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This case shows the substitution of four periodontally damaged lower incisors by four 3i implants 3.75×15” and 3.25×15”, one of which failed in the following weeks after insertion.

periodontitis in the lower incisor region  periodontitis in the lower incisor region, three dental implant placement

The patient had annoying mobility in the incisors and wanted to replace them. She didn’t want to hear about extracting the other teeth for a 6-implant fixed denture, for example.

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Normally, four lower incisors can be replaced by two implants and four crowns on top. She just wanted four implants as replacement, which is very critical surgery as we will see.

I extract the teeth and analyze the ridge. I find insufficient width in the central as to place the narrowest 3,25”implants.

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So, I expand the ridge to the limit of its elasticity with a set of expanders, gradually bigger and simultaneously on either central alveolus.

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It’s a very critical maneuver. You need to stop when either the bone starts to crack a little or you reach enough with before that happens.

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Then, it’s time to place the implants. 3i 3,25” implants are very delicate.


They have many narrow threads. They need many turns to be screwed.


If you drill or expand too much, the implant may be loose. If you drill or expand too little, they may need too much torque, with the risk of bone heating and failure.

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3,75”implants are easier to handle. They are more “self-tapping”.
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Still, the error margin is close to none with such little space.

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Healing takes place with increasing pain in the 42 area. Maybe bone heating, maybe lack of hygiene… implant on 42 failed and I had to remove it. I healed with great resorption, so I abandoned the though of placing another one, since three are more than enough.

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These are the impression pillars and the prosthesis by Dr. Jon Igaralde

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lower incisors implant

three dental implants in the lower incisor region

And the final panorex, before fixing the prosthesis.