Treatment planning for implant placement with narrow mesiodistal space?

I'd do pretty much the same you're doing. I would just remove the crown on tooth #13 and place a better provisional before the surgical guide is made. It'll give you a better notion about the real space you have to place the implants and the crowns after that. I hope have helped you in something. Good luck.

extract the premolar, place two implants and a 3 unit bridge. No sweat.

This case could not be more incorrectly treatment planned.. The doctor who suggested an ortho consult was giving you a courtesy break. There is posterior bite collapse from the loss of the lower molars and the consequential tipping of the molars and per-molars, Whether the patient is is is a financial,position to correct this or not is no reason for you to allow a patient to dictate improper, or worse, negligent treatment. You can not allow yourself to perform treatment that has no relationship to the overall diagnosis, which you have clearly not made, Stop for a moment and do the right thing. If the patient can not afford to fix the underlying problem in it's entirety, do not allow your license to practice to be subject to a lawsuit when all begins to fail.

Poor planning. This patient needs orthodontic treatment primarily to correct the occlusal collapse. With dental repositioning the space will appear. And the other missing teeth what Mr. Will do?

thanks for your comments above. As i have mentioned to you, patient is aware of her options prior implant placements. however, the patient wishes to proceed implant placements on missing 23 and 24. i would be appreciated if you guys could comment the use of narrow platform implants at these sites.

Simply inform the patient that a pure cosmetic approach (without mastication rehabilitation) will soon lead to implants' overloading and, if she has a financial problem, suggest making conventional prosthesis.

Manage the collapsed bite, supraeruption and drifting for optimum implant placement. Diagnosis is key. Don't just look at the mesio-distal space, have a plan with options.

This case needs a classic work-up and at minimum an orthodontic referral, which is ideal! Please try to explain this to the patient. There is no sense in building errors into the treatment.

Please correct my website URL

To answer your question.... I see no problem with 3.35mm platform implants at all. I use them all the time for many many years in premolar and well considered molar areas.

I would do it similar. Othodontc treatment is prefered, but I understand you that patient simply doesn't want it. If someone can afford himself to send patient like this to someone else, great, but sometimes patient just doens't want it (because of time and0or money) and in some contries in the world economical situaton in very bad so you must accept almost every case. I would make new crown + one new crown on tooth 26 (#14) in cases like this with implant in lower jaw so that you have at leat some stable occlusion. Now the implants would be overloaded. I have not used ND implants in molar region (in premolar yes) but my colleagues told me that in most cases there is no problem. I would go with at least 3.5 diameter on canine.

The 3.25 implants will work just fine. Ortho and replacement of other missing teeth to fix the bite would be nice. But The 3.25 implants with light functional load and narrow table will work very well and give your patient what she is asking for. Just be careful of the load that you subject these implants to. Try to eliminate as much of the contact that is off of the long axis as you can in building these crowns.

I do implant and ortho treatment regularly. I disagree with doing ortho treatment in this 53 yrs pt that has some periodontal issue. Uprighting the last Mandibular molars in this case might cause both of them to be in worse prognosis - we might end up loosing them. So it's better to work with this situation as it is. I will just shave the premolar crown (#13/25) since it has RCT already. At the last slice of CT you see radiolucency at the apex, so this tooth might need implant in the near future. I will not put the new crown because of it's guided prognosis. I will then put 1 implant on # 12/24 area and restore it with cantilever 2 unit bridge on the mesial (canine). It's easier than placing 2 narrow implant. I had several cases like this and I found out that it is very difficult to restore the canine in good relation to lateral incisor, maybe because the angle of lateral is protruding more due to collapse of occlusion / perio problem. But I will maximize the size of the implant, from the CT Scan it show that we can use 4.5 or even 5.0 width of implant. For the lower arch, it's better to restore the edentulous sites with implant as well or at least partial denture. I personally will not even consider placing implant on the upper arch just for esthetic( if pt is unwilling to pay for lower partial denture ), because functionally the implant will be overloaded. Ideally, I will suggest the patient to use Valplast or stay plate on the upper arch and placing implant on lower molars first before placing implant on the upper arch. At least I will fabricate a good lower partial denture before I restore the cantilever bridge on # 11/12 ( 23/24). Functional first then esthetic second - this I always try to emphasis, especially dealing with middle age women. Implant is not for everyone. If pt has limited financial problem, I will just restore the upper arch with Valplast & that will be it. Otherwise you will risk yourself to deal with broken screw or post, no matter what kind of implant you will use. Think 1 or 2 steps ahead of the game ( like in the chess). If # 13/25 need to be extracted after you place implant(s) next to it, it will be really bad situation. Then you'll make her problem to be your problem.

Hi Guys, Coming to this a bit late but imho this looks like a good case for a chrome/cobalt denture. This will give better aesthetics and will also be cheaper. Just because we can do implants it doesn't mean that they are necessarily the most appropriate option. I certainly agree with sentiments expressed that you should should not allow pts lack of money to compromise sound treatment planning.