Narrow space for implants?

I treat these areas with two 2.5X15 implants. The inter-implant spacing can be less. the bone here is probably Type 1 or 2, good for support. I use stock abutments and telescope the crowns. Probably no peri-implantitis, ever. Singles or splinted is OK. Dennis Flanagan DDS MSc

Great question. Your on the right track. One standard and long implant in site 25 ideally placed with cantilever for 24 should be esthetic and functional. Based on pan, I would discuss with patient prognosis of 23 and 26. I would propose a second treatment option of 2 implants in 23 and 26 with 4 unit bridge to replace for a more long term treatment and leave it to patient to decide. Especially if 23 and 25 were lost due to Perio. Implants in the anterior region need to be placed a little deeper due to narrowing on the coronal. This will eventually compromise the interproximal bone height with adjacent teeth and mandibular anteriors need an excuse to lose bone. If implant in area 25 is placed deep enough, you will see rapid degeneration with interproxinal bone with 26. I usually keep the price reasonable between both treatment options so patient makes the right decision which both myself and patient are comfortable with. Disregard second treatment option if patients Perio is good as well as 23,26 are periodontally stable. Also, would love to see if any arteries in the area. Do you have cone scan? Great case. Thanks for posting.

What system has a 2.5 two piece? Adin has a 2.75. To my knowledge that’s the smallest. If you use adin just go screw retained.

You need a 3 D image before you can decide. There is clearly enough vertical bone but most likely the bone width will determine either the implant diameter or surgical method. However it is not reasonable to determine the distance of the edentulous space with an OPG. It looks like there could be enough room for 2 implants but it would be silly to be definitive. As mentioned by others, you also need to provide a long term prognosis for the adjacent teeth because whatever you do now will influence what can be done in the future. My personal opinion is that less than 3 mm diameter implants would not be a great idea. I worry about their strength and surface area, but also they are notoriously hard to get a good aesthetic result in the lower anterior region (the abutment tends to be very long and thin and gingival position problematic). Maintaining the crowns or bridge also needs careful consideration when designing the prosthesis. Depending on the above, if there is not enough space for 2 implants, I would be more inclined to place a larger diameter implant in the central region of the edentulous space and cante lever off two half units (ie centrally placed implant reduces the rotational forces of a cante lever prosthesis because the cante lever “arms” are reduced in length). If you do this, there is no problem if you eventually need to implant in the adjacent teeth areas. However as mentioned, the final decision would depend on the 3D image results and analysis.

I think one implant is enough with cantilever for replacing two teeth after diagnostic 3dimensions radiograph.

Remove the laterals and do a bridge on 2 implants, or, do one implant and a 2 unit crown with a lingual wing similar to a Maryland bridge, to attach to one lateral.

3D imaging acquired. Bone augmentation needed, frenectomy also indicated.

I personally can not think of any reason to even consider placing 2 implants in such a case. One conventional 3.5 platform fixture with a cantilever would be sufficient.

I have a very good experience with 2.5 mm wide mini dental implants in such cases. You can insert really long MDIs, and they will probably be successful and survive much longer than the mandibular second incisors