Will two implants be sufficient in this case?

I would remove the malposed #32 and place your implant. Upstairs I would place an implant at #12 premolar and #14 molar the lab wax up will determine the spacing other wise remove the drifted 2nd molar for a three unit bridge. You should have enough space for two implants with two individual crowns without extraction. I would start on the left to full restoration and occlusal stability keeping #32 as a spacer then extract and place the first molar implant on the right.

CRS, I agree with your advice with regard to the upper left quadrant, but it would be interesting to hear the consensus on your advice to remove the lower right third molar and place an implant in the lower right second molar (#31) region. Although LR8 (#32) is tipped mesially it appears to be a sound functional tooth with an excellent periodontal state. In my opinion it may not be ideal but it beats an implant hands down. If it was in my mouth I would accept the status quo. "If it works don't mend it!".

Well there's always the option to place implants in the spaces available and then to use the implants as anchorage to upright the tilted teeth. The difficulty comes when the teeth have not only tilted mesially but also supra-erupted. Tough choice!

Ditto on Upper Left, BUT #32 is a sturdy support which could be valuable with adjustments. At present, it appears to be a balancing side contact with the propensity to drive the right jaw posteriorly. In less severe cases of tipped molars, a simple trimming of the overhanging Mesial helps most cases, but this #32 could probably be saved by an uprighting crown, MOBL onlay, and maybe endo tx if the post pulp horn is too close. It would be a shame to waste all that natural, strong bone, but one cannot leave it as it is or damage to the joint and other problems are likely to ensue.

It will depend on the pre-op wax up and ct scan. You are replacing three teeth with two fixtures. It is simply a matter of contact points and embrasure anatomy. Bv

I find the panoramic to be a poor representation of what is going on at 29,30 and the 31 area. Bv

Two implants for #12-14 for the UL will be fine. #32 is interesting, I had a very similar patient situation. Young man was in ortho tx and they were trying to push the tooth back to make room for an implant, I suggested the reverse. The orthodontist wasn't happy but he did a great job bringing the 3rd into occlusion and contact with #30; no implant was needed and the patient was thrilled.

Do a diagnostic waxup of the maxillary edentulous area. If you can fit three normal size teeth, talk to the patient and give him(her) the option to get a three unit bridge on two implants or three individual implant supported crowns. If there is not enough room for three teeth of normal dimensions, I would do the three unit bridge, otherwise you may end up with some unwanted interproximal bone loss if the implants are placed closer than 3mm from each other. I don't like removing periodontally sound, functional teeth for convenience so I would use TADs to distalize the lower right tilted molar or bring it mesially to close the space. By moving it mesially you will avoid the need for an implant in the 2nd molar region. Good luck!

I like the wax up idea for the max left, but may not be necessary. Just watch your spacing. Personally, I'd extract #32. I suspect a balancing interference. Ortho at 6 thousand to 7 thousand with an uncertain outcome is one of my last recommendations... doesn't matter whether you upright it or bring it into contact with #30. I've seen too many molar ortho cases in adults that end up just as tipped. I am a periodontist who would rather save a tooth than place an implant, but not this one.

Upper left is no problem, but a 3-D diagnostic aid is needed to treatment plan. That is: visual patient exam, study models, or scan with actual measurments. From what is seen on the pano there appears to be space for 2 implants with or without a pontic. This can be decided only using that 3-D info. The lower right is not so simple as the comments have shown. However, there is a simple solution to the not yet a problem # 32 area. Many may think that my suggestion is foolish, but it has worked several times in the past for me. Adjust the occlussion on the #32 and place a 2, 2.5, or 3mm small diameter implant (Sendex type or other) in the space. This type of implant with a light bite and protection from the adjacent teeth will hold up very well. Adjustment to the proximal of the molar may be needed.

There appears to be ample ridge height, but likely somewhat narrow? I'd put two Bicon 4.0 x 5.0 or 4.5 x 6.0 short implants in the #30 spot with separate crowns. If too narrow, a 2 appointment, windowed, ridge split should work fine and also add new attached tissue at the newly widened ridge crest.

Interesting views on how to manage #32. So far we've had three in favour of orthodontic intervention, two in favour of a restorative approach and two in favour of extraction. I suspect the patient isn't even aware he/she has a problem. My advice remains the same - do nothing!

John, I agree. Why are we treating the lower right second molar area? Did the patient request it, or....... Need I say it? Bv