prefer tissue level implants in the molar and perhaps in some premolar area.

    Wisdom tooth is fine and will not cause any problem for the implant.

  5. Actually im pretty sure that the implant platform at the bone level when i place it
    I dont know why it looks slightly out of the bone in the image, maybe its the cover screw?
    For more information, the implant i use is biohorizon tapered internal with lovely laser-lok on the neck, according to the manufacturer the gingiva will stick to the laser-lok even its placed slightly protruded from bone level, is that true? I have a very little experience, please clue me what to do my friend

  6. I think that this is a job well done…and a slightly larger implant would not make any difference…..one only has to look at the Bicon Implant System and see the disproportionate relationship between the size of the implant and the superstructure to see that “size does not matter” when commenting on dental implants.

  7. To me, I think the implant was placed a little bit distal than right at the centre. There maybe a slightly larger dead space between the premolar and the implant crown. To reduce food trapping, a mesial hygienic pontic could be considered.

    1. Thanks for ur advice, i just heard about mesial hygenic pontic, what it looks like? Is it something like levitate cantilever pontic at the mesial?

      1. Ocllusally, it just like routine molar size and shape. But at the cervical area, the mesial part looks like a mesial root of the molar so as to occupy the dead space. But make sure there is still space to place the interdental brush to clean the mesial part of the implant.

  8. Well done, I am concerned that your 4.6mms fixture size is committed to carrying the occlusal load of a lower molar more than twice as wide as the fixture width (mesiodistally).
    The mean mesio-distal dimensions of lower first molars are in the range of 10 to 12 mms.If pericoronal food traps and dead spaces are to be avoided ,one must extend the restoration to the adjacent teeth contact points.
    With such a large fixture/crown width discrepancy ,the potential cantilevering forces on the implant will be considerable. Careful monitoring and retrievability is essential here.
    Lastly, was there an extraoral radiograph of the impacted third molar to eliminate pathology? Sometimes it is best to remove the third molar at the same time as removing a hopeless first molar so that autogenous bone can be harvested from the adjacent ramus region,if indeed an implant option is chosen for the first molar region.

  9. Size most certainly DOES matter. You will be placing a molar sized crown on a premolar sized root. You will have to overcontour which will make hygiene difficult, or leave large triangular spaces which will be food traps. Look at the 2nd molar right next to it and the size of its multiple roots which support its crown. A better option IMHO would have been to place two smaller implants and create a 3rd and 4th premolar.

    On the positive side; your placement is excellent- good centering and parallelism.

    I suggest a hygienic design leaving triangular spaces under the crown which can be easily cleaned with proxybrushes, and take the crown ever-so-slightly out of occlusion, using shimstock to gauge it, to reduce any “cantilever” forces which could cause your abutment screw to unwind.

    Great case for reviewing. Thanks for posting!

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