Nobel active size 3.0 NP implant for 8 and 9?

For the number eight and nine position, you would normally want implants that have closer to a 4.5 mm diameter. With a smaller diameter implant the challenge will be to create an emergence profile that allows you to create an aesthetic restoration. If your patient has a low lip line that doesn't show the gingival margin, then this really shouldn't be much of an issue. If, however, your patient has a high lip line then he will probably get the best result with a custom fabricated abutment.I hope you found this information to be helpful,Dr. Champagne

I'm a Nobel Active guy myself, but every now and again I'll dabble with other implants due to situation that calls for it. I recently had to make a similar judgement call, and after some research I found that the Biohorizons 3mm implant is a good bit stronger. The Active 3.0 is technically supposed to be reserved for laterals and lower incisors, but it sounds like it was 3.0 or nothing if the patient couldn't afford to do additional grafting. For future cases, consider trying the Biohorizons if you have to, and the rep will lend you a kit and help you with the surgery if you feel uncomfortable with their product line. 

That being said, with the ones you have in there now I would recommend letting them heal for at least 4 months to make sure the healed bone is well mineralized. At that point I would make a set of transitional prostheses -- I typically have a lab use a temporary cylinder and a composite or PMMA screw retained crown. I would ask for low contacts to encourage papilla fill, but I would also ask them to make the teeth about 1-1.5mm out of occulsion and completely free of contact in excursive movements. This may mean they are clinically shorter than you prefer, but it's only for a few months. I make my patients wear those crowns for about 2-3 months to allow the gingival contours to stabilize as well as complete some progressive loading on the small implants so the supporting bone's density has been improved (remember Wolff's law?). At that point I would consider fabricating custom abutments to support the porcelain everywhere and to improve cantilever forces, and then I would likely have 8/9 fabricated as splinted crowns so they can reinforce each other. I would still try for very light occlusion. A bite guard for the patient once finished would be smart as well - hard flat plane acrylic or hard with a soft liner (to avoid tugging too forcefully on the implant crowns). 

Best of luck!

At this point, the implants are in so my best suggestion is to make sure you minimize any cantilever effect on the implants. Make sure the crowns are as close to the axis of the implants as possible. The other issues are the patient's lip line and how far under the tissue the implants are placed. If the implants are minimally subgingival, the crowns may not look like centrals, but may not be a big problem if the patient has a low lip line and/or smile line. 

Although there are no standardized sizes of implants for defined areas 3.0 is probably a bit too narrow for maxillary central incisors. This also depends on the individual patient (i.e. Is it a tiny 70 year old women or a 250 lb bruxing body builder) As long as there is good quality bone around these implants and when restored they are in light to no occlusion in excursions then they may have a long life. The other issue is emergence profile but I'm sure you are aware of that. Just make sure the patient understands the issue.

It depends on the size of the the clinical crowns, and the type of soft tissue/papilla quality that you are working with.  In order to manage interproximal papilla, you will want at least 3mm of spacing between the two implants and to achieve a proper emergence profile require proper depth of placement.  Therefore, NP Platform is not necessarily too small for a central incisor.