Upper lateral with narrow dimensions: thoughts on this case?

Hi, I think this placement is absolutely perfect. I have completed the diploma in Implant in Scotland recently. I place mainly Straumann system and am quite interested to know more about the system you are using. What is actually your name? Please write more about what you like about DIO system and how long research has been done on this system. Well done on this placement.

This looks good and shows her are always many solutions and they can work well . Placing with the accuracy shown here is not that easy . This can be the better solution , long term as well for these cases . In the Uk sadly we are too fearful of what may go wrong , rather than enjoy our successes. Not the traditional approach but looks good and will work in this difficult situation. Regards Peter

Looks good, I am one of those fearful people that would have placed a 3.0 two piece with platform switch.

Your case looks great! I used to use a one piece implant, the Zimmer 3.0. My issues with one piece implants are: 1. Prosthetic inflexibility- your abutment is a straight line with your implant with no room for prosthetic flexibility. Many cases need prosthetic wiggle room for success. 2. The crown margins are deep, and I had a few cases with recalcitrant cement related peri-implantitis. With a two piece system, you can screw retain or bring the cement line more coronally with a custom abutment. What's the diameter of that implant at the widest point?

Perfect placement.

Hi Shila I have placed about 1,200 Dio Implants in the fast few years ........maybe come to Porto for their conference .... Well engineered , cost effective sums it up. Peter

Perfect placment. I have many cases with the same situation. I used one piece in some cases and 2 piece in the others but not in this diameter. Of course 2 piece more flixable in prosthetic restoration. One piece has limited prosthetic options. My concern about this case 2 things: 1- is that that the maximum space gained by ortho treatment. What about the size of the crown in the upper left lateral to make it symetrical? 2- is that diameter FDA approved? Regards

My dear friend I would have appreciated if u could have uploaded post oprative photographs to congratulate you on your effort. My person advice is keep things clear with your parents about all the pros and cons of any treatment and document it. There is nothing like learning yourself ,only see to it that you have a decent backing of theory , evidences and ethics. Once your patient is happy you will your rewards. You seem to have done good job.all the best and be ready to do it and learn.Personally I feel mini implants do give good results provided your case selection is good.

I think you did a great job....but in future, do not your let the patient do the treatment planning. Orthodontics should have been done to open the space mesial-distally. I have had this experience years before, with the same scenario, Maryland or bonded bridges kept falling off........but remember, this edentulous space did not have a natural root to stimulate the bone, and the buccal /palatal dimension may be thinner than you think.......on of the two implants I did failed!! Don't rush for the final restoration, leave it in a temporary state as long as you can to be sure that osseointegration did take place, and get a scan. Good luck Gerald Rudick dds Montreal, Canada

You aced this one! If you can thread this needle hole, you will go far in implant dentistry. Stop fretting, and pour yourself some aged single malt on the rocks. Cheers!

Hi there, You are being extremely modest there. Placing with micrometric accuracy is indeed very difficult and this could have not been made better in any possible way. We have been using these Dio implants for such situations in limited cases. Lateral incisor and the lower centrals and laterals mostly. These also come in ball attachments for over dentures. To be honest we do not have long term results to know their stability and crestal bone loss. These are one piece so limit our options later on and do not offer us any flexibility of angled abutments etc. But having these mini implants on our armamentarium has been useful to us so far. Cheers!

I agree with Uzair . No reason to suppose this won't be successful just make sure they lock in tightly on insertion , 50 Ncms . Probably don't need any initial incision for this diameter , this could just be an extra complication and your bio temp will form papilla . If peter is still there , looking forward to seeing you in devon

very good placement .

While I would certainly applaud the positioning of this implant based on radiographic representation, remember that this is with respect to mesio-distal placement only. There is no way to determine the position bucco-lingually, and, to a limited extent because of the postioning of the x-ray head, the apico-coronal position. Seems like the provisional extends father apical than the CEJ of the adjacent central incisor. So....does this represent "perfect" postioning, or simply adequate spacing with regard to the adjacent structures? RJM

Nice placement. I have done many lower anteriors and lateral minis.. I find them easy and fun to do free hand. The last one, two weeks ago, was one similar to yours. Placed 3,0 mini implant (Hiossen, it comes with temporary cap). Saw patient one week later for post op. Was met with, "doctor, I did not feel a thing, absolutely nothing!" Most patients do feel some soreness. But being flapless keeps discomfort to a minimum. I really think these will be your favorite implants to do. Just watch out for the occlusion......Good Luck!!

Hi David , yes I will show in Devon a four year loaded bilateral case with even less space !!! .... but the author placed very well mesio-distally here as not easy . I have a case where I did bilateral laterals wi so to say with minis 12 years ago and saw her about a year ago and was happy to see the long term aesthetics were great ...but I only do a few so not routine protocol Regards Peter

Peter Fairbairn; "What is the show you are presenting at in Devon?" I am a technician specialising in C&B and Implant restoration construction, based just outside Bristol, and am interested. By definition, I am required to work with whichever implant system is supplied, and it is important to keep up to speed with them all! David Broughton

Hi David at the ADI study club for the South West....... Regards Peter

Peter, Thank you. Regards David

hello everyone, I used narrow implants to treat a bilateral congenitallymissing lateral incisors 2 years ago and I ended up with two failures because of poor planning because that adult patient had a very strong bite with deep overbite so immediate loading of the implants with temporaries was not a good idea... so my first remark would be accute case selection and expectations of the patient are very important for a good outcome so I waited some months but when you're a dummy you dont analyse your failures in a honest way and make more mistakes:so I reimplanted without caring enough about bone status - healthy or not,enough bone cells in the site to promote healing, etc... and I had although no loading a second failure... second remark make a safe and comprehensive analysis of bone before placing implants in delicate sites like those; my patient is a nice guy, he helped me a lot in advancing the quality of care I could eventually provide him despite these failures : he went through orthodontic treatment to enhance the neibourghing roots positions and augment the quantity and quality of bone by some kind of site remodeling. after 8 months of active treatment, I finally placed larger sized implants in these sites and waited anxiously for 2nd stage surgery; everything worked well and I placed 2 nice lateral incisors at last so my last remarks would be for compromised sites, some kind of enhancement can sometimes be achieved by orthodontic treatment (root extrusion, for example, etc...) and last not least, be committed to your patients, do not make overpay for your misjudgment, honesty and good behavior can transform failures into success. hope this help implant starters( I placed implants for the last 15 years)

The case looks great. I have used narrow diameter in cases like this with success. I am not familiar with the DIO implant but I have used Shatkin F.I.R.S.T by Intralock and 3M small diameter implants. My only comment is that the smooth collar is usually not placed in bone. I usually stop the insertion so that only the threads are in bone. From the angle of the x-ray it looks like the smooth collar is resting in bone. Overtime you might get resorption to the first thread, but I think the implant is sufficiently long enough to survive this. Keep patient in temporary for at least 16 weeks. Then remove temporary and check stability of the implant. Should be fine. Kind Regards A. Smith, DDS

Congratulations on the placement! However, this could very easily turn to a disaster (touching adjacent teeth , end in an unfavorable position etc). Taking unnecessary risks and using treatment plans that require heroic skills and good luck will give you a lot of stress and trouble in your professional life! So consider this case an exception and never try this again. Next time may not be your lucky day and guess what, if the result is not successful you will be accused for poor treatment planning behind your back by the patients and colleagues even if you have patient's informed consent....

You couldn't have done any better with the m-d placement...X-ray looks ideal. The rest is hard to comment on without photos, but you sound like you are careful and I'd bet it looks great. My comment is to do whatever it takes to assure minimal to no anterior guidance on this, including crossover. Assess the temp for wear facets over time and be sure the final restoration has the same freedom. If necessary for esthetics or to provide freedom, adjust lowers. Pressure/stress on a narrow implant over time can lead to breakage at the neck and there is no good recourse then.

Wow. Very nice. I've done several of these in missing 7,10 areas. With pts with a gummy smile, it always seems like there is a very very feint greyness show through of the implant through the gums. Anybody else run into that? If so, is the recommended: 1) connective tissue or dermis graft to thicken? 2) bone graft to thicken 3) or both. (I guess it depends on the situation, but what's the more popular protocol for these?) Oh and I forgot 4) remove the implant (a lot of colleagues in this forum think that's always the answer. I try hard not to yank a nicely integrated implant)