Should Dental Implants Be Placed Side by Side?

0 votes
On Tuesday morning 5-22-2012, I  had 2 implants placed where teeth have been missing a long time, #21 and #28 . I have worn an upper denture for approx 20 years. I have no lower teeth on either side.

There are 6 remaining teeth in between in the front and I'm scheduled to have those removed once we are certain that the first 2 implants have integrated ( 3 - 4 months ). Then the plan is to extract the 6 remaining lower front teeth and place Endosteal implant mandible/maxilla in #22 and #27.

However, what mystifies me somewhat is why would they put implants side by side like that? Wouldn't it be better to skip a tooth and put implants in a tooth away rather than side by side ( this is to support an overdenture)??

Will there be any movement of the overdenture when eating say a submarine sandwich with this set up? I thought there was going to be implants placed more than 1 tooth away but in looking over the dental plan tonight I saw that wasn't the case hence my questions. Thank you in advance for your reply(s).
Location: Port Charlotte, FL
asked May 28, 2012 by tpili
edited May 28, 2012 by choosedental
   
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2 Answers about Should Dental Implants Be Placed Side by Side?

0 votes
Spacing of dental implants can be done in various ways. It sounds like the sequence suggested will allow the two implants to integrate then add more implants. That should work fine. Will you be able to eat well? The answer is that you will be able to eat better than if you had a denture without implants, but there are options that offer more support. The tradeoff is that those other options are more expensive and involve more implants to be placed. A bar overdenture for instance stabilizes the denture better, but it is a much more involved treatment. There are other non-removable options, but these too are even more involved to do and more expensive in general.
Dr. Michael Tischler
Woodstock, NY
answered May 28, 2012 by Michael Tischler DDS - Woodstock, NY
edited May 28, 2012 by choosedental
Yikes, Hi, no there's no proposal to do anything else, just place those implants for a removable lower denture. Your answer is not making me feel very good about the plan. I was under the impression originally there would be 2 additional implants spaced a tooth apart from the ones already placed. Perhaps there's a mistake in the plan?
 
I made it clear that I talk for a living which is why this is being done in stages. However I also made it clear that I'm not interested in any movement of the lower denture while I'm eating ( sub sandwiches, steak etc ) but what you are describing at least it seems to me is a long way from that. Money is not a consideration. I'm not rich either but the goal is to have something that I can eat easily
The issue here apparently is really about a removable vs. non-removable (i.e. fixed)  treatment option. It sounds like your treatment plan is for a removable plan, and you are now leaning towards a fixed option.

Even though both removable and fixed treatments should provide a satisfactory outcome, a fixed prosthesis, as opposed to a removable one, provides the highest level of quality and function because it is like having your own teeth. (here is one post that goes into this in more detail: http://choosedentalimplants.com/content/26368-fixed-hybrid-dentures-what  ).

If you feel more comfortable with the fixed option and don't have a problem with the higher costs, you should speak to your dentist as soon as possible to discuss this option and see if its possible for your specific case. It is not really possible to say which treatment option is "better" for you, since we don't know all the details of your specific case. Both removable and fixed treatment options will work fine with the right implant team. But, if you are uncertain as to which treatment option you prefer, and you believe a fixed option would be better for your situation, then surely bring this up with your dentist as soon as you can.

Also, here are two more additional past questions, that may be of interest to you:

http://choosedentalimplants.com/content/26462-full-upper-denture-how-many-dental-implants-are-needed

http://choosedentalimplants.com/content/26382-hybrid-denture-vs-denture-upper-back-teeth
No actually I'm more interested in the removable. I thought I was but now I'm not. Let me explain a little more. I had an upper denture since I was 32 and only 7 teeth on the lower. One molar on the lower right side and the still remaining 6 front teeth which are in pretty rough shape. That molar finally broke on me a few months ago and there was no more time to wait on this, really this was long overdue. But unfortunately as you probably already know there's not much bone left in some places especially the upper so the primary goal was to fix the occusion/bite with a new upper and a partial lower. That was done and wow I could suddenly eat crunchy veggies and things I had not eaten in many years. The next step was to do the implants.
While experiencing the lower partial, obviously food particles get stuck in there and it's easy to remove it and clean out my mouth easily which doesn't appear to be the case with a non removable. And it was explained to me that cleaning the removable would indeed be easier so why suffer extra procedures to do the non removable. All set with doing a removable.
Now that I have a plan to place 4 implants I naturally found a lot of information about "all on 4" and the placement made sense to this civilian. I thought the 2 implants in stages also made a lot of sense to place 21 and 28 and then sometime end of august or sept place #26 and #23, similar to the pictures I saw on youtube and other places for the all on 4. Had the implants placed last week, it's memoria day weekend and I started reading the pan again. That's when I spotted the next implants as 22 and 27 and that just didn't make sense to me, it seemed too much space in between in the middle. I have nothing other than a feeling that it didn't make sense, for all I knew it does, but I couldn't find any video's showing those placements and being memorial day weekend I started hunting the internet and decided rather than go crazy waiting to ask questions at my follow up in a few days to post a question to other professionals to which you have so far replied and I'm grateful.
Am I worring needlessly ?
P.S. The oral surgeon said 4 implants max in the lower. I assume its because of the lack of bone but now I'll ask that question when I see him this week.
4 implants should be fine to support a lower overdenture. In general a removable overdenture will have some movement by it's nature. You should be able to eat what you want. A fixed bridge option like an all on 4 or a Prettau Bridge www.prettaubridge.com will offer increased stability though.
0 votes
You have received excellent answers by Dr. Tischler, so I will just reiterate some of the points he made.

You said you are  not interested in having any movement while you eat, however the removable overdenture in your situation is likely to move a little if forces are placed in the molar areas since it rests on soft tissue there.

You can diminish the movement with a bar overdenture where the bar extends posteriorly to the first molar area.

If the first implants were already placed, more than likely you will not be able to get the all on four anyway, because it requires a different placement protocol.

Placing the implants in place of 23 and 26  does make more sense since it increases the anterio-posterior spread of the implants and makes for a more stable implant supported denture (the legs of the chair are further apart).

You do not give any details of the overdenture, will there be a bar? what attachments? where?

You should ask your dentst to describe and explain these, and maybe you will feel more confident about the treatment you choose.

Good luck!
Dr. Carlos Boudet
West Palm Beach , FL
(561) 968 6022

answered May 28, 2012 by Carlos Boudet DDS, DICOI - West Palm Beach, FL
In your opinion Dr's is there time to make changes in the plan if appropriate to do so?
You can still change the treatment plan up to a point, but what you need to do is talk to your dentist and decide what you really want.  Get all your information, ask all the questions and you should be a little more comfortable with your decision.

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