Two implants or cantilever for maxillary incisors?

I always cantilever the lateral unless spacing conditions are truly optimal for two implants. Remember that implants need to be about 3 mm shoulder to shoulder to have a real chance for an esthetic bone supported papilla. You don't have that space here. In this case, while I have not seen it, I would ext both teeth. Ridge preservation in the lateral socket with very slowly resorbing graft material - I'll say it quietly as to not upset the masses- xenograft. I would then cover the socket with a CT graft to get as much tissue there as possible. Put your implant into the central, and cantilever the lateral. Occlusal design must be meticulous. Pontics are powerful in the practice of implant dentistry. Whether you do this as immediate or not, that's up to your skill level. Lots of bone loss and presumed infection from resorption defect. I've done cases like this immediate and had great results. If there are soft tissue fistulas or a thin gingival biotype then delay. If you do delay, which may be a good option, do not have a removable putting pressure on the sites. insider growth factors in the central socket. This is a young patient, and this needs to last for a very long time. If you don't have a lot of experience, you may want to follow this with a trusted mentor. If your soft tissue grafting skills are not up to par, take a course and learn them. If you do anterior cases, you need to know how to augment and optimize soft tissue. Keep us posted, thats a good case.

Whatever you do make sure the thru and thru defect is well healed, infection free and regenerated. These teeth needed to do years ago and the pathology has a head start. If there is significant regeneration then two implants but right now the central spot is iffy.

Even though a surgical component is supposed to be successful placing a single implant with cantilever will lead to an implant dislocation because of its fulcrum loading.

My treatment plan is a bit different. I would extract #8, 9 & 10. Graft and place implants at #s8 & 10. Use an Essex as a provisional. Then subsequently restore with a three unit FPD. Graft material and membrane is the docs choice. Pay attention to soft tissue management and removing infection.

cantilever the lateral if you are keeping #8 but I would agree with Richard; #8 looks to have guarded prognosis.

The fellow taking this on is headed for disaster with these two teeth undergoing external/internal resorption--for years, not months. They should have gone into the wastecan in about 2010--long before the destruction seen here. And by the time the residua of the two teeth and apices is debrided, what a defect that will be left! This is a case for a very experienced surgeon, bone grafting it immediately with cancellous bone and a PRF or other non mesh membrane. And it will ultimately need two implants, not one.

The pathology does look advanced but the teeth appear to be still well anchored in the bone. As there is no right way to treat this case without all information, photos, probings, mobility, occlusion, esthetics etc. Considering the young age of this patient and if the other information supports the decision you may want to consider keeping the teeth and resecting the roots when you clean out the defect and buy as much time for the patient as possible. It is a little out of the box but I learned it from Frank Spear and have several successful cases with very sort roots. Like I said, a lot of additional information to make this a reasonable possibility but it may be worth considering and discussing with your patient.

I like the idea of removing 8 also, look at the inferior endo treatment. It will be next, but as I read the post, 9,10 are out and the graft was done. I like GTR, tacks, non-resorbable membrane/titanium mesh. I would do graft only with essix for one month and then place a nice valplast temp that rests on cingulums of anteriors if possible. A major bone graft, I would let heal six months, place implant #8, keep covered for 6 more months. Uncover, form nice cuff for a month, then final impressions, zirconia abutment and zirconia cantilever. One issue here: a graft of this size may need a second bone graft or a second CT graft and you need to decide if they are included in the fee. Patients don't like a large addition to the original plan. Time and caution keep you and the patient happy. Sincerely Leonard

But there is no pathology associated with #8 tooth, so why would you want to remove it ?!

My suggestion would be RE-endo of #8. Apical resection of # 9& 10 carefully cureting out all infected tissues, pack the bony defect with xenograft and membrane. Splint canine to canine. Extraction of # 8 & 9 and implants with immediate loading can thus be deferred for a much later date.

I agree leave 8 unless symptoms appear ( no Xla , we will all die one day , no need to commit suicide today ) , Place implant and graft at the 9 site and cantilever the 10 .... Standard case extract leave for three weeks then flap good site preparation ( clean site well ) place Implant at 9 and graft the defects with synthetic ....... Peter

I agree with mr Richard for extraction of two centrals and one lateral and place two implants connect them with a fpd

If use Essix as provisional, what material would you use to add the missing tooth? I used composite but it fell out from the Essix. Thanks.