Crown and Bridge Style Restorations

Fixed-Detachable or Overdentures

Width of replaced tooth 2

from proximal of natural tooth

Implant placement next to a natural tooth Ideal Distance

Width tooth 12

Width tooth 22

+

R1 2mm R2

Implant placement next to a natural tooth Safe Distance

Implant Selection and Positioning Guide

Drs. Ken Hebel and Reena Gajjar

2 mm + Radius of implantdistance from proximal of natural tooth

=

The Ideal Distance between the centers of implants

The Minimum Distance between the centers of implants

R1+R2+2mm

R2

Concept 1

Concept 2

Concept 3

Concept 4

INST

RU

CTI

ON

S FO

R U

SE

The

reco

mm

enda

tions

in th

is ha

ndou

t are

mea

nt a

s a

guid

e to

impl

ant s

elec

tion

and

plac

emen

t. Ev

ery

dent

ist m

ust d

ecid

e if

indi

vidu

al v

aria

tion

from

the

aver

age

exist

s in

the

size

of th

e pa

tient

’s te

eth

and

mak

e ap

prop

riate

allo

wan

ces.

Also

, the

se re

com

men

datio

ns a

re n

ot m

eant

to re

plac

e a

diag

nost

ic w

ax-u

p if

indi

cate

d.

SIZE

SEL

ECTI

ON

:Re

com

men

datio

ns a

re m

ade

to re

late

var

ious

size

d im

plan

ts to

the

size

of th

e ro

ots o

f the

teet

h th

at th

ey re

plac

e as

indi

cate

d in

Tab

les 1

and

2. Th

e siz

e of

the

impl

ants

in th

e ta

bles

repr

esen

t th

eir d

iam

eter

at t

he p

rost

hetic

inte

rfac

e.

FIX

ED D

ETA

CH

ABL

E O

R O

VER

DEN

TUR

ES (C

once

pt 1

):Fo

rmul

a 1

: R1

+ R2

+ 2

mm

repr

esen

ts th

e min

imal

spac

ing

requ

ired

betw

een

the c

ente

rs o

f im

plan

ts fo

r fixe

d de

tach

able

or o

verd

entu

re p

rosth

eses

. If t

he p

ract

ition

er w

ishes

a g

reat

er a

llow

ance

fo

r bon

e or t

issue

hea

lth, 3

mm

can

be su

bstit

uted

in th

e for

mul

a. Th

e min

imum

spac

ing

allo

ws f

or ti

ssue

hea

lth a

nd im

pres

sions

of i

mpl

ants

that

are

slig

htly

misa

ligne

d. If

atta

chm

ents

are

to

be p

lace

d be

twee

n im

plan

ts, t

hen

mor

e th

an 2

mm

is re

quire

d. If

you

feel

3m

m is

idea

l, pl

ace

3mm

in th

e fo

rmul

a. F

or fi

xed-

deta

chab

les o

r ove

rden

ture

pro

sthe

ses,

the

impl

ants

do

not n

eed

to b

e pl

aced

in p

ositi

ons r

elat

ing

to th

e ro

ots o

f miss

ing

teet

h. Th

eir p

rimar

y ro

le is

to p

rovi

de su

ppor

t and

they

are

cov

ered

by

the

patie

nt’s

lips o

r the

flan

ge o

f a p

rost

hesis

.

IMPL

AN

T PL

AC

EMEN

T FO

R C

ROW

N A

ND

BR

IDG

E T

YPE

RES

TOR

ATIO

NS:

Ve

rtic

al P

lace

men

t:

3-

4mm

bel

ow th

e gi

ngiv

a if

an a

esth

etic

em

erge

nce

profi

le is

des

ired.

Bu

ccal

Lin

gual

:

Fo

r sin

gle

toot

h im

plan

ts, t

he b

ucca

l asp

ect o

f the

impl

ant s

houl

d no

t ext

end

past

a li

ne d

raw

n be

twee

n th

e bu

ccal

asp

ect o

f the

adj

acen

t tee

th.

MU

LTIP

LE IM

PLA

NTS

SPA

CED

AS

SUPP

ORT

FO

R C

ROW

N A

ND

BR

IDG

E ST

YLE

RES

TOR

ATIO

N (C

once

pt 2

):U

sing

the

sizes

of n

atur

al te

eth

as a

gui

de, t

he sp

acin

g fr

om th

e ce

ntre

of t

he o

ne im

plan

t to

the

next

can

be

dete

rmin

ed fr

om th

e fo

rmul

a:

w

idth

toot

h 1

+

wid

th to

oth

2

2

2

This

will

spac

e th

e im

plan

ts s

imila

r to

the

root

s th

ey a

re re

plac

ing

prov

idin

g co

rrec

t spa

cing

for

aest

hetic

s w

hen

view

ed fr

om th

e bu

ccal

. If c

ontr

alat

eral

teet

h ex

ist in

the

patie

nt’s

mou

th,

they

shou

ld b

e m

easu

red

and

plac

ed in

the

form

ulas

. Oth

erw

ise, t

he a

nato

mic

ave

rage

s fro

m th

e ta

bles

shou

ld b

e us

ed. A

ll of

the

calc

ulat

ions

for a

nato

mic

spac

ing

base

d on

the

aver

age

size

of te

eth

and

usin

g th

e fo

rmul

a ar

e pr

esen

ted

in T

able

3.

IMPL

AN

T PO

SITI

ON

ING

NEX

T TO

A T

OO

TH (C

once

pt 3

, Ide

al D

ista

nce)

:Th

e w

idth

of t

he to

oth

to b

e re

plac

ed d

ivid

ed b

y 2

give

s the

dist

ance

away

from

the

exist

ing

natu

ral t

ooth

to th

e ce

nter

of t

he im

plan

t. Th

e to

oth

size

to b

e us

ed in

the

form

ula

can

be ta

ken

from

th

e ta

bles

pro

vide

d in

this

hand

out o

r as a

firs

t cho

ice

by m

easu

ring

the

com

plem

enta

ry to

oth

on th

e co

ntra

later

al si

de o

f the

pat

ient

’s m

outh

if th

e to

oth

is pr

esen

t. Th

is pr

ovid

es fo

r ind

ivid

ual

varia

tion

as fo

und

from

pat

ient

to p

atie

nt. Th

e roo

ts o

f som

e tee

th a

re ti

pped

or d

ilace

rate

d an

d so

me t

eeth

hav

e nar

row

crow

ns. Th

e use

of t

he fo

rmul

a, th

e wid

th o

f the

toot

h di

vide

d by

2, m

ay

plac

e the

edge

of t

he im

plan

t les

s tha

n 2m

m fr

om th

e adj

acen

t too

th in

som

e situ

atio

ns.

IMPL

AN

T PO

SITI

ON

ING

NEX

T TO

A T

OO

TH (C

once

pt 4

, Saf

e D

ista

nce)

:If

the

prac

titio

ner w

ishes

a la

rger

zon

e of

safe

ty fo

r sm

all t

eeth

in so

me

situa

tions

, the

y ca

n us

e th

e fo

rmul

a R

+ 2m

m, R

equ

alin

g fo

r the

radi

us o

f the

impl

ant.

The

cent

re o

f the

impl

ant w

ill

not b

e an

atom

ical

ly c

orre

ct, h

owev

er, t

here

will

be

a co

nsta

nt 2

mm

zon

e of

safe

ty.

IMPL

AN

TS P

LAC

ED B

ETW

EEN

TW

O N

ATU

RA

L TE

ETH

The

impl

ant r

ecom

men

datio

ns in

the

tabl

es fo

r spe

cific

teet

h ar

e va

lid fo

r mos

t sin

gle

toot

h re

plac

emen

t situ

atio

ns. S

ome

teet

h ho

wev

er a

re sm

all m

esio

-dist

al a

nd a

s suc

h th

e im

plan

t will

not

fit

with

suffi

cien

t bon

e be

twee

n th

e im

plan

ts a

nd a

djac

ent t

eeth

.

The

max

illar

y la

tera

l inc

isor i

s one

such

exa

mpl

e. A

smal

ler i

mpl

ant,

3.25

mm

or 3

.5m

m, m

ay b

e m

ore

appr

opria

te e

ven

thou

gh a

4.1

mm

pro

sthe

tic T

able

mor

e ap

prox

imat

es th

e ac

tual

root

size

.

Mes

ial-D

istal

Cro

wn

Mes

ial-D

istal

CEJ

Mes

ial-D

istal

CEJ

- 2m

m R

ecom

men

ded

Impl

ant*

Cen

tral

5.3

3.5

3.5

3.0,

3.3

, 3.5

Late

ral

5.7

3.8

3.5

3.0,

3.3

, 3.5

Cusp

id6.

85.

24.

13.

75, 4

.0, 4

.3

1st B

icus

pid

7.0

4.8

4.5

3.75

, 4.0

, 4.3

2nd

Bicu

spid

7.1

5.0

4.7

3.75

, 4.0

, 4.3

1st M

olar

11.4

9.2

9.0

3.75

, 4.0

, 4.3

, 5.0

2nd

Mol

ar10

.89.

18.

53.

75, 4

.0, 4

.3, 5

.0

Mes

ial-D

istal

Cro

wn

Mes

ial-D

istal

CEJ

Mes

ial-D

istal

CEJ

- 2m

m R

ecom

men

ded

Impl

ant*

Cen

tral

8.6

6.4

5.5

3.75

, 4.0

, 4.3

, 5.0

Late

ral

6.6

4.7

4.3

3.0,

3.3

, 3.5

, 3.7

5, 4

.0

Cusp

id7.

65.

64.

63.

75, 4

.0, 4

.3

1st B

icus

pid

7.1

4.8

4.2

3.75

, 4.0

, 4.3

2nd

Bicu

spid

6.6

4.7

4.1

3.75

, 4.0

, 4.3

1st M

olar

10.4

7.9

7.0

3.75

, 4.0

, 4.3

, 5.0

2nd

Mol

ar9.

87.

67.

03.

75, 4

.0, 4

.3, 5

.0

Max

illar

yM

andi

bula

r

Cen

tral

- C

entr

al8.

65.

3

Cen

tral

- La

tera

l7.

65.

5

Late

ral -

Cus

pid

7.1

6.2

Cusp

id -

1st B

icus

pid

7.4

6.9

1st B

icus

pid

- 2nd

Bic

uspi

d6.

97.

1

2nd

Bicu

spid

- 1s

t Mol

ar8.

59.

3

1st M

olar

- 2n

d M

olar

10.1

11.1

* D

enot

es d

iam

eter

of p

rost

hetic

tabl

e*

Num

bers

mar

ked

in re

d ar

e th

e re

com

men

ded

Nob

el R

epla

ce Im

plan

ts

Tabl

e 1

- Max

illar

y A

rch

Mes

ial-D

ista

l Cro

wn

and

Roo

t Dia

met

er o

f Max

illar

y Te

eth

and

Impl

ant R

ecom

men

datio

ns

Imp

lan

t Se

lect

ion

an

d P

osi

tio

nin

g B

ased

U

po

n A

nat

om

ic A

vera

ges

of

Teet

hTa

ble

2 - M

andi

bula

r Arc

hM

esia

l-Dis

tal C

row

n an

d R

oot D

iam

eter

of M

andi

bula

rTe

eth

and

Impl

ant R

ecom

men

datio

ns

Tabl

e 3

Stan

dard

Ave

rage

Dis

tanc

es B

etw

een

The

Cen

ters

of I

mpl

ants

as

a G

uide

for I

mpl

ant P

lace

men

t

Man

dibu

lar A

rch

Impl

ant S

elec

tion

and

Posi

tioni

ngfo

r Cro

wn

and

Brid

ge

Max

illar

y A

rch

Impl

ant S

elec

tion

and

Posi

tioni

ngfo

r Cro

wn

and

Brid

ge, M

illed

Bar

s, an

d Fi

xed

Det

acha

ble

Impl

ants

pla

ced

in th

e fo

llow

ing

posit

ions

: C

entr

al, C

anin

e, 2n

d Bi

cusp

id a

nd 1

st M

olar

Impl

ants

pla

ced

in th

e fo

llow

ing

posit

ions

: C

anin

e, 1s

t Pre

mol

ar, 2

nd P

rem

olar

and

1st M

olar

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Natural + Natural Implant + Natural Implant + Implant

Free gingival margin of the centrals at same height

Free gingival margin forthe lateral at or below a line

from the central to the canine

W/L = 75% to 80%Gerard Chiche;

Esthetics of Anterior Fixed Prosthodontics

Tarnow DP, Magner AW, Fletcher P. J Periodontol 1992;63:995-996

Grunder U.Int J Periodontics Restorative Dent 2000;20:11-17

Tarnow D, et al J Periodontal 2003;74:1785-1788

The distal of central and lateral are more curved to create larger distal embrasures and a more youthful appearance

Esthetic Guidelines