Two Missing Teeth. Space Too Small for Two Implants. Options?

Hey Amanda19,

There are several options for this situation.  If there are just 3mm remaining than one implant should be able to support both crowns.  The dentist can ask the lab to create a wax-up to give you a preview of the crowns.  If you are satisfied with the esthetics of the wax-up and the dentist thinks there’s enough bone to place the implant in the proper position then you’re all set.  In the rare instance where esthetics are compromised, orthodontics may be an alternative to move teeth in order to recreate space.

When you do not have enough  space for 2 implants there are few options that you might consider for an esthetic outcome. You can have orthodontic treatment to create needed space for second implant or close it, so you might not need it. You need to obtain orthodontic consultation to determine what would be the best for you. Another option is to place one implant ant make two crowns to fill the space. The best treatment option for you can be determined by dental specialist who will analyse your case and will give you the most favorable treatment option. Good luck

There's no reason that every missing tooth has to be replaced with it's own implant. The first question in doing an implant is always whether there is enough bone. As long as a comprehensive exam has been done, and the case well planned (by both surgeon and restoring dentist), a good lab should be able to make a crown that blends in well with the adjacent teeth. 

I would suggest to have an implant placed and a crown with a small extension to close the space.

Hi Amanda19

Its always hard to answer these questions without doing an exam first.  But if the remaining space after one implant/crown is only going to be 3mm, it is hard to imagine why one implant cant be used to fill the whole space.  Its not that hard to make a single unit crown look like two teeth.  Perhaps the dentist will have to work with his/her lab to come up with a creative esthetic solution, but it really shouldn't be too difficult.  And the implant must be placed really well.

Of course if the teeth are poorly aligned, the treatment might require some orthodontics (Invisalign) after extraction, and prior to implant placement.

However, there may be several solutions.  First of all, the bone should be evaluated 2 months after the extraction of #4 (grafting may be necessary at the time of extraction or depending on the defect, later, as well).  Once one knows what the quality of the bone is al well as the distance between remaining teeth, here are some options:    1: orthodontically create the ideal space (it sounds like a complicated proposal, however depending on what is behind #4 space, it can be as quick as 1mm/month). 2: Place one implant in the bast quality bone position, and cantilever the other tooth (have a crown welded to the implant crown).  In a premolar area, this is doable as long as the occlusion (bite) is well adjusted.  

Best of luck, 

Anca Bazile, DDS, MSD, Periodontist, New York City

Great question, Amanda, with many possible answers.  Most importantly, is there sufficient bone in the area to suport an implant.  If so, a single implant could be used to support a cantelever bridge (one tooth hanging off the implant supported tooth, a carefuly designed single crown that aesthetically appears as if it was two premolars or a single molar sized crown to fill the space.  Which is best will depend on the condition of the surrounding teeth, functional concerns, width of your husband's smile and aesthetics.  Coordinated treatment planing is critical, especially if more than one doctor is working on the case (oral surgeon placing the implant and general dentist restoring the implant).  We use integration of the Galileos Cone Beam CT scan and CEREC crown system to design the case from implant to crown placement.  This system provides us with the ability to design the resoration first, then fabricate a precise surgical guide to place the implant in the optimal position.  Dentists in your area who use this system can often be found through ComputerAssistedDentistry.com.

Great question Amanda! Unfortunately, there is not one simple answer. The MOST IMPORTANT consideration in your husband's case is to ensure that there is a clearly defined plan BEFORE any implants are placed. His entire mouth must be evaluated by the COSMETIC or RESTORATIVE dentist. It is always beneficial in a case like this to have the restoring dentist and implant dentist on the same team. 

You might consider moving adjacent teeth (Invisalign), it might be possible to replace two teeth with one implant, or restoring/cosmetically enhancing teeth adjacent to the missing teeth might also be an option.

At the end of the day, the treatment plan must be developed by the restorative dentist according to the patient's goals, time frame and budget and must be clearly understood by the patient AND the surgeon who will place the implant.

Good luck!

How many implants are the right number when you don't have the right sized space? Your question smacks of one of my biggest irritations with dental implants-namely a specialist might tell your husband- "No problem, we can just put one implant in there and your dentist can put two teeth on it". 

The biggest problem I see in implant dentistry is that not enough thoughtful planning and direction by the dentist who makes the crowns is done beforehand. The key to a case like this is to have the cosmetic dentist or general dentist take models of his teeth and PLAN the whole thing out before any treatments are done. Specialists get excited to "get the implant in there", but ultimately, the cosmetic dentist is the one who has to make it look right, fit right and last long enough.

He'll look at the alignment of his bite, the spacing between the teeth, how far back his smile shows, the overall health of his teeth, habits like clenching, (and other factors).

It's possible one solution might be to bond tooth #6 to close up some of that space, and possibly make the new #5 slightly wider. A lot depends upon the alignment of his bite and what shows in his smile.

Often in this sort of case, a wax design or template is made before starting anything. As I tell my implant patients all the time: "Don't let anyone put in any implants until I tell you it's OK."

Thanks for your question, Scott Greenhalgh, DDS

When you are missing one tooth, you do not always have room for a Implant.  There are many reasons why Implants won't work including the location of the other roots of your teeth, bone thickness, esthetics's, and more..  One great option for the situation you are describing, is  using one Implant with a cantilever tooth attached.

What that means is that if you have room, you place one Implant ideally for replacing one tooth and then the lab constructs 2 teeth to attach to the one Implant.  This can be an exacting and great challenge for your dentist, but can work.  You would need to do a consult and let the dentist do their evaluation.

Great question -Much success-Dr. Wendy