Molar Crown on 4.0mm Dental Implant

Do you think you could create a look of 2 teeth. Do a wax up of the space and where the implant abutment is where it lands and havee the lab create the look needed. You are correct in making it narrow. Are you concerned about the "tipping" of the tooth m/d because with a broad contact should eliminate the problem I hope it is an internal connection implant or screw breakage will be a problem.

Consider a couple of goals when restoring the tooth. Perhaps an Atlantis Abutment might help you close the embrasure spaces on the mesial and distal. Additionally, minimize the buccal-lingual width of the tooth if possible. Also, make sure you establish wide flat contacts by discing the adjacent proximal surfaces prior to making the master impression. Only allow centric contact and try to establish a 'lingualized' occlusal pattern. It would be better if the patient has no parafunctional habits...

Have you discussed this with your lab? 12mm is not that wide for a 1st molar (mesio-distally) but way too small an area to esthetically put two teeth......2 small bi's measure about 13-14 mm. Narrow, lingualized occlusion is a must but the design of the metal substructure has to be of a nature to support the porcelain. There are a lot of factors that need to be discussed and your lab needs to be in on the planning for this case to be successful. Let the lab know what the patients expectations are, they may have already done a case of this nature.

I think that everyone here is on the right track and I agree completely. Light/narrow/lingualized occlusion is a must. The lab must create a proper framework extended for porcelain. If the vertical space is limited, you may want to consider a metal occlusal over a cementable abutment depending on the implant system you are using. This is a very difficult problem to solve and these "lollipop" or "pancake" crowns can come back and bite you with screw, abutment and porcelain problems down the road. Let your patient know you'll do the best you can within the anatomical limits that are there. Short of replacing the implant, it's all you can do.

I do agree with other clinician's suggetions except removal of implnat and placing wider implant asit is 1,against patient's willingness 2,expensive 3,time consuming.Also if implant is close to sinus floor it may invite more difficult tasks. you could think in direction of restoring space with hybrid prosthesis with composite tooth, ofcourse with narrow occlsal table.

Tell the patient the implant has to be removed, but it will be minor almost no surgery. Ask the patient what he thinks surgery means, then explain the procedure to him and see if he won't accept a flapless, no swelling, no pain procedure, easier than an extraction. Get a surgical trephine and remove the implant and at the same surgery place a 6 or 6.5mm implant. No flap, local anesthetic, way simple and easier than suffering the prosthetic struggle you are going through now.

If there is that space it is significant to think that before the teth loss it was there. so the first step is to speak to the pacient and talk about the space. one possibility is to creat a proximal contact into the 1.3 making a mesio overconturn to ensure 2,5 to 3 mm between the cervical of the 2 teth then make a proximal contact from 4,5 to 5,5 mm above the bone - this way you create papilla. In distal to the 1.5 leave a space between 2 to 4 mm. You can try it with provisory crowns and have the opinion of the pacient. other solutions ? (orthodontics? - Cl II Div II ?) need the pictures and cefalometric study!!

I have had extensive experience with similar situations and would echo the sentiments of several of the practioners that the best option is to explant the implant with a trephine and place a wide diameter implant. My personal recomendation would be to use ITI/Straumann's WNI implant. It has the most secure abutment connection on the market and the most advanced surface technology. In my opinion, working with the existing implant is avoiding the inevitable: problems of chronic screw loosening and eventual fracture of the implant. Good luck

A fully integrated 13mm long implant and multiple doc.'s want to remove it with a trephine?? Could it be possible that the surgeon placed a 4mm diameter implant because the boney anatomy was inadequate to house a wider diameter implant? You might want to contact the surgeon to discuss the case before you declare him/her to be incompetent and remove a perfectly good implant. With the limited info available on this case, the only practical solution is to make a master cast with full arch upper & lower impressions. Let your CDT work his/her magic with a conservative occlusal scheme. PS-Please don't have it removed without a very, very good reason. It is a standard diameter implant-should last a long time.

I respectfully disagree with swilsondds. There is no excuse for placing a narrow implant in a molar site. If there is not enough bone, the site can be predictably grafted with autologous bone to allow the placement of a proper diameter implant. Trying to rescue a problem ridden implant with expensive prosthetics is money down the drain and avoiding the inevitable. For a a competent surgeon, it is easy to explant the implant and graft if necessary and then place a proper diameter implant that can sustain the loads, look natural, and not be susceptible to chronic screw loosening and fractures. I have been down this road several times and learned the hard way.

I would explain the difficulty to the patient and let them make the choice and take the responsiblity with it. I would also suggest fabricating the crown as a screw retained restoration so that if at any time the screw loosens retreiveablity is simple. The patient has to understand that if the crown even hints to him/her that it is loose they must call the restorative doctor right away. If the crown is worn loose it could destory the machined interface. I will only fabricate cemented molar crowns on 4mm implants when the patient takes the risk. Don't take responsiblity for surgical mistakes and poor treatment planning

I found this article interesting since I am a patient of a prominent surgeon who replaced #19 with an 4.8 iti esthetic plus solid screw wide neck implant. My case is interesting in that I am a perfect candidate for an implant and yet I had horrible trouble and pain with it leading to removal after (2) two years from the original surgery date. Even more disturbing to me is that toward the end I had no pathology on an x-ray. A lot of Doctors refused to listen to my pain and simply judged me by what they visually saw- by an oral clinical exam and what the x-rays showed. However (1) one particular doctor did explain to me that my implant appeared to be up to high and that the wide coronal part of the implant was creating chronic inflamation. This Doctor also noticed clinical bone loss in the area. I was also told the implant was big and seated in a tight area and that could be why I was in pain. To make a long story short, I ended up leaving the state of California to have it removed by a kind Doctor in Washington State because no-one wanted to get involved in removing a perfectly good implant that was causing pain. Sure enough the Doctor that removed it-with a trephine bur-found it had poor integration and was not fused properly. He explained to me I had an infection and gave me back the screw that was covered with granulation and fibrous scar tissue. The Kind Doctor that removed it said I was rejecting it or it was contaminated. I am writing this comment so that my voice will be heard- SOMETIMES THINGS ARE NOT AS THEY SEEM & yes SEEMINGLY WHAT APPEARS TO BE A PERFECTLY GOOD IMPLANT, MIGHT NOT BE PERFECT AT ALL. Thank-you Andie

I had an edentulous space of about 15 mm at the site of my first lower right molar. It was recommended to me that I get a double implant done. I had two 4 x 10 mm implants placed and a single crown was used for the restoration. I hate the results. The aesthetics are terrible, there are hygiene problems, and the occlusion is terrible even thought it's been worked on by 2 different dentists. It never feels comfortable and I hate the hygiene aspect as well. I really wish I never agreed to this. I was told later by another dentist that I did have enought bone for a wide diameter implant. I would like to have them removed. Could anyone explain the procedure to me? Also would it be possible to try again at a later time this time using a single wide diameter implant?

15 mm should indeed be treatment planned for 2 fixtures. However, the fixtures should be narrow and allow 3 mm or more between them and 2 mm or more to the adjacent teeth. at times, a stent is needed to place the implants in the proper position. Treatment planning is probably the hardest and longest part of the treatment in these cases. Cutting corners leads to problems. removing implants for the sake of placing smaller diameter fixtures instead of them most often will involve grafting the site and waiting about 3-4 months or so before the new implants can be placed. I find autogenous bone scraped from the surrounding area to work well for the amount of bone needed is not very large, success rates are high, results are fast, and cost is kept to a minimum.

Progressive bone loading -will give you an idea of how the bone is reacting. Cusp fossa relation ship, prevent lateral contacts. You have 2 mm of bone buccal & lingual. Progerssive loading may increase the density of bone. Appropriate stimulation to the bone should help you maintain the implant.