Recommendations for Implant placement?

I’m a patient, but I hope I can get some feedback on my case (please see photo below).

Background: I am a 33-year old man, non-smoker, healthy and in the coming period I’ll need 2 (or 3, I’ll explain later) dental implants. I am trying to figure out what the best treatment option is for myself. I have read several articles and studies (found on internet) in order to understand as much as I could, but I still have some questions.

1. I decided to go with Straumann as the implant brand. What other trustworthy brands do you recommend that maybe less expensive than Straumann, while retaining the same quality/benefits?

2. What kind of implant type is more durable, bone level or tissue level? (I read that tissue level ones are better in posterior areas, as in my case)

3. Which implant insertion procedure is best for the long-term: conventional (flapped) or flapless (using 3D stereolithographic technique)?
(I read about advantages and disadvantages on both sides, but I’m interested which has a better long-term prognosis, in terms of implant survival)

4. Regarding flapless procedure is there any official scientific study to confirm that bone resorption is less when it is used as the technique?

5. About my 3rd possible implant (as can be seen in the image attached, the one from right-upper side), my current dentist told me that there is no space for an implant in that place as it’s small. Instead of an implant there, the recommendation was to “move” the last 2 teeth closer to the next ones in order to fill the empty space. Do you think this is the best option in this case?

6. Any recommendations in terms of preparation before the implant intervention?

Thank you for your help!

12 thoughts on “Recommendations for Implant placement?

  1. ed says:

    why are you choosing the brand of implant? Or bone or tissue level. The doctor should be making that call. And Straumann works, yes…but so do 30 other brands, and work sometimes better. The cost of the implant has nothing to do with the cost the doctor is charging you, and if that’s the case, you are at the wrong office. I sell dental implants by the way. They should place a quality implant, at a good price and never discuss such topics with the patient. Good luck

  2. Francois says:

    Hello.
    I understand how difficult it is for a patient to understand everything and make informed decisions.
    As for the brand of implants, yes it is a subject I discuss with my patients. ┬╗There is a world of difference between a good system and a poor copy.
    Straumann is good, so are several other brands. You could get confused with all the technical stuff, surfaces, connections, etc…Look-up several company sites. WE LOVE ASTRATECH FOR THE CONICAL CONNECTION AND EASE OF RESTORATION. bUT SEVERAL OTHER BRANDS ARE AS GOOD. tWO THINGS TO LOOK FOR: CONICAL CONNECTION AND PLATFORM SWITCHING.
    bUT YOUR DENTIST OR SURGEON IS THE BEST PERSON TO INFORM YOU.
    yOU SHOULD FEEL CONFIDENT ENOUGH WITH THAT PERSON TO LEAVE HIM/HER THESE CHOICE AND EXPLAIN THEM TO YOU.
    As for the 3rd implant I do not see on the x-ray that there is a problem and would place an implant. But I have not seen you, examined you , or seen a Scan of the area.
    There is no advantage or disadvantage to either placement technique, flaples or other.
    I like to raise a small flap and see for myself, others will do differently.
    Beware of getting too many opinions! you will get mixed up!
    Concentrate on finding a surgeon you trust. Get references. the surgeon your dentist would go for himself.
    I Hope this helps.

  3. Dr Bob says:

    Start with the restoring dentist that will actually make the teeth. You really do not want implants what you want is teeth. Going to a surgeon first could result in having the implants placed in a position that might be very hard for the dentist that places the teeth onto the implants to do his job. The restoring (tooth making) dentist will instruct the surgeon what kind of implant to place, where to place it, and at what angle, so that a tooth can be put onto the implant with as little complication as possible.

  4. Amir Mostofi says:

    In the field of dental implantology the most important factor is the knowledge and expertise of dentist which is placing and restoring the implant by a superstructure. Today in the market you can find many good implants systems and you do not have to go for Straumann only.
    Your best approach is to find a dentist which is knowledgeable. How to find such a dentist? Ask other dentists in your area. Sometimes qualifications and the type of post graduation training from a reputable institute helps, but not always. There are no specialist training in the field of clinical dental implantology ,however there are reputable universities that provide Master of Science post graduation courses in clinical implantology. A dental prosthetic specialist can be good as well and perhaps a specialist in periodontology(periodontist). Contact the universities in your area and find out who is the head of clinical training in implantology. Go to his/her office.
    A patient should not choose the type of implant. Leave such a decision to the implantologist. There are too many factors involve and no matter how much online reading you do, you can never determine the treatment plan as good as a well trained dentist.
    Remember a very well trained implantologist does not come cheap. Equipment, material and good dental laboratory work are expensive.Good and comprehensive training in implantology is very expensive too.

  5. dr ez says:

    I agree with what Dr. 2 and 3 say, both are relevant. If you have a surgeon who restores then you don’t have to worry about communication between the two, but either way is fine. TRUST the doctor you choose to make the best decision for what works well in HIS/HER HANDS. Re. the implant type there are many quality implants and again let the doctor decides what works well with him. That being said, if you want to use one of the major players, straumann, nobel, astra are a few of the”traditional” large companies which produce a great product.
    P.S.: you have decay on at least 2 other teeth that should be treated first.

  6. Perio JW says:

    Your dentist and surgeon need to agree on a plan to replace the missing teeth; study models of your mouth and a wax up of the teeth to be replaced are prudent to have done to see the final product first. Then, one can fabricate a surgical and radiologic stent from that wax up. This will serve to communicate the ideal placement positions of the implants to the surgeon.
    You will need a CT scan of the areas to be treated to assess available bone, it’s quality, and the proximity of important anatomical structures that the placement of implants must avoid. I believe an open flap is best, but all of the other details will depend on esthetics, the types of restorations, available bone quality and quantity, angulation that the implants will need to be placed, the relation to the opposite arch (will help dictate vertical placement and angulation), whether or not they will be screw retained or cement retained, and the requisite prosthetic parts that will be necessary for the lab to fabricate the implant restorations. This is the foundation necessary to properly plan the case and in turn to be able to answer your questions in detail including brand and type of implants and to generate a financial treatment plan as well as deliver informed consent to you including risks versus benefits.
    Good luck!

  7. sbmnath says:

    According to a review literature published in IPS journal no implant system is better than other.They concluded that the scientific literature did not provide any clear directives to claims of alleged benefits of specific characteristics of dental implants.so let your dentist decide the implant system.

  8. CRS says:

    Personally I would not be able to please this patient, based on the implied outcome guarantee posed by the type of questions asked. Kinda like asking a heart surgeon what kinda of valve he is going to use. Needs to trust an expert, Good advice given but something doesn’t seem right to me.

  9. John T says:

    Good for you. The more information you glean from the literature, the more informed will be your choice. Don’t be afraid of patronising remarks by the “experts” – you’re the person who is undergoing the treatment and will be paying for it.

    Unfortunately the evidence base for many implants is shamefully poor and in many cases we simply don’t know the long term complication rate. Even the manufacturers have no idea!

    In reply to your specific queries:
    1. Yes, I think Straumann tissue level fixtures are a good choice. They’ve been around for a long while (although even Straumann had problems with their earlier hollow cylinder design) and seem to have a low abutment and screw fracture/loosening rate.
    2. Personally I would opt for a conventional open flap approach and there is no evidence that it will lead to clinically significant bone resorption when compared with a flapless technique.
    3. Your x-ray indicates that there is sufficient space at all 3 sites although you will need a premolar shaped tooth in the upper left first molar region. Orthodontic closure of this gap would be difficult, if not impossible, and time consuming. There is sufficient bone height at all three sites and the bone quality is good. You don’t need a CT to prove the obvious unless clinical examination confirms the ridges are particularly narrow but make sure your dentist does a trial wax up and uses an implant placement guide.
    4. Don’t be tempted to have the upper right extraction and implant placement as a single stage. Much better to remove the roots and let the site heal for a couple of months before placing the implant.

    3 other tips – (a) as a general rule the fancier the website the higher the bulls**t level, (b) make sure the dentist gives you a high quality informed consent letter (outlining the problem, the treatment plan, a schedule of work and the cost thereof) and (c) finally make sure the dentist gives you all the details of implant brand, catalogue numbers, etc once you’ve received the treatment. You would be amazed at how many people have no idea of what’s been stuck in their heads, and it can lead to major problems if repairs are required at a later stage.

    • Bogdan says:

      Thank you very much for your time to offer me such a detailed answer and advice, the best ones that I could receive.

      Indeed, I don’t know why, but my questions were misunderstood.
      I’m patient and is good to be informed (as I saw many that are not) for this important intervention regarding my body (even the head) that will last long, I hope as much as longer, maybe a lifetime (ideally). And for this reason I need to be aware about brand/type/material/procedure that are used for my implant.

      Of course I will not decide instead of my dentist, but when the dentist decide for me, is useful to understand his decision as much as I can.

      Thanks again for the valuable information that you shared.

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