Conventional and Mini-Implant?

I have done several cases similar to this with great success. I would suggest the Imtec Max mini implant which is 2.4mm in the maxilary area instead of the standard 1.8 mm implant. Check out Imtec.com for more info. They work GREAT. I feel they are better than standard diameter implants in this situation and they can and should be immediatelly loaded.

You can manage space better with ortho and have better esthetics.

Sounds like a diagnostic problem. Wax up and ortho sounds like the way to go. Damn shame to find this out after the ridge grafting and sinus.

My entry should read. "I am considering placing either 3.5mm Zimmers or a 1.8mm IMTECs. I am planning on splinting the two crowns together." The pt's age is 78 and ortho considered but not an option.

you can place a wide neck or even regular neck ITI or any system you preferon # 13 and cantilver # 12 keeping it in minimal occlusion and away of eccentric interfernce. but in this case try to choose the longest and widest implant diameter possible.

You could also place an ordinary implant of your choice for 12, and at restoration time cantelever 13 off a crown on 14 with a rest on the distal occlusal of 12. I have done one of these for similar reasons, and it worked well without compromising my implant with off axis loading in the posterior maxilla. Good luck.

yes I am agreeable with Ken and have done several cases with two mini or reduced diameter implants.You could use the 2.4 diameter imtec and splint them together or induvidually if the primary stability is good. They will last as several of these cases are more then 3yrs.But make sure you have good primary stability and osseointegration. Provitionalise for 2-3mths or more if need to and then restore permanently. All the best.

I have had success with the IMTEC MAX implant in maxillia. I will use it where there is inadequate misial distial space for a 3.5 implant such as upper laterals, lower centrals, narrow ridge width, or as you have a lack of space. This is not my first choice but one that has proved very successful for me. They have been so successful I am creating a presentation on there usefulness to present at ICOI meeting in 2008. If they did'nt work would Zimmer come out with a one piece 3 mm implant design? They are more placement sensitive due to there one piece design. I have found that the imput of the implant team to help in alinement of these are critical. Lab design will create a natural appearance the patient will appriciate. But shame on you for all the preplacement surgery and not knowing the prosthetic requirements ahead of time. Do your wax-up and restorative design then plan your implant surgery

Dr.Bream,Thanks for the reply. Rest assured that the preprosthetic requirements were established well before the graft surgery and discussed with the patient the fact that with limited space that conventional size implants would more than likely not be the case and that midi sized implants would be likely. However, the nice thing of having a forum such as this does allow one to continually rethink and more importantly ask opinions of others. The previous suggestion by Dr Crummett is one I had not considered. The 2.4 size IMTEC suggested by Dr Koay is what I have been considering from the orginal treatment plan. All excellent thoughts-Thanks

One of the other thoughts would be to possibly slenderize the mesial of #14 and distal of #11 if the roots are divergent and thus allow you the possibility of placing two implants of adequate size???? I think the jury is still out on using small diameter implants in type III/IV bone. Promising, but early, even if some have had success..........Thank you for sharing.

use the smaller bicon implants...you have room for them..