Can I do an implant for upper left premolar?

The space appears to be too narrow due to drifting. I would remove the carious #14 graft it, remove #13 since t is rotated and restore with two implants or a mini bridge according to the wax up. I would also replace th opposing lower molar. Patient needs caries control. Remember that those root canals are failing so those will need to be replaced in the future so eventually the patient will have the implants placed symmetrically. If you hav a good comprehensive treatment plan it can be implemented in stages. You also could prep #13 for a crown to see how much space you can get instead if extracting it. CT would be helpful for width. I think it is a nice case but try and think comprehensively vs sticking a narrow implant in a compromised space. Thanks for reading.

My plan is to remove teeth number 13,14. Replacing by two implants with an enough diameter at the sites 12 and 14. Or 3 implants at 12,13 and 14, if there was acceptable space for. Thanks for your reading.

I think the patient would be better served by removing #14 and rotate 13 with segmented otthodontic treatment followed with grafting the site of # 14. Then placing implants at 12 and 14. Another approach is the extract #14 and bridge from 11 to 15 .

Agree with Richard , best for patient in long term to ortho rotate and keed then 2 Implants . Peter

Looks narrow, but clinically how much Mesio-distal space is there? PAN's sometimes can fool you. I agree with #14. Looks nonrestorable and #13 is rotated.

I think the patient would be better served with removal of rotated 13 & unrestorable 14 and placement of 2 implants and 3 unit bridge, much as described above. I think ortho will drag out treatment time and add to cost for the pt. Both ways are very valid and I would present both options to the patient, clearly outline pros/cons and let pt decide. If you are happy that every option you present is a good long term solution and you are capable of doing them all to a high standard, then whatever the patient decides upon is a valid option and you cant be in the wrong for coercing them down a path they may not necessarily like.

Pano is inappropriate to determine the interdental space; distortion is too great. It appears the #13 tooth is rotated but perhaps it is misrepresented by the radiograph. Take a PA and measure, if it's close consider a CT. Evaluate the clinical crown space as well as the interradicular space. Without proper data it is premature to decide the fate of 13 and 14. BTW, I'd focus my attention on the missing mandibular tooth (19?), it is far more important to long term occlusal stability. If 18 goes, the left side is unstable.

I think the best is an orthodontic consultation with appropriate radiographic documentation, photos and study models. You may then decide whether to only orthodontics, orto + extractions and implants or something else. D'ont forget to considerate the molar right mandibolar region.

Yes ortho is a great option and a consult is warranted. In that case the thirds should be removed, spaces closed and #14and #19implants. The ortho is great for future perio to remove the crowding. Probably remove the other first bicuspid for symmetry. There is quite a bit of drifting due to tooth loss. One never knows what the patient will chose when given all the options! Again should not be done piecemeal but consider the whole mouth.

I would never consider extracting the second bicuspid, #13! You need to treat the caries, remove the unrestorable teeth, failing endos, get the mouth cleaned up, then I would ask myself what put this mouth in this accord and deal with those issues. Once you have a patient on board, I would consult with my favorite orthodontist to look at other options. The lower arch appears to have rotations and crowding and this patient may likely benefit from full mouth orthodontics prior to implant placements. Consider the occlusion as well. Deal with the entire mouth by the stages of most critical issues first, whether caries, perio, infection, then, the permanent restoration of missing teeth.

A little late to comment, but won't it be better to extract 1st molar, derotate the 2nd premolar, allowing it to drift mesially closing the small space of 1st premolar in segmental ortho, and then, place two implants in the acquired space distally?