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Ultra Wide Diameter Implants: Clinical Experience?

Last Updated: Dec 27, 2018

Ultra-wide-diameter implants (defined as greater than 6mm diameter) are gaining in popularity for molar sites, because of the mechanical burden of these sites, combined with the much larger socket dimensions. These ultra-wide-diameter implants allow for increased engagement of molar socket walls and provide better stress distribution under the high occlusal loads. Furthermore, the ultra wide implants simplify prosthetic design and improve emergence profile.

However, there aren’t many clinical studies around ultra wide implants. In one recent study ¹, Ultra-wide diameter implants (7-9 mm) were placed immediately after molar extraction in a 1-stage protocol, without raising a flap or using any bone grafts. After 4 months, the implant was loaded with a single screw-retained crown. Bone loss was evaluated using peri-apical radiographs.

The study concluded:

Ultra-wide diameter implants have a predictable outcome, demonstrating very little bone loss. Papilla and crown dimensions were comparable to the contra-lateral natural tooth. Read More

There was another previous study where 7mm-diameter implants were placed in molar healed sites after socket preservation for molar replacement. ²
That study concluded:

Single post-extractive ultra-wide 7mm-diameter implants, in combination with socket preservation, might be a possible strategy in the replacement of hopeless molars in both jaws, with high implant and prosthetic survival and success rates, and good aesthetic outcomes. Longer follow-ups are needed to properly evaluate this therapeutic option. Read More

What has been your clinical experience with ultra wide implants?

1.A prospective study on ultra-wide diameter dental implants for immediate molar replacement..Clin Implant Dent Relat Res. 2018 Dec;20(6):1009-1015. Hattingh A

2.Single post-extractive ultra-wide 7mm-diameter implants versus implants placed in molar healed sites after socket preservation. Eur J Oral Implantol. 2016 Tallarico M et al.

7 Comments on Ultra Wide Diameter Implants: Clinical Experience?

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michael pollak

12/27/2018

In my experience, the buccal walls of maxillary molar sockets are generally very thin, and I wouldn't want to engage the wall with an immediate implant, as remodelling resorption is a very likely outcome (socket grafting or not). Better to either extract the tooth, wait for healing and dimensional stabilization to occur, and then place the implant, or place a narrower implant in the palatal root space or inter-septal bone and leave a 'jump-gap of 1-2 mm on the buccal. Similar thoughts on immediate mandibular molar implants, unless the pre-op CT indicates a buccal plate thickness of greater than 2mm. I find that I'm doing less immediate molars than in the past. The placement into a healed/grafted site is much easier, and less prone to complications, leading to a better night's sleep. patients aren't as hung up on getting an immediate implant as we Dentists think they are, and will accept our sequencing of treatment, if they know it's in their best interest.

Bfulk

12/27/2018

I agree Michael! Why place a wide implant which will ultimately leave less bone to surround the implant? Just because something is easier does NOT make it better. In my opinion and experience, a narrower (4.0-6.0mm) Implant with more supporting bone has a better long term prognosis than an extra wide implant close to the buccal plate. Not to mention the potential catastrophic defect that occurs with a failed 7.0-8.0 diameter implant.

Francis G Serio

12/28/2018

I agree with Dr. Pollack. I never quite understood the rush to place immediate implants in molar regions. More complicated surgery. Bone not ideally positioned. So much easier with healed/reconstructed ridges. Reminds me of the old adage- “Just because we can, does not mean we should.”

Dok

12/28/2018

Any implant from a reputable company will work as long as there is quality bone, good surgical skills and "room for it". That's the catch, "room for it". Squeezing a large diameter implant into a space that is "just big enough" is always a tricky thing to do. Probably better off going smaller and augmenting if necessary.......save yourself headaches about bad positioning, thin boney plates or perforations. Sleep better that way.

Robert J. Miller

12/28/2018

Ultra wide implants have been around for decades. They seem to come in and out of favor, as soon as those clinicians who used to use them are out of the picture. Then younger doctors, who have not experienced failures with these implants start to experience the same things we did years ago. First, there is no higher success rate with ultra wide implants (8mm or greater) than with 6.0 to 7mm. The predominant complication? Dehisence remodeling on the facial and palatal walls. This is simply a function of early overcompression when the implant is placed, following by a normal loss of thin plates of bone from lack of stimulation. We got tired of a significantly higher complication and failure rate using these diameters, and have simply refused to continue to use them since that early experience. But, if you want to reinvent the wheel, feel free to go through the same learning curve. Guess that's the secret of gaining wisdom.....

Greg Kammeyer, DDS, MS, D

1/2/2019

I've had extremely good luck with 6mm implants. Even with those and some socket grafting, the patients don't complain about food collecting any more!! Since this size doesn't put pressure on the buccal plate and easily allows 2mm of buccal bone, it is the best in my opinion. Immediate molars are great!! Saves surgeries, visits and costs for the patient and my referring docs seem quite happy with the results. Preping the osteotomy takes patience on lowers. Uppers are a slam dunk.

Mahmmod Alrawi,BDS, MSc.

11/12/2019

I am currently conducting a study, using wide implants ( 6 mm with wide neck ) immediately post extraction in sockets where oroantral communication post extraction is a definitive outcome ( Radiologically , then confirmed clinically) with and without grafting, and the results have been positive so far without a single implant failed ( 3 months - 14 months period of observation) , my next step is using Ultra Wide implants for the same purpose, and I hope that someone can suggest me an Ultra Wide implant system that is reliable and been used successfully . Thanks

unable to make abutment level impressions recommendations ucla type implants crowns have less of a tendency to loosen