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 cases.  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 24,25 Narrow Ridge
      #23 Endo Failure; determine Cuff 1st 2.5 mm 1 Piece   25 Horizontal Fracture    
      #25 Lingual Abscess: Center Placement Allograft Fills Defect   24 Mobility Buccal Shift    
            L Midline Diastema    

Sequential Cases of Immediate Implants and/or Immediate Loading for the Lower Incisors: 1 2 3 4 5

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Xin Wei, DDS, PhD, MS 1st edition 01/19/2013, last revision 07/30/2020