Inadequate mesiodistal space for installing both implants: recommendations?

Last Updated: Jul 26, 2013

I have treatment planned a patient for implants to replace # 9 and 10 [maxillary left central and lateral incisors; 11, 12]. There does not appear to be adequate mesiodistal space for installing both implants and crowns with ideal esthetic contours. If I install two 3.5mm diameter implants there will be less than 1.5mm space between the implants and adjacent natural teeth and less than 3.0mm between the implants. I can install one 3.0mm diameter and one 3.5mm diameter implants but that still leaves too little space. Could I install one 4.5mm diameter implant and cantilever off one crown? What do you recommend?

9 Comments on Inadequate mesiodistal space for installing both implants: recommendations?

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peter Fairbairn

07/26/2013

Your best bet is to place a central ( stick to 3.5 ) and cantilever the lateral , socket graft the lateral site with HA material to retain the profile . Placing 2 will create papilla issues and be a difficult aesthetic restoration. Good luck Peter

Sb oms

07/26/2013

There are very few indications to place central and lateral implants. As said nicely above, there isn't enough room. Pontics are powerful, use them in cases like this and you will look like a rock star. The lateral incisor is a great tooth to cantilever Pontic. Basic implant dentistry. Good advice from dr fairbairn.

greg steiner

07/27/2013

The above advice is good but I would prefer to determine why the patient has a lack of space and then correcting it. Did the ridge collapse? Do the adjacent teeth have over contoured restorations? Did the teeth migrate? I assume there were teeth present at one time with proper spacing so if you figure out the reason for why the space has decreased you may be able to reverse the change and restore this patient to full form and function. Irrespective of how you handle the implants if you have significantly less space for 9 and 10 than you have for 7 and 8 you will never achieve an esthetic result. Once you have it figured out you can ask the patient if they want compromise therapy that will be quicker and cheaper or do they want to make the extra effort to be made whole again. Greg Steiner Steiner Laboratories

Peter Fairbairn

07/29/2013

Hi Greg hope you are well , they were probably previously rotated which may have contributed to their loss . Even if you used orthodontics as well to re-align the teeth , I feel the best option still would be a single Implant cantilevered which would be easier to have a better long term esthetic ( Papilla ) result. Regards Peter

Gary L. Henkel DDS

07/30/2013

Unless you want significant loss of papilla and interimplant bone loss going forward, you never want to place fixtures in the central/lateral or lateral/canine region that are too close together. In fact, most of the time you do not want to place adjacent fixtures here. i would refer you to an article frank spears published in the compendium a few years back regarding placement of multiple fixtures in the aesthetic zone. very difficult to maintain bone and papilla, nearly impossible to get back once it is gone. so i too strongly suggest fixture in central position with a cantilever of the smaller lateral, using an ovoid pontic concept. gary

djoko

07/30/2013

I prefer use two 3.0mm or 3.2mm implants to avoid rotational forces from cantilever pontics :D

pisitroj

07/30/2013

orthodontic treatment to gain proper space. then cantilever.

Matthew Watson, DMD

07/31/2013

IF I UNDERSTAND YOU CORRECTLY, YOU ARE DOING 11 AND 12 ALSO, THEN PLACE IMPLANTS AT 9,11&12 THEN BRIDGE/ SPLINT THE IMPLANTS. IF YOU ARE NOT DOING 11 AND 12 THEN ORTHO FOR IDEAL SPACE EQUAL TO 7&8... (ALMOST) ALWAYS DO CANTILEVER IN ANTERIOR CENTRAL LATERAL CONDITION. USE A GOOD AESTHETIC IMPLANT SYSTEM LIKE ASTRA AND CUSTOM ABUTMENT.

Samir Nayyar

08/14/2013

You already got the best answer, Just go for one implant in the central and give cantilever of lateral. There won't be any problem.

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