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Single implant tx planning
Hi everyone. I am new to placing implants and have been planning some cases and a couple have made me question what the proper plan should be.
Case #1 patient has limited mesiodistal space. Nearing 6mm. It is #5 location. My main concern is obviously lack on space but also what size implant is appropriate for certain teeth. This area has upwards of 15mm bone height but my concern is if a 3mm x 12mm is deemed sufficient and if you would even place a 3mm is this space. Patient has class 1 occlusion no signs of parafunctional habits
Case #2
Patient has great width of bone both both mesiodistally and buccal linguallly but it is tooth #29 and approaches the mental foramen. A 9 or 10.5mm implant seen on the CBCT implant planner looks uncomfortably close on the mesial aspect. Just curious how you all would think through this. Okay with a shorter implant? Or okay with the proximity? Use a guide for safety. Really just trying to figure out how all you smart implant docs use your brains for these cases. Thanks in advance!
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2 Replies
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Isn’t it amazing how truly few “ideal” or easy implant cases there are!
In case 1 you correct to assume you are limited by the interproximal dimension, but added length to narrower implants can help (think more about the total surface area in contact with bone, also why short but wide implants still can work, biology permitting).
I would be okay placing a 3.0 or 3.2 in that space, almost certainly using a guide to help with angulation. In protected occlusion, no occlusal pathology and it’s not the terminal tooth, I would keep it just out of occlusion for final restoration.
Case 2 I think you’re likely being a little over cautious with the mental, it seems you have a measurement of 12mm or so and are still probably 4mm above the mental. My safety space is 2mm, however (if you’re able to place traditional width implants like 4.0+) there is a limited return on additional length beyond 9-10mm. So I wouldn’t bother placing longer than 10mm just because you can, and that will also keep you so far from the nerve it shouldn’t even be a concern!
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Appreciate the reply and information! Looking at the mental it doesn’t seem like it issue but when you see exit on the buccal side it looked like the 10.5mm got a little close. But that’s all great info. Thank you
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