Immediate Implant for the Lower Incisors (Prevent Lingual Perforation)
Due to limited space, the diameter of the implant for the lower incisors is small (3-4 mm). A case of delayed placement is introduced first to show that the patient does not like to wear a flipper. Every patient wants quick treatment. So immediate implant is highly recommended in this region. Depending upon the space, either two- or one-piece implants are chosen. If there is enough space mesiodistally, an implant with relatively large diameter (3.5 or 4.0 mm) is preferred. First, two piece implant can be placed. Angulated abutment provides better restorative position. Second, the implant with relatively large diameter can obliterate the buccolingual gap and reduces the chance of bone graft. The buccolingual width of the lower incisors is wider than mesiodistal one. Otherwise, one piece implant is indicated (3.0 mm).
Which is the deciding factor for choosing the narrow one piece implant: mesiobuccal or buccolingual width? For a single tooth or two, the former is more critical, whereas for multiple missing teeth, the latter may be more important. A bridge is a good option for lower multiple missing tooth casses. When to use ? How to treat exposed implant threads? How to avoid thread exposure?
Immediate implantation in the lower incisor area is safe as long as osteotomy is confined within the buccal and lingual plate (lingual foramina). Occasionally osteotomy for the longest one piece implant (23 mm) may damage the terminal segment of the Incisive Canal and cause transient hemorrhage, which is arrested once the implant is placed without bad consequence.
|Implant Placement Options for Lower Incisors||Features||Surgery||Follow-Up||Features||Surgery||F-U|
|Delayed||Two piece||Single Unit||Narrow Ridge||Graft||#26,27 Residual Roots||Lingual Perforation|
|Multiple Unit||Uneven Crests||Repack||#23,25 Incisive Canal||2 & 2.5 mm 1-Piece||2nd Place.|
|One Piece||Multiple Unit||Severe Perio||2.5 mm 1-Piece Implant||#24,25 One Implant Two Crowns||4 mm Cuff|
|One Piece||Single Unit 2 3||Advanced Perio||Extract & Immediate, No Splint||#25 Narrow Bone 2.5x10 mm 1 Piece||New Osteotomy|
|Multiple Unit 2 3 4||Bruxer||Infraocclusion||#22,23 Traumatic Occlusion||Central Placement|
|Two piece||Single Unit||2 Centrals||Implants/Tooth Too Close||#22/23 Fusion, Narrow Ridge|
|Multiple Unit||Lateral, Central||25 Occlusal Trauma: 1st Implant for FMR|
|One Piece||Single Unit Next 2 3 3'||4 Incisors, 2 Implants||1- vs. 2-Piece Implants||Oval Pontic||23-26 3 of 1-Piece Implants|
|Multiple Unit 2 3 4||Failed FPD (#22-27)||Where to Place Implants?||23-26 Apical Abscess||Two 1-Piece Implants for 4 Incisors||Bone Graft|
|LR Ant Residual Root||1-Piece Implant||#23 Distal Bone Loss, Thick Gingiva|
|#24 fracture 2 mm Cuff||Angled 1-Piece Implant||#24-26 Severe Mobility|
|#26 Buccal Fistula||Lingual Placement, Exostosis||1 or More 2.5 or 2.0 mm Implants|
|#23-26 1 or 2-Piece Narrow||Change Osteotomy Position|
|#23 Endo Failure; determine Cuff 1st||2.5 mm 1 Piece|
|#25 Lingual Abscess: Center Placement||Allograft Fills Defect|
Sequential Cases of Immediate Implants and/or Immediate Loading for the Lower Incisors: 1 2 3 4 5
Return to Immediate Implant 1-Piece
Xin Wei, DDS, PhD, MS 1st edition 01/19/2013, last revision 01/07/2019