Replacing Maxillary Canine with an Implant: Wide Platform or Regular Platform?

I persnonally am very cautious with canines , both in surgical and oclusal. As with any technique I think we should talk about different factors o risk factors. for example. Strength of the implant metal at least as grade IV titanium Internal conection Implant diameter as wide as posible taking into account the prosthetic components and M:D and B:L distances. If a bruxer I would not use a canine disoclusion would in every case place an oclussal splint be very carefull to inmediatly provisionalize, I leave a 2mm infraocclusion and had failures. Post extraction pose high surgical dificulty and CAT can is much recomended to avoid surprises good luck

Dr. Anon; There are a lot of questions in this question, most of them sould be pretty to answer for any first year implant specialty sudent. My recomendation is exactly that, become a certified specialist before doing implants in the canine area The potential for disaster in that area is almost limitless.

Width of implant is selected based on mesio-distal and bucco-lingual space, and size of contralateral canine, as well. To the best of my knowledge, in these situations canine guidance occlusion should be avoided. Several criteria must be considered when choosing an occlusal scheme. For example, periodontal support of the remaining teeth should be considered. Another example: Generally, patient's natural occlusal design should not be changed, if possible. ANY OCCLUSAL DESIGN WILL RESULT IN SUCCESS IF IS SELECTED CORRECTLY. ON THE OTHER HAND, NONE OF OCCLUSAL SCHEMES WORK IN ALL SITUATIONS. Avoiding "overload" is the key in implant success. Best regards, Neda Moslemi

i would really appreciate if senior clinicians give their views on cannine replacement. although cannine replacement is one of the most difficult prosthetic situations some general guidelines from experienced clinicians would be appreciated.

I do not under any circumstances agree to immediately load a canine but you can get the benefit of soft tissue support/preservation by making a custom healing abutment with a PEEK temporary abutment and light cure composite to fill out the sub gingival area. Trim it to the level of the free gingival margins and provisionalize with an Essex type retainer that does not contact the temporary abutment. As a specialist I have to always calm some of my restorative doc's enthusiasm to try immediate loads in the esthetic zone. Many are new to implant dentistry and having done this for 30 years I know the disasters that can occur.

In my experience the ideal diameter for a maxillary canine is anywhere between 4.5 and 5mm. This gives a nice emergence profile to the restoration. You can get by with a smaller diameter but you will most likely see at on one point of time a concavity at the alveolar level. If the lipline is low, this is not an issue but if not, it may be a compromise, because of the lack of canine eminence. It is important to distinguish between immediate load and immediate temporization. Immediate load of a stand alone canine is an invitation to failure. Immediate temporization can be successful as described above with a good amount of interocclusal space and a long implant. In my hands, I prefer longer than 12mm. Here is one of my canine cases (please scroll to page 9 to bypass commercial material): http://issuu.com/docaz/docs/canine_trilobe

When selecting implant diameter and length, bone volume and shape is the key to selection. The clinical borderlines for implant placement is well described (This paper is esthetic based but rules apply to all anterior treatment: -Common implant esthetic complications,Implant Dent. 2007 Dec;16(4):340-8-)in many books, reviews and papers. You asked: "is it necessary to place a wide platform implant fixture or will a regular platform be satisfactory? If you place a wide platform implant fixture, can you then create canine guidance in the PFM?" The platform itself has effect on the emergence profile and interdental relation with neighboring teeth. The guidence has nothing to do with platform. You choose and prepare your occlusion depending on the occlusion of the patient. The load transmitted from occlusal relations are forwarded to fixture.Which again leads us to the beginning, length and width of chosen implant.

Firstly ,a wide platform implant is not recomended for a canine ,maxillary or mandibular.The mezio distal and bucco palatal dimensions dont make it a recomandation.Nobody wants reccesions and buccal bone loss so a regular platform will do the job .Maybe somebody with the expertize would use a NOBEL PERFECT ( not easy to place ).Canines usually are not candidates for immediate temporization -I use this term because it's more like a progressive loading - and there's a lot of things about that in literature but not a ''cooking receipe ".After you have a stable osseointegrated implant you go for phase 2 and built the more appropriate occlusion you see fit on that patient - it's not all about what the theory says .

I agree with the earlier comments that when it comes to occlusion, an immediate temporization is totally different issue than immediate load. In my experience to design an occlussal scheme, I take into consideration many factors, like the patient type of occlusion, the existence of parafunctional habits, and whether the patient is a petite female patient, Vs a 300 pounds male, the number of remaining teeth. Please remember that establishing an immediate canine rise is an optimum situation from a muscular point of view, with less occlussal loading. I Always use a regular or wide platform with a 13mm and up, and never finish the prosthetic part without using T-Scan computerized occlussal analysis, which allows me to verify not only the amount of the occlussal force , but also the timing of it .For the long term protection, an occlussal splint is also a good insurance policy. For our young colleague that stated “become a certified specialist before doing implants in the canine area The potential for disaster in that area is almost limitless”, I say it’s always nice to go to school and learn, however a wet finger confident dentist, with good education, and long experience can always do what your instructors are teaching.

When we replaced canines as an individual the problem of overloading is always possible, so you must take into consideration the existent situation before go ahead. if only one implant is to be used , cautions always existed regarding occlusion in implant.i think in this situation we need an extra coordination between adjacent teeth and implant; mainly you must not used the concept of canine guidance at all. but if the canines will be restored with other implants it's better to joints the implants together and there is no problem in using either canine guidance or group function occlusion. in view of this fact that canines located in most esthetically critical area of both jaws, we do not used wide platform at all. the best choice is to use regular platforms mainly between 4.1-5.5 mm. so the wide platform implants should not be used in this area due to aesthetics.

Hi Dr. Azari I don’t know the exact criteria to classify implant diameter, however a 5mm and up is a wide platform per Nobel Biocare. The bone bucco-lingual width is an important factor in deciding the implant width, and in an aesthetic zone a thick gingival biotype is very helpful . I totally agree with the range of platform that you suggested.

Make a wax up model of the canine that you are trying to replace.. and then select the implant diameter. RP will work most of the time

what my opinion is a wide platform is not recommended in the esthetic zone as the implant sinks 2mm deeper than the adjacent cej and there can be problems with wide platforms(as in straumann having wide platform of 6.3)so a regular neck implant works all right in this zone.im although new in this field but never read about someone placing wide neck implants in canine zones.

I think there is no agreement on what constitute a wide platform, I’m assuming a 5mm and up is a wide platform. I’m puzzled by the fact that a lot of my colleagues assume that a group function is the way to go. Please remember that the muscular forces associated with group function or progressive are by far greater than that associated with the canine guidance. A group function in the long run will likely cause some form of wear and tear to the designed occlussal scheme, on the other hand a canine guidance is the most gentle and stable form of occlusion, due to the fact that muscle activity is kept to the minimum. I do not see how this could be different when restoring an implant.

wasn't the question Replacing Maxillary Canine with an Implant: Wide Platform or Regular Platform? ” have on hand several implant widths all 15mm or longer, use periotomes to atraumatically remove the root if it hasn't been done already, definitely iCat scan the area to evaluate hard tissues and to preplan, if the canine was already extracted but not grafted then plan on needing to graft keep in mind that you need 2 mm of bone circumferentially so watch your widths...get a ct scan and a surgical stent made by the way, who is a certified implant specialist, last time I checked there was no such specialist qualification