Space too narrow for implant?

I have a very challenging case.  As you can see on the x-ray, the space in the cervical area is 5mm and the space between roots is 4mm.  Even if I use a 2mm diameter implant it only leaves 1mm space between implant and tooth.  I learned in dental school that the ideal space between the tooth and the implant is 1.5mm.   Is it possible to place an implant in this case?   Please note that I cannot provide a CBCT because there is no CBCT available in the area where I practice (outside the US).   

22 thoughts on: Space too narrow for implant?

  1. Moe says:

    Why bother with an implant, especially since there is inadequate space for placement and restoration? I would recommend ortho (invisalign) and close up all the space. Patient also seems to have issue with mandibular arch, doing ortho (invisalign) or braces, if needed, can fix those issues as well and you have done great service by the patient rather trying a difficult procedure with questionable outcome and then sweating bullets the entire time.

    my $0.02

  2. Rick says:

    Patient has crowding 21-22. Tooth 11 is missing with slightly convergent roots. Patient needs ortho to idealize 11 and 20 sites. Then most likely traffic and implants. Ortho to close space will shift maxillary teeth and midline.

  3. Alan Merchanthouse, DDS says:

    Have been in dentistry for a long time and learned, among other things, that ALL spaces do not need to be filled. But ortho may solve the problem easily. If then left with space you feel must be filled, crown the adjacent molar and extend mesially to close the gap. Or even crown both molars and cantilever a small pontic. There is a nerve bundle down there somewhere so why take that chance?? I’ve felt for a quite a while that dentistry CAN be very simple!! It’s dentists that make it complicated!!!

  4. Jalil Sadr DMD, MSD says:

    Hello, all suggestions are well, but just with one radiography is very difficult to diagnosis and giving final treatment planning. For case presentation or case report is much better to have chief complaint (reasons for coming to office), patient’s age, sex and more pictures/ X-ray of posterior and anterior teeth and occlusion and also maybe study casts. After having more documentations, I agree with Orthodontic consultation for upper and lower arches or leave it alone ( upon patient demand and desire). Dr. Alan Merchanthouse suggestion is for Molar and making larger crown which Molar is not involve in this case (Bicuspid are involved) and making cantilever is NOT indicated by book and references, because # 11 (cuspid) is missing and in upper jaw replacement of cuspid is hard and different than lower cuspid because of force distribution. Anyway should go for more evaluations and orthodontic treatment. Some dentist may go for mini-implant!!!!??? depend on??
    Sorry for long comment. good luck. let us know your final decision.

  5. Jalil Sadr DMD, MSD says:

    Hello again, Not only cuspid cantilever is not indicated especially in upper jaw even regular bridge for upper cuspid replacement is complicated and need more abutments. of course depend on other factor too.

  6. Jalil Sadr DMD, MSD says:

    I am sure in this case aesthetics beside function and comfort is so important to the patient. So we could not crown # 9 (bigger/wider) and veneer # 12 and close the existing space. we should see the other side and also do not forget tooth/teeth proportional form aesthetics point of view

  7. Barrow Marks says:

    A 1.8 mm small diameter implant would would work nicely here. I have placed several of these in this area usually to replace a lateral incisor. Look at Shatkin or Intralock implants. Clear orthodontic aligners would be my choice here. But if the patient wants a quick fix a small diameter in plan would be most efficacious. Let us know how you are proceeding.

  8. PA says:

    After reading all above suggestion, still if ( u or pt) want to go for implant, then first create more space orthodontically then things will be easy

  9. Alois says:

    For this situation is possible to use thin implant Nanoimplant with diameter 2,0 mm produced from nanostructured titanium. That is why its strength is like imlant dia 3,5 mm from normal titanium.

  10. Philip Christie says:

    I agree Ortho to close spaces or ortho to create the space needed for the implant. Conversations around options ( pros and cons) first with orthodontist, the with the person (patient), then maybe both together.

  11. oralsurgery JJ

    You gotta see the study model of the patient.
    Canine is normally protruded laterally or diagonally, so it might have more distance than you see in the panorex.
    But since you seem to have no or minimum experience in canine area implant, it is best to leave it to other acknowledged doctor around your town.
    I personally think Mx canine should be restored with thicker than 4mm diameter implant in order to successfully support canine guidance.
    Lateral force to smaller diametered implant can easily crush the neck of the implant.

  12. Greg Kammeyer, DDS, MS, DABOI says:

    This thread surprises me….Canines take a huge lateral load!! I wouldn’t want a canine cantilever nor an implant smaller than 4mm in diameter in my mouth. I’ve found 5mm implants can be nice yet they can be a challenge with having 2mm of buccal bone thickness. I also wouldn’t want perfectly good teeth cut down for a bridge or splint. Ortho and then an implant would be best. Clearly there are other crowding issues that ortho would solve.

  13. Yassen Dimitrov says:

    The german word for a canine tooth is eckzahn (tooth in the corner, ecke-corner). Like the pillars in the corners of the house. It IS the tooth, DESIGNED by God or nature to take the highest punishment, during lateral movement, and survive for a lifetime. This root is he LONGEST in human dentition for a reason. So it could transfer less strain to the surrounding bone (remember the great prof. C. Misch-larger contact area between implants/root and the bone-less strain on the bone. I 100% agree with Greg Kammeyer- you can’t do a tiny , narrow implant there, because IT will overload the bone around itself. It is not the implant, but the BONE around it that can (and probably will) get overloaded .
    If the patient wants fixed teeth, send for ortho (there is crowding in lower jaw also), so perhaps a little bimaxillary protrusion won’t hurt , open the space and do a 4.0 or 4,5 mm implant.
    If the patient refuses ortho, I would refuse and implant treatment. I have too many things to worry about im my daily life, I don’t need extra.
    Hope it helped, good luck and please, share the patient’s decision with us.
    Dr Yassen Dimitrov

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