Sometimes there is just not any room for dental implants. I have placed thousands of implants so I can certainly tell you that there are times that having an implant would create more problems. That being said, dental implants are still the absolute best replacement for a missing tooth or teeth when done correctly.
When there is no room for an implant it is usually because the roots of the teeth have tilted into the space. Sometimes the top part, we called the crown of the tooth has tilted in as well. To have a successful single tooth implant or even multiple the other teeth need to be mostly upright. If there is no space than you create some of the space for implants to be properly inserted into the bone.
Risks When Space is Tight
Some risks would include hitting the root, coming too close to the root, or placing an implant into a space that cannot even be restored with a crown.
It would be strange to have an implant put into the bone and then not able to place a tooth on top of it. Believe me, sadly this happens! I see this fairly routinely for people coming for second opinions
Sometimes it is because the baby tooth was never lost and the real tooth did not develop. This happens in adults with baby teeth that fell out late or sometimes were just taken out way too early causing shifting teeth, creating a lack of proper spacing.
No Room From Top to Bottom
The other time where there is a lack of room is from top to bottom. If you are missing a segment of teeth or just one the other teeth around it tilt into its place
The opposing teeth over erupt out of their sockets trying to look for a tooth to bite on. This makes the top to bottom space much smaller. This is called “inter- arch space” or “interocclusal space.”
If not managed or diagnosed correctly it can lead to a tooth is very short at the gum line or not even restorable at all.
How to Correct the Spacing?
Most of the time the spacing can be managed with limited orthodontics to upright the teeth or sometimes just shaving a little bit of extra enamel, making a filling or crown on an adjacent to can fix it when the problem is minor.
Sometimes the space is too major to move the teeth or you are not interested in orthodontics so you can consider things like a fixed bridge, Maryland bridge or cantilever bridge. But with those options the teeth have to be drilled down.
Correcting the room from top to bottom can sometimes be treated with placing a crown on the tooth that is sticking out too much. In addition to orthodontics can intrude a tooth.
If the root is hit very badly it may necessitate a root canal or even extraction. I like to keep about 2 mm on average between teeth but the more the better! There are times where you purposely have to get closer thought.
So if you do not have enough room often times you can make more room. The worst thing to do is to try to place an implant with no spacing and end up with a compromised result, redo or even lose other teeth!
Planning in advance is the key!
Your comments and questions are welcome! Stay safe during COVID 19!
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry