Impacted canine extraction: 2 vs 3 implants?
This is an update to the case that I posted a 6 months ago. I ended up removing the impacted #11 [maxillary left canine; 23], doing a block graft for # 7 [maxillary right lateral incisor;12], sinus lift and simultaneous GBR for horizontal augmentation for maxillary left quadrant with 100% Puros bone. Patient had no swelling whatsoever thanks to Dr. Hom-Lay Wang who taught me to work with finesse. My dilemma is that my patient wanted to get a fixed bridge on 2 implants to save money. Now, I wonder if I should go back and place a third implant?
Pan Pre Implants
Pan Post Implants
13 Comments on Impacted canine extraction: 2 vs 3 implants?
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TOBooth
4/9/2013
nice case however, i really dont think you needed the sinus augmentation. If you look you could have placed the most distal implant 2-3mm more mesially , fixing it almost in the corticated wall of the sinus. Granted a block or ridge split were necessary.
CRS
4/9/2013
Where were you thinking of placing it?
Michael Vo
4/9/2013
In between the 2 implants. She did not want a fourth tooth. CRS, I like your comments and your philosophy a lot. Can I see your surgeries live someday? Regarding the sinus lift, it took me 15 min extra. The GBR was much more unpredictable because of the extent of the flap.
CRS
4/10/2013
I think you obtained an excellent result. A three unit bridge is fine, but an additional implant in-between would maintain the bone and give you a cleansable situation with three crowns, I like it. Please post the follow up on the block graft and thanks for the complement.
Diorgenes Mendes Machado
4/9/2013
Did you do a palatal bone block? Nice aproach. I think a pontic has a better esthetic result. I woud do a distal implant in 1st or maybe 2nd molar site.
MICHAEL VO
4/10/2013
I filled the palatal void AND did a buccal GBR.
mwjohnson dds, ms
4/9/2013
Your implant placement looks perfect. Nice job. with those long implants a three unit FPD shouldn't be a problem.
Dr. Vipul G Shukla
4/10/2013
Nicely done!
A three-unit bridge should give adequate function here, especially that the distal implant is nice and broad, plus they are both long implants.
I have never flapped the palatal tissue so extensively, and have some queries:
1) Any anatomic structures in the area you flapped? Especially the greater palatine?
2) Was the canine defect continuous with the sinus?
3) Your second photo shows a fat thick ridge. Did you GBR in the canine area as well besides the sinus lift? If yes, what did you use?
4) Was all this done under local anesthesia alone?
Thanks for sharing.
MICHAEL VO
4/18/2013
1- The greater palatine does not worry me. I am only concerned with the lesser palatine artery.
2- No. There was a wall. And there was 2mm of bone between the impacted canine and the latera incisor. This case was tricky.
3- I did GBR from the lateral incisor to the 1st molar area with Sonic Weld. This bone will look even better in 3 months.
4- Yes, local anesthesia is all I need wheter it is GBR or even bilateral sinus lift with symphysal graft.
Dr Shyam Mahajan
4/12/2013
Compliments for bone augmentation.
In maxilla I shall prefer more implants. In this case distal to sinus- Pterigopalatine angulated implant Though two implants & 3 unit bridge will give adequate occlusion, in maxilla its better to get more support for long term success.
CRS
4/13/2013
I think there is enough bone in the maxillary tuberosity to place an angled implant for the sake of discussion. Bear in mind that the patient needs to be able to maintain the hygiene. The three unit bridge on the two beautifully placed implants should suffice!
rsdds
4/18/2013
very nice case but with all that maxillary bone i would place an additional implant even if i have to pay for it. THAT IS A LONG SPAN IMPLANT BRIDGE IT LOOKS LIKE YOU CAN FIT 2 IMPLANTS IN THE PONTIC AREA. GOOD LUCK!!!!
Sam Jain DMD
5/1/2013
In my office, we offer package price for the job, if I think 3 implants are needed for good job, we do three implants. If px insists that I place only 2 implants, to cover the span, I tell the px that i would have to charge them more because I am setting myself up for complications.
Bay area implant dentistry
