[Diagnostic / Planning]  Guided planning

I am just after your thoughts on implant diameters and positioning particularly then depth for the following 4 implants. I have attached 2 PAN images.

Image 1 tooth #34 bridge abutment: Planned for 4.5 x10.  Would it be more idea to go 4.0x10 and move a bit more towards the crest while respecting buccal bone width at the crest. Again I like the plan but am wondering if it is too deep.

Image 2 tooth #36 bridge abutment:  Planned for a 5x7. Would you leave this or maybe go 4.5 x8.5 and maybe move a bit lingually and apically

Image 3 tooth #45 single tooth implant: Planned for 8.5x4.5. Guess I like the diameter and length am I bit too deep here

Image 4 tooth #46 single tooth implant: Planned for a 5x10. Should I go to 4.5x10 and move apically a tad while respecting buccal bone width at the crest.

Mainly just looking to get thoughts on if the implants are buried a bit much or if this is ideal.

CUD is the opposing occlusion.


by Chad Denomme at Wed, Apr 18, 2018 6:39 PM

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Ho-Young Chung Replied at Tue, May 15, 2018 8:04 PM

Hi Chad,

sorry was busy getting ready for GBR workshop in Vancouver.  I hope that i'm not too late in answering this post.

4.0 diameter is fine for premolar but I would place minimum 4.5 for molar and make sure you have minimum 2mm of bone lingual and buccal of all implants.  Unless you are lacking inter-occlusal distance, I would not place implants so deep in order to accommodate implant with for that particular ridge width at that site.  Main factor in countersinking fixtures for me is based on biological width of implants which is approximately 4mm.  This means if tissue is 3mm then implant should be subcrestal by 1mm.

if ridge is deficient, then simultaneous implant placements and GBR can be achieved or you can stage it out depending on your comfort level.  Either way, achieving tension free primary closure would be a must.