Missing Lower First Molar and Second Premolar: One Implant or Two?

Anon. asks:
I have a patient missing the lower left first molar and second premolar. I would like to place one implant in the first molar space and connect it with a bridge to the first premolar. This way I could replace two teeth using one dental implant. The other option would be to place 2 dental implants – one for the first molar and one for the second premolar. The second treatment plan is more costly. Would my first treatment plan, using only one implant, be in accordance with the standard of care or should I use two implants? I have heard many lecturers on this subject state that if done properly with appropriate case selection, it will work. What is your opinion?

19 thoughts on “Missing Lower First Molar and Second Premolar: One Implant or Two?

  1. DRMA says:

    If the first premolar is mobile ,it’s no question, use two. If it’s stable, two is better, one can work, but after ten years with a mobile first molar and no bone on the seconds area, it will be late to rethink.

  2. Mike Stanley, asst. says:

    Also read the thread on this site called “Current thinking on connecting implants to natural teeth.” It seems that few doctors recommend bridging between a natural tooth (your first bicuspid) and an implant.

  3. JP says:

    never splint an implant to a tooth.
    A natural element is a little bit mobile, an implant not. Logicaly, this will cause stress on your prosthetic structure, with failure after time.
    Thus 2 implants in this case !

  4. JM says:

    The problem is not only the prosthetic structure but the possible intrusion of the natural tooth; there are several reports in literature describing this phenomenon. Too risky. Go for the 2 implants.

  5. steve c says:

    Even if the 2nd premolar could benefit from a crown, I would still use 2 implants. If the premolar is a virgin tooth it would be a crime to bridge onto it from an implant.

  6. R. Hughes says:

    All of the options listed by Anon are reasonable and the standard of care. I have been placing and restoring dental implants since 1990, and have NEVER seen a natural tooth intrude, that was an abutment in a tooth and implant supported bridge. I have done countless cases like this. I will admit that I use copings on the natural teeth. There is always a first time. I am not doubting what is in the literature but I believe this is rare.

  7. GHONEIM, Iyad says:

    Well I think bridging the the implant with a tooth is not that good choice but I think when it comes to the financial point you can convence your patient that having two implants will give a perfect investment for his oral health that will elongate his teeth’s life span, I really advice you not to bridge them donn’t loose his four.

  8. A:Romano dr med, dr dent Italy says:

    The solutions on this question are three:

    two implants for two missing teeth

    a bridge between implant instead the missing molar and the fourth premolar.

    a bridge between implant instead the missin molar and a simply but strong preformed rest on the premolar.

    the last two solutios i applied in the past , often ,without inconvenients and i find the question : implant and natural tooth toghether good too because i never found any problem in the last 25 years in spite of many authors say the contrary, but on which founda ment? I speak about my long positive and practical experience. but i know that on this argument many coll eagues are of my mind.

  9. Rob Dental Lab Tech says:

    What about the stress on the porcelain and substructure from the movement of a natural tooth connected to an stable implant? The dentists I work with would never connect an implant to a natural tooth. The chance is too great that the restoration would fail.

  10. vancouver says:

    Hughes – in a previous comment you mentioned copings on natural teeth; could you please elaborate on that?

  11. R. Hughes says:

    vancouver- One cements a gold coping over the natural teeth with a hard cement and then cements the brigde work with a not so hard cement. Since there is little movement with the implants and slightly more with the teeth there is a chance for increased recurrent decay of the natural teeth. The use of copings reduces the chance of recurrent decay and helpe to elimimate paralleling issues.

  12. Dr. M.A.Mohealdeen says:

    a tooth and implant supported bridge. I have done 70 cases like this with follow up of 2 years with NO problme.

  13. Dr. Raouf El Batanony says:

    well Anon i would go for two implants if i was in your place. maybe because i don’t favor the tooth implant connection, and also as mentioned by DRMA later on you will lose the bone at the second premolar and it will be too late to rethink. so go for the correct treatment plan from the start.
    “if you fail to plan, you plan to fail” – Dr. K Judy
    keep that in mind it helps out.

  14. Roger Forbes says:

    Are any of you aware of any journals/studies carried out so far to back up these arguments re: one v two implants to replace a single first molar tooth – would help with my own MSc Implant studies


Comments are closed.

Posted in Active Posts, Clinical Questions, Planning & Complications.
Bookmark Missing Lower First Molar and Second Premolar: One Implant or Two?

Videos to Watch:

Lateral Sinus Lift: Perforation, Repair, and Implants

These two videos demonstrate the lateral window sinus technique, and implant placement following the repair[...]

Watch Now!
Single Tooth Replacement with Implants in the Esthetic Zone

Dr. Jack Hahn provides tips and reviews cases for implant placement in the esthetic zone.[...]

Watch Now!
Surgical Consideration for the Flapless Approach

In this video, Dr. Jack Hahn discusses and presents cases to review the surgical considerations[...]

Watch Now!
Bond Apatite: Socket Preservation Cases

These 2 videos show the use of Bond Apatite in socket preservation cases, one with[...]

Watch Now!
3D Guided Implant Placement

The placement of multiple implants in this case was helped thru the use of 3d[...]

Watch Now!
Ridge Splitting Cases in Narrow Alveolar ridge

This videos shows ridge splitting, which when combined with bone expansion, is an effective technique[...]

Watch Now!
Placement of 4 Implants and Cement-Retained Bridge

The treatment plan was to extract the lower incisors, canines, and lower premolar and place[...]

Watch Now!
Failing Bridge Replaced with Dental Implant Supported Bridge

Ahe patient presented with a failed dental bridge from the upper right canine to the[...]

Watch Now!
Lateral Sinus Augmentation with CGF

Following membrane elevation with the lateral approach, and confirmation of an intact sinus membrane, concentrated[...]

Watch Now!
Titanium Mesh for Ridge Augmentation

The use of titanium mesh is a reliable method for ridge augmentation to provide adequate[...]


Watch Now!
Implant Grafting Techniques: Demineralized Sponge Strip and Tunneling

This video reviews several unique grafting and surgical techniques, including the use of demineralized cancellous[...]

Watch Now!
Mandibular Fixed Screw Retained Restoration

This video shows the use of a surgical guide for a mandibular fixed screw retained[...]

1 Comment

Watch Now!