Here’s another one for you all! Just saw this 76-year-old male this week. He was referred by his new periodontist for a restorative evaluation. The lateral incisor is hopeless and will be extracted. The surgeon is wondering if I can use the implant in the canine position. The implant in the premolar position is well integrated although it is too far buccal for good alignment. Should the premolar implant be removed?

What should we be thinking about relative to implant placement and restoring this part of his mouth?


Commenter's Profile Image Mike Weisbrod
November 11th, 2010
My first thought is occlusal function- which tooth/teeth will provide the guidance? Second thought is esthetics- how is the lateral incisor going to be replaced and how will that affect the final gingival margin placement. Third I would consider how the patient wants to replace the posterior teeth. More implants, or implant supported RPD? Fourth- depending on the final restorations, single implants for a single tooth, implant supported FPD, cantilever bridge, etc it will come back to occlusal function and thinking about torsional forces. Great thinking case. Thanks! I think....
Commenter's Profile Image Victor
November 13th, 2010
I think we can joint the two implants and make a cantilever on the 7. Make the provisional cantilever joining the two implants and the lateral (could be ovoid pontic) and delivered at the time of the extraction. For occlusion, get contact on the canine and premolar during the lateral movement.
Commenter's Profile Image Ryan O
November 17th, 2010
Does the patient have anterior flaring due to lack of posterior function? How well will an anterior implant (or #7 cantilever bridge) withstand that torque, especially considering the current bone height.