Expert: Rafael Mosery,D.D.S. - 8/9/2007

Question
QUESTION: My son recently finished with braces and is genetically missing #'s 7 & 10 adult teeth.  Both the orthodontist and general dentist sent him for a consult to the same oral surgeon about implants.  Unfortunately, he said there isn't enough room for the smallest implant, but asked the ortho if he could move the teeth some more to give more bone space.  My son refuses to be in braces again and the ortho now recommended a different oral surgeon (said he may use a smaller implant) I remember the oral surgeon saying you can only go so small and then you give up support needed, especially in these front teeth used for biting.   The general dentist said we can do a Maryland bridge if he can't get implants.  I am at a crossroads of what to do.  I don't know if I should see what this other oral surgeon has to say or resort to the Maryland bridge. He is only 16 and I am thinking that maybe the Maryland bridge is the way to go for now and then down the road when he is an adult technology will have improved even more.  He is at a crucial age in his life as far as self esteem, etc. and I really want to help him get this resolved.  HELP

ANSWER: Get those braces back on and make room NOW if you can,The other option though costly perhaps would be invisalign if the orthodontist thinks this is a suitable case.The Maryland bridge is an alternative but the implant is definately the way to go.You don't want to squeek in with the narrowest smallest implant this thing has to last and last.I'd like to see a minimum 3.5 mmx13 implant in this site.It may seem like lots of work but it will be worth it in the long run.

---------- FOLLOW-UP ----------

QUESTION: So if I go for this other consult and the implant they suggest is less than 3.5mmx13 should we opt for the maryland bridge?  It seems like the ortho thinks there is plenty of space and no need to move anything and that this other oral surgeon can accomodate that because he uses smaller implants.  I don't want someone saying they can do it just to "get the money"  I want to do what is right and something that will last.

Answer
In order to place an implant this size between the central and canine you need 2mm on each side plus the implant.That's a minimum of 7.5 mm in an ideal world,that is to say nobody could place the implant dead dead on. The idea is to place the implant and have enough undisturbed bone between the implant and the adjacent roots.This should NOT be the patient's concern really.It's the responsibility of the team effort between the ortho and placing Dr. to communicate what's adequate and what's not. By the ortho saying there's enough and the surgeon saying there isn't you'll get no place. They have to concur and work as a team. I find myself going to the ortho and telling him to give me more space.He doesn't tell me "there's plenty "he just gives me what I want so I could do my best.Shoot for the implant the Maryland bridge is a compromise treatment I would use if I positively can't make the implant happen.