Implants at an angle or straight?

I am a 60-year old male. I got a bone graft with sinus lift on my right upper jaw 10 months ago. Now I am ready to get 3 implants. At #5, #6, and #7. However, the bone width does not seem sufficient to allow all three implants to be placed straight with proper spacing. One option I was provided with is to place implants on #6 and #7 straight and on #5 angled? Is this a good idea? Or should I get 2 implants (on #5 and #6) now and then the third one at a later date after another bone graft (socket graft) to augment the bone at #5. Any recommendations will be highly appreciated. Thank you in advance.

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12 thoughts on “Implants at an angle or straight?

  1. Place two wide diameter implants into the graft at prosthetically ideal place(molar and second premolar) and cantilever first bicuspid.
    One piece screw retained three unit bridge with anterior one tooth cantilever.

    The sinus lift-graft left an anterior void.

    No angled implants necessary.

    1. This would be my recommendation also, as long as you have excellent home care. Do you use floss threaders under the lower bridge?

      You can have two implants placed, in the 6 and 7 spot as you call them (that’s Orthodontic terminology BTW, General Docs in US start in the back and count forward in this quadrant, so #2, 3, 4, or in the UK #15, 16, 17).

      Anyways, if you have two implants placed, one at your 6 (#3, aka16) and one at your 7 (#2, aka17) then you can have the pontic as a “mesial extension” cantilever.

      The pontic is the “tooth” typically in the middle of the bridge with nothing supporting it, but in your case it would be hanging off the front (mesial extension= hanging toward the midline of your arch), which is OK because it’s a slightly smaller crown for the bicuspid. You would have very good support from the two implants further back in healthy bone.

  2. The sites are 2, 3 and 4 based on teeth missing and present.

    Ridge width can be increased at time of implant placement using ostetomes. The issue here is that the graft placed is a little deficient at site 2 and 4 as the graft was not extended far enough mesial and distal. This can be corrected at time of surgery doing a crestal lift to gain more height and have the apical of the implants in bone.

  3. I agree..a straight implant can be placed in the site of tooth #7 by doing an osteotome sinus lift at the same time that the rear 2 implants are being placed. If possible it is good to try to avoid angled fixtures as the direction of biting forces ought to be ideally directed along the long axis

    1. 3 straight implants would be the gold standard, but 2 straight implants in the molar areas with a slightly angled premolar implant/abut isn’t a bad option. It would be nice to know if there’s canine guidance or group function, or any parafuncion/bruxism…

      It’s certainly an acceptable option. Not the best, not the worst. Maybe 2nd best?

  4. I agree with Dr. Kurtzman, in that this is most likely correctable at the time of implant placement using ridge explansion ( osteotome or expansion drills). However Cone Beam CT (3-D image) would be helpful to determine the exact plan. I would avoid angled implants in this case and generally not a good idea to cantilever off of implants as suggested by Sb oms. There are exceptions where a cantilever is OK( ie lateral incisor where spacing in an issue and forces are minimal), but this is not one of them. I personally would place the implants straight and in a position that avoids the need for a cantilever. Re-graft if necessary.

  5. There appears to be enough vertical bone to place the #5 implant. The width of the ridge can not be evaluated from this image. If it is at least 5mm the ridge can easily be expanded and an implant placed. Short implants ( 5-6mm) from Bicon, and Quantum, and other companies have used with great success.

  6. Just do an internal lift on the anterior implant at placement straight implant. Also be sure to use a splint for placement in multiple implants don’t eyeball it!

  7. I like straight as possible , just old fashioned , although my mentor first used angled abutments in 87 when they were taboo ….
    Calling that Healthy Bone is laughable …………or al least not host bone ….. it is mainly graft material , CT and a small amount of host bone . Again just a small abuse of the Queens language but calling it a hard material ( maybe it is ??? ) is more appropriate …
    Only a core sample will tell us the truth .
    Anyway place the Implants where they are best sited for the restorative outcome and a straight as possible , and if using three not 2 them best not to splint as Woolfs law means function will improve the bone .
    Regards
    Peter

    1. Why not do a three unit splint with the 5 site being a short straight implant. The bone width is critical but there are many short implants which will do well being splinted to the other two, providing they are robust enough in width and length.

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