What size of Implant: wider or narrow?

I am planning an implant bridge. Ridge width is good, but cortical bone is very thick on buccal and lingual surfaces. I am questioning whether to use a wider implant or narrow. Photos are 3.7 by 10 vs. 3,2 X10. Is vascularity an issue here?Opinions welcome!

18 thoughts on: What size of Implant: wider or narrow?

  1. Anon

    Ridge is sort of “mushroom” shaped. The widest point at top of ridge where platform would be is 8.2. Below that, the narrowest point is 7.2. Using a tapered implant of course.

  2. howard abrahams says:

    3.7 seems like the better choice. you can always tilt the implant away from the concavity and correct with an angled or custom abutment. 3.2 seems like a small implant for posterior region. Consider if patient is a bruxer or clencher. GIven the thick bone, that may be a very real possibility.

  3. Dr Dale Gerke, BDS, BScDent(Hons), PhD, MDS, FRACDS, MRACDS (Pros) says:

    This case looks well designed. I presume you will progress with a surgical guide.
    I would suggest the wider platform but possibly consider a 11-12 mm length implant (there seems to be plenty of room for them to be a little longer).
    I wonder if the anterior implant could be placed further mesially? If the ridge is a little narrow in that area, it might be worth considering the narrower implant and positioning it further forward.
    The reason I raise this point is that the emergence profile would be better and create less food trapping (and easier cleaning) if the abutment and crown was a little closer to the adjacent tooth. It may not be possible – just worth considering I think.

    • Anon

      Good point. I was planning an cantilever at position 21. You are right, the ridge at 21 site is wide enough but the “meat” of the bone is a too far lingual, I think. It doesnt show on the images I posted but when I render and examine the scan, the position of an implant at 21 site is quite a bit out of line of occlusion. Also, I figure a cantilever at that position is fairly well protected being right behind the canine.
      I appreciate your expertise. Thank you.

  4. Carlos Boudet, DDS says:

    Give us a little more information about the patient. Is he or she a clencher? I would not put anything narrower that standard diameter implants in the posterior region. You have plenty of bone for the 3.7 implant. Vascularity may not be a problem.

  5. Mark Bourcier DMD FAGD says:

    There is no advantage to placing an implant that is longer than 8mm. Regarding width, use the widest implant that leaves sufficient bone all around, minimum 1.5-2 mm.

    • AG says:

      Just a question why are longer then 8 mm implants are not beneficial ? What is your evidence on this subject, that use of short implant in the area were longer can be placed without harm are not beneficial? Respectfully AG

  6. Ed Dergosits D.D.S. says:

    I agree that there is no benefit to using an implant longer than 8.5 mm in a healed site. Longer implants are sometimes needed to achieve initial stabilization for immediate placement in fresh extraction sites. I would place a 3.7 given the choice but I would also consider placement of a 4.0. I think your approach to use a cantilevered mesial pontic is a good plan.

  7. Barrow Marks says:

    Can some doctors comment on the use of cantilever on implants. What are the general rules for placing cantilever pontics on implants

    • Moe says:

      One of the rules that I got from one of my instructors, You can always cantilever to the mesial but never distally of an implant because as we go more distally the forces increase. Of course the always rule applies based on if Pt is not a horrible clencher and as long as other teeth are present. As a rule, I was told, a good cantilever is Lateral incisors (cantilevered from #6 or #8 implant site). Cantilevered tooth should be in minimal occlusion with no interference in working/non working movements.

  8. Ed Dergosits says:

    Over the past 38 years I have restored hundreds of missing second bicuspids with mesial cantilever pontics with only a first molar as the abutment. None of them have failed after more than 2 decades of observation. I have also restored many cases with cantelevers using implants. What “they” say about cantilevered pontics is simply not true. Next week I will be placing a 4 unit bridge placed on implant abutments in sites 28 and 30 with pontics in sites 29 and 31. I know it will service fine for decades.

    • Steve Hurst says:

      Our practice restores 600 implants a year. Do your best to keep occlusal forces down the long axis of the implant. Minimize the forces that are not. Most of my failures and headaches have come when I have pushed the envelope.

  9. oralsurgery JJ

    It seems like D1.5 type bone to me.
    Just make sure you cool down the drilling site in order to avoid heat necrosis.
    Especially when you use implant guide, D1 bone with narrow drilling guide can sometimes
    cause heat necrosis.
    I prefer to use wider diameter of implant in case of wider bone like this patient.

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