Restoration of a wide edentulous posterior site with two small-diameter implants: Biologically-driven alternative treatment

Abstract

Crestal bone stability, implant rigidity and occlusal loading are issues with small-diameter implants. This article demonstrates the use of two small-diameter implants replacing a missing wide edentulous site and discusses factors that may affect bone changes. Patients who wanted to restore an edentulous space measuring from 12 to 14mm wide in the posterior region were offered an alternative treatment option, using two narrow or regular-diameter implants instead of one wide implant. In the study, the crestal bone stability of 12 implants in 6 edentulous sites was assessed by cone beam CTs and periapical radiographs in follow-up visits for up to 4 years. The bone level of all the implants was stable at buccal, lingual, mesial and distal sites, with mean values<1mm. The average buccal bone thickness was 1.15±1.07mm and lingual was 1.86±0.89mm, meaning that implants were surrounded by a sufficient amount of bone. The good treatment outcome may be attributed to the capability of fabricating better emergence profiles, angles (Mean: 20.67±7.82°at the mesial and 20.25±8.23°at the distal site) and cleansable embrasures of prostheses which are key to maintaining good oral hygiene and implant health. Using two narrow or regular-diameter implants to replace a single edentulous site measured around 12-14mm wide in posterior region seemed to be a feasible treatment option. It is especially suitable for sites with ridge atrophy and/or patients suffering from systemic diseases.