Two Dental Implants Vs. Cantilever: What is the Preferred Treatment Plan?
Dr. P. asks:
I have a patient who is missing the right maxillary lateral and central incisors [#7 and 8]. There is a total of 12mm mesiodistal space available with adequate bone in the buccolingual dimension. I am considering placing dental implants in the lateral and central sites – a 3.5mm diameter implant for the lateral incisor and a 4mm diameter implant for the central incisor. I am going to have 3.5mm space between the two implants and 1.5mm between each implant and the adjacent natural tooth.
As an alternate treatment plan, I am considering one implant of 4.8mm diameter in the central incisor site and cantilevering the lateral incisor. This would require only one implant and would considerably reduce the cost of the treatment plan. The patient is wearing a mandibular Kennedy Class I removable partial denture with only the mandibular canines remaining. The loading forces from the opposing arch are reduced.
What are your recommendations? Go with Cantilever or two implants?
25 Comments on Two Dental Implants Vs. Cantilever: What is the Preferred Treatment Plan?
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Hung Dinh
1/5/2010
This sound like and older patient. How old is the patient anyway?. Is he/she planning further implants placement for the anterior lower?. If not, then I would go with just one and cantilever. Save the expense for more implants in the lower, maybe. I would just make sure you have about 1.5mm buccolingually beyond the implant. Send us some radiographs and pictures for our enjoyment :). Good luck and have fun.
Dr.Puneet Kathuria
1/5/2010
Hey Doc,
I believe, its all about controlling forces & placing a 4.8mm is a great ides.It maintains an optimal implant -tooth distance as well. The forces currently are minimum as its opposing an RPD.
Make sure you have a good ceramist to give a perfect illusion of 2 crowns over one Implant (& that too in anteriors) great.. all the best.
Puneet
Amer Suleyman Atassi
1/5/2010
I agree with an implant and a cantilever bridge since occlusal forces area limited. You don't need 4.8 mm implant. This will increase the risk of crestal bone loss and thread exposure, unless cretal bone is too wide. In my opinion, 4 mm implant is sufficient. Regarding the prosthetic phase, screw retained bridge will eliminate the risk of debonding.
ssargent
1/5/2010
The cantilever bridge is definitely the way to go, when there is sufficient bone, for the forces involved. Side by side implants in the esthetic zone are much more difficult to achieve and try to maintain. Plan on either or both, gingivoplasty and a custom bridge to guide the emergence profile. There are many internet resources available to show you how to achieve this.
Alejandro Berg
1/5/2010
If you are concerned with a cantilever, you are right.
place 2 implants, and if you are somewhat shaky in termas of mseio distal bone, just use 2 3.3 or 2 3.5 implants. witha a good surgical guide you will get the correct placement and the correct rehab.
Ro bert Salisbury
1/5/2010
What is the gingival bio type?
Are we preserving it or does it matter?
What is the Lip and smile line?
Are blunted papilla ok or not?
Dr. Gerald Rudick
1/5/2010
There are options available in a limited space, where a cantilevered prosthesis is not necessary.
Consider using a standard diameter implant for the central incisor and a narrow diamter or a mini diameter (1.8mm) for the lateral. The mini will integrate, and will prevent forces on the lateral from torquing loose a cantilevered prosthesis.
Dr Matteo Rossini
1/6/2010
Helly everyone! i'm in agreement in according with dott. Berg. you can use 2 little implant (3.3 or 3.5 diameter) with excellent results!
Dr.Amit Narang
1/6/2010
Had cantilever been the best option, you would'nt have been asking this question... THINK AGAIN
Don't try to do some procedure which gives you sleepless night n also failure down the line...
Definetely put two narrow or one regular and one narrow implant and sleep well.
Carlo
1/6/2010
In my opinion If you have space place a 4.5x8.0 or 5.0x8.0 Bicon implant.
Don Callan
1/6/2010
Two implants would be the best option. What would you do if two natural teeth were present. Treat the area if there were two teeth present. With proper placement, implant size, spacing and adequate bone the gingival result should not be a problem.
Robert56
1/6/2010
Mount it up
Analyse
wax up
determine bone
determine load
determine aesthetics
proceed
what the heck is all the advise with out looking at the mounted models
Maurice Salama
1/7/2010
Dr. P;
Have done many cases with cantilever restorations in this situation solely based on the "esthetics" and predictability. I have found no difference with success rate of the implants or the restorations. In addition, there appears nothing in the literature that supports the view that this is a high risk treatment option. With a high lipline and high esthetic expectations, the Central-Lateral replacement is the Bermuda Triangle of implant dentistry. Many have gone in and only a few have returned safely.
Enter cautiously and good luck.
Dr. Maurice Salama
Larry Skoczylas
1/10/2010
Dr. Salama - glad to hear your opinion. Dr. Carl Misch lectures to never do a cantilever off a central incisor, though his brother Craig seems to disagree. I heard them at the last OMFS meeting in Toronto. Have you ever talked to Carl about this?
Peter Fairbairn
1/11/2010
As Robert Salisbury said this could be a soft tissue driven decision. High lip line , thin Bio-type, flat papilla could dictate a cantilever for aesthtetic purposes. But technically 2 would be best and the patient would prefer it as long as the soft tissue issues can be met.
satish joshi
1/12/2010
Without looking at condition of nos.9,10 and 11,It is not right to give advice in this matter.But cantilever does better as far as esthetics are concerned.
Occlusion is very favorable in this case.
Diagnostic wax up is must.
Esthetic should prevail,not function.what is the use of two solid implants with unattractive smile.I would rather place fixed partial.
Jeffrey L. Tarlow
1/12/2010
What you have proposed would be: 3.5mm + 4.0mm (implant diameters) plus 3.5mm inbetween implants plus 1.5mm space next to proximal teeth = 14.0mm. You have 12mm of mesio-distal space. A 4.3mm diameter implant for #8, with a cantilever pontic for #7 would be a safer, more predictable option, in my opinion.
Robert56
1/14/2010
Function follows form
Form follows function
You must have both to preserve it long term.
OH
Are we doing this for long term?
Dr.Omar Alirhayim
1/16/2010
Dear Doctors
There is a very important aspect u have to check it well:
- how long the patient missed the teeth , its very important in the esthetic zone to plan very well for gingival shaping and in the same time for the adjacent natural teeth marginal gingiva type.
- u can do implant for the central incisor with firm procedure and cantlivering the lateral incisor with a wing just like in the maryland bridge attached to the natural canine .
regards
Omar
Dr. Samir Nayyar
1/19/2010
Well just go for 2 single piece implants. They'll reduce the cost as well as will give good results as according to me their failure rate is less.
Dental Implants
1/20/2010
I agree with Robert
Dr. Jennifer Watters
1/22/2010
Depending on the patient's age, available bone width and height, esthetic demands and gingival biotype & architecture, a single standard implant in the central incisor site with a 1.8 mm mini-implant with a prosthetic head in the lateral site is a viable option in my opinion. I stopped doing multiple implants in the #7-10 region in highly esthetic cases years ago before the minis were available, now I might feel differently. Good luck!
Robert56
2/1/2010
Jennifer
a 1.8 ITI implant is a RN 4.8 mm head that shows the weakest link in the ITI system since it is the one that fractures the most.
Be careful.
3.3 to a 4.8mm is a distater but if you use a 4.1 to a 4.8 then maybe you can get awty with it.
Dr. Dennis Nimchuk
2/5/2010
I am not sure that I agree that a cantilever lateral pontic off a central implant will produce superior esthetic results as has been stated unless there is a specific issue with the soft tissue morphology.
From your description it sounds as though you have enough space for two implants and I believe this would be the design of choice although I also believe the cantilever would work, providing you are able to make the implant length on the longer side for more resistance to compensate for the torque of the lever arm of the suspended pontic.
dr kurien varghese
3/23/2010
different opinions ,but i will like to ask about the patients smile line ,high lip line or low lip line ,if pt has a high lip line then cantilever , if not done properly will be a problem ,also you have to think about the emergence profile since it is in esthetic zone .also cost should not compromise your treatment plan,always place each implant for each teeth .temporarize immediately to get a good emergence profile
