How to restore this space: one or two implants?

One Wide Diameter Implant with Selective occlusal load.

How much buccal palatal width will determine how wide you can go. I would do a wax up and determine if two premolars would fit the non esthetic functional space based on the opposing occlusion. Let the patient know due to the odd space two premolars are optimal.

CRS gives you good information. A wax-up is ideal for larger cases, but you can use calipers and measure the space available, and the space required for a normal sized premolar without spending time or money on a wax-up. I would not use a wide diameter implant in this situation. If you measure, you will see that you would have to place two narrow premolars to fill the space and this would not give you the best aesthetics. Also, you might compromise the resulting gingival morphology by having to place the two implants too close to each other. 3 mm should be the minimal distance between them, and 1.5 mm from implant to tooth. Anything less risks crestal bone loss. In my experience, I have found that it looks better to place a correctly sized first premolar (looks like the two premolars are missing) and leave a small space behind that could easily be closed with orthodontics if desired. My two cents. Good luck!

The premolar in front looks heavily filled and can be crowned ..... then a single Implant and crown ...... Implant size not Important as dictated by the available bone as CRS states . In that way the dimensions can be adjusted to create good contacts.... Peter

I'd play it safe and put two implants in unless you can fit a single wide diameter implant.

Two implants wont fit in that space following the recommended 2mm between implant and natural tooth and 3mm between implants because in a 2 implant scenerio the spacing along eats up 7mm of the 11mm available. I would recommend a 5mm wide implant centered into the space which would give you 3mm between implant and natural tooth on either side then have the lab fabricate it to look like two premolars on the occlusal and buccal sides. I would do it as a screw retained.

Dr Milankov DDS I should be place 3 implants of 2,4 mm ( MDI, 3M... or some of small diameter), one phase, I mediant with 2 crowns

In space 10mm+ where adequate bone is available I use straumann WN (6.5) tissue level which gives wide emergence. However for this implant wax up is even more important as its less forgiving when it comes to positioning of implant and if u not familiar with tissue level implant then do any 5mm . I would corwn premolar as Prof Fairbairn suggested. Cases like these I am keen to have screw retained restoration for the ease of maintenance. However, some may not agree.

11 mm would allow placement of two 2.5mm implants. It would imperative to have no contact with excursions so the only substantial load on these would be axially directed. If the bone is less than 4.5 mm wide then it should be split with a scalpel and channel former with immediate or delayed implant placement. Additionally, a 3.2 mm and a 2.5 mm implant may fit. Narrow diameter implants do not require 3mm interimplant spacing. 1.8-2.0 mm is OK. Dennis Flanagan DDS MSc

Heresy on this board but anyone for a conventional three unit fixed bridge?

If you look at the radiograph the edentulous area is quite dark. Bone Width bucco-palatally will consequently be very thin. This will preclude any thoughts of a wide implant unless grafting or ridge dilation is performed.

5 mm implant and orthodontics i suggested

Looks like the molar Endo is short, possibly failing, open margin on the distal of the crown and the premolars looks suspect too. Interesting to hear some of the treatment options, if you can't negotiate the molar mb canal you have lots of room for a couple of implants after the inevitable extraction. Great comments always multiple way to skin a cat, but I think this cat is very sick already?

14 and 11 look a bit weak, a bridge is still a viable option.

To the original poster: Help us to help you. If you want meaningful clinical advice that is appropriate for the case in question, then we need all the info you have. Pics or at least some comments on the ridge width and your thoughts on how you'll manage a resorbed buccal. Are you able to manage the sinus if you were to place 2 implants? Or are you preferring to avoid 2 implants to avoid the sinus?). Y'all have assumed you know exactly what this measurement is: "This space is about 11mm across the top." I don't know what that means. I read: "about 11mm" and I'm not sure if the measurement was eyeballed with a ruler in the mouth. I read: "across the top" and I'm thinking measured mesial contact area to distal contact area, or is it "about 11mm" root to root measured at the bone crest on the xray? I did not read which teeth are missing. Seeing only half of the mesial tooth makes us guess and we shouldn't have to guess. It is obvious there are a lot of experienced dentists interested in helping... Their most meaningful advice will come from knowing as much about the situation as possible.