Dental Implant Treatment Planning

Let’s discuss Dental Implant Treatment Planning. The first appointment when seeing an implant dentist is a very important part of the whole dental implant treatment planning. Usually this initial assessment is where the dentist will listen to the problems you may be facing with missing or damaged teeth. A thorough examination is usually carried out which includes an assessment of the medical history and general health. If you are suitable for dental implant treatment then the dentist will carefully take records of your mouth. These records include the number of teeth present, the number of missing teeth, how many teeth are filled, crowned or root treated etc.

Frontal view of teeth, note missing teeth on patients upper left side

During the assessment the space which will require an implant needs to be accurately assessed if it is suitable for dental implant treatment. Firstly for an implant to be placed into the jaw bone, sufficient bone is needed in both width, height and thickness. The diameters of dental implants which we use in our clinic range from 3.0mm-7.0mm in diameter. In addition to the amount of bone present, we also need to ensure that there is sufficient space for the final crown or bridge to fit.

Two missing premolar teeth on upper left side

Sometimes due to tooth loss having occurred a long time ago, the space available for tooth replacement is not sufficient for a dental implant to be placed. In this post we discuss a case where a patient came to our clinic for a solution to a space on the upper left side.


The teeth had been missing for several years and for several reasons the patient had been unable to have any treatment carried out to date. The patient had lost 2 premolar teeth about 8 years before.

bone loss noted due to teeth being removed 8 years ago

When teeth are missing, the surrounding bone shrinks by way of a natural process.

Natural teeth provide stimulus to the surrounding bone and during chewing and function the bone is stimulated by these forces.

This ensures that the jaw bone is maintained when natural teeth are present. When natural teeth are lost this stimulus stops and the bone shrinkage ensues.

artificial teeth on plaster model showing size of new teeth

In addition to bone shrinkage, teeth adjacent to the space move. Teeth can tip towards the space, opposing teeth can over-erupt and the space can be reduced in size. This lack of space can cause problems with dental implant treatment planning when new teeth are being planned for the missing teeth space.

During the examination it is important that impressions are taken in the mouth so that ‘study models’ can be produced in order to allow the implant dentist an accurate scenario of what is in the mouth.

two smaller premolar teeth in position

In this case it was noted that the two premolar teeth had been missing for several years and the first molar tooth had in fact drifted towards the space. The patient was informed of this and we explained that if the space was to be replaced with teeth exactly as they were originally then it would not be possible.

The space presently was large enough for two premolars however they would be smaller in size than the original teeth which had been lost 8 years ago.

We explained to the patient that if we did want to replace the space with the exact size of premolar teeth as before then orthodontic treatment would be needed in order to push the molar tooth back to the position that it was before the teeth were lost.

premolar teeth in position

It was decided in the end that we would make some trials with the study models for the patient to see what the replacement teeth would look like.

If the the new premolar teeth were going to be acceptable then the patient would proceed with two dental implants and two crowns, even though the replacement teeth would be smaller than the original.

The second option was to consider orthodontic treatment to push the molar tooth backwards in order to provide space for the two original sized premolar teeth. This option would give a better aesthetic result however it would take longer to complete as the orthodontic treatment usually takes 18-24 months to complete. One also has to bear in mind the added cost of orthodontic treatment on top of the dental implant treatment costs.

occlusal view of premolar teeth

The third option would be to consider just one implant with one crown (and no orthodontic treatment) This one crown would be the same size as the original premolar teeth which had been lost. By replacing just one tooth a small space would be left behind the premolar tooth. It could be argued that the single tooth implant would be more aesthetic as the tooth would be more proportional in size to the original teeth which had been lost. The disadvantage of this option would be that a small space would be left behind the first premolar and this space may be out of site when the patient smiles.

I hope this blog article hasn’t confused you, hopefully the pictures in the article are helpful. If you require any further information about dental implant treatment planning please feel free to Contact Brighton Implant Clinic or Call us on 0800 111 6623.

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