(updated October 2024)
Sometimes there is just not any room for dental implants (the space is too tight for 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 (missing bottom teeth, missing top teeth, etc) 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.
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
Burbank, California
818-843-3203
Hello, I was just informed that I didn’t have enough room for an implant and was off by 1mm. My orthodontist is hesitant in doing work on me because there is no other gapping to make space between my teeth. I’ve mentioned shaving the teeth beside down and he is hesitant on that as well and thinks it will be a difficult process. Do you think it’s worth going through this process? Also this is my upper lateral incisor.
This should not be a problem to just shave off half a millimeter on each adjacent to totaling 1 mm. But every case is unique and there are some cases that are super tight. I would have to see you to make that final determination but there is typically always a way using some specialty implants. You may want to seek out somebody who is very experienced in these scenarios. I hope this helps. Best of luck.
Is my implant too low and too distal? Will custom abutment work? The gum completely grew over. A cap was put on the implant but no healing abutment.
blob:null/b473eaf2-314d-4492-9a55-3ca11046385f
I recall seeing your x-ray that was sent to my office.
Being distal is not a big deal.
Yes, it is a bit deep, but that’s always better than being shallow.
The best thing to do would be to uncover it and make a temporary crown on it and see how it does.
Was the implant placed at the time of extraction? ☺️
Thank you for your reply. The implant was placed 5 years after extraction.
I was thinking that it was placed at the same time of extraction because of its depth.
Keep me posted on how it works out with your temporary crown
Hi dr amin i lost my milk teeth wen i was 15 and now im 29 and i didnt replace any temporary teeth on it and i leave it for years bcuz of some problems and now its room is so close maybe 2mm left in between and how i can implant it or not ?
Respectfully, as the article says if he only have 2 mm left in between a dental implant is not going to work without orthodontically moving your other teeth. At age 29 this should be a simple process. I would encourage you to create space with orthodontics and have it done in the right way. Best of luck!
I appreciate how thorough your article on dental implants was, especially when it came to the difficulties of putting implants in constrained spaces. In order to make wise choices about their dental health, I believe it’s critical for patients to comprehend the advantages and disadvantages of each treatment option.
Dr. Amin; I got an implant done for my #15 molar which was damaged by the neighboring wisdom tooth growing in sideways (after MANY years of not moving). The crown was just placed yesterday, and for some reason the implant is way off center in the corner of the crown. I asked the dentist why, and all he told me is “because that’s where the implant is.” Looking at the x-ray, I see that the bone is not as deep back in that corner, as it is in the center of the crown. Did the dentist make a mistake when he placed the implant?
Thanks for all the advice you publish here.
I had an implant place 2 days ago and by looking at it, it’s not placed between my teeth necessarily but a little off to the side. I know I had to get some bone grafting but should I be concerned at the placement?
This is more critical for a front tooth than a back one. Where is it? In some cases, it may be necessary to place the dental implant slightly off-center in order to avoid critical structures, such as nerves or blood vessels. This may be done if the implant would otherwise be too close to a nerve or blood vessel, or if there is insufficient bone in the center of the jaw.
Hi Dr Amin
I have been in an accident back in sep 2019 I had a surgery for my mandible fixation ,the out come of that I lost several teeth in my upper jaw ,I had to wait around 3years till my gum recession have occured ,the maxillofacial surgeon ask my for cbct scan after evaluation he told me that I’m a candidate for dental implant ,also I have paid a visit 3month later for another doctor his opinion was way different about my condition after my cbcd has done the doc said to me that there is no enough room for my jawbone to assimilate the dental implants as I need at least 3mm between each implant thus my condition will not be eligible for that kinda procedure and he recommended me implant supported bridge with last 7teeth in my upper jaw so he will implant 4 titanium posts with 3.3 diameter attached with 8 artificial biohpp teeth ,but I’m confused as about how much bone I would lose as if some area that haven’t posts into it would lead to be absorbed.fyi about 22years ago I have extracted central incisor that maybe lead for that decreased room , I’m too much concerned as I want to restore all 7 missing teeth solely without bridge implants or so .also I need a bone graft in the right area of my upper jaw, I would be very glade and appreciated if you help me with the best option for my condition.
I have a cone beam x-ray I don’t know how can I send it to you ?
I recently lost my baby tooth that for some reason never fell out back then and I’m wondering if I would have enough space for a dental implant. If there isn’t an ideal amount of space can implants still be placed? If not what other options can I consider to resolve this issue?
If there is not enough space, then you can have limited braces to create space.
Like this
https://burbankdentalimplants.com/wp-content/uploads/2022/02/Burbank-Dental-Implants-Before-After-Bone-Graft-2.jpeg
I have a situation where I am missing two teeth on the bottom left (roots still in there, impacted), and I am missing two on the top right. I have only been eating soft foods for about a year now, and I am so miserable. I was told that I do not have any space for a dental implant to fit because the top of my teeth fits into the area where the missing tooth is, and it should not be. I was told I could possibly have three teeth at the top removed and implants put in. also the top right, they want to shave the gum down and put implants. IDK. I just want to be able to eat again. I am in my early 30s and do not want teeth pulled. I would think they could just shave teeth down to make the implant fit.
Sorry this comment from 2022 went into spam. What did you ever end up doing here? Ramsey Amin, DDS
Dr. Amin,
Many thanks for the work you do. I lost my two front teeth during an assault. They finally had to be extracted. Failed root canals apioectomy.
I am now told there may be only room for one tooth in the upper front. How is this done and does it still look cosmetically pleasing?
Oh gosh! That is terrible news! …sounds like you might need braces to do this properly. Another option would be a cantilever, but these do not always work. Were your teeth crooked before the assault?
Dear Dr. Amin, Thank-you so much for your prompt reply. You are a blessing to the community. My teeth are not particularly crooked but I am now sixty-five the assualt was in my thirties. Regardless, I will ask the oral surgeon about braces and the “cantilever” tooth. I beleive he mentioned this word but I could not think of it. I did not know there were special risks with it.
Kind Regards,
Luci
Hi Burnank I unfortunately need to have my LL6 removed due to an infection I have also lost the back left molar many years ago however all my other teeth are good and were straightened in 2012. I have a retainer top and bottom.
I’m extremely keen to have the molar replaced with an implant once the healing has completed.
Due to the loss of the left molar and the heigh of the LL6 my top molars have slightly pushed in and down to accommodate the bite. The Dentist has advised there may not be enough inter-arch or “interocclusal space to have the implant placed. My question is if there isn’t enough space can you help correct there to allow me to have the 1,2 mm room what is required.
Kind Regards
The process you are describing is called supraeruption. It can only be corrected via orthodontics or an overlay crown. If you do not have enough interocclusal space that a recipe for disaster with an implant. Maybe you can have that one tooth “intruded” back into place orthodontically
About a year ago I had an implant procedure started to replace my top left molar. The post was placed and healed well but because of the pandemic, the crown was not placed until today. About 3 hours after returning home, I noticed the five teeth in front of the implant including my front left tooth are numb. Have you ever seen this happen before. Any ideas on the cause? Thank you for your thoughts.
Hmm. Was the floss space to tight pushing the teeth?
How is it now Pam?
I love reading your blog because I like to be educated about the dental issues I have and foresee to come. If possible, you’re on my future travel list.
Though, I am confused by your statement above: “I like to keep about 2 mm on average between teeth but the more the better!” Does this mean that you keep 2mm of space between the upper and lower teeth? If so, how is this possible? In a proper bite aren’t premolars and molars (and typically canines) supposed to come in contact when occluded to distribute biting/clenching forces, while the anterior teeth don’t touch but provide guidance for molar relief? If there is 2mm of space, wouldn’t bite forces not be distributed properly to bone/gum recession?
Thank you.
Speaking about space between an implant to a natural tooth. So the screw is not too close to the roots of the teeth if possible. Thank you for your kind words 😉
Hi I had an implant a year ago top right!! I’m 64 he said I did not have to have bone graft! Lately tooth felt sore and had slight pain in corner of eye, went back last week because of pain in ear and jaw! Dentist said everything fine but still suffering! I know it’s that implant but keep being told there nothing wrong yesterday I had no pain today it’s full on please can you help regards
There is a problem for sure. Likely a gum problem and/or failing implant.
Hello doctor! I actually scheduled an appointment with you. While waiting in excruciating pain, just wanted to describe my situation. Unfortunately, my 1st impant on #13 in upper jaw was placed into not sufficient bone ()
While waiting for an appointment with you, in excruciating pain, I just wanted to share my story. Unfortunately, my implant was put in place of #13 in upper jaw in November 2020 without sufficient bone and with no sinus lift and is now protruding into sinus cavity, causing unbearable aches. I look forward to a consultation and hope for relief solution.Thank you kindly!
Hi Ekaterina,
I am so sorry that you are in pain. I am looking forward to meeting you!
Usually when the implants are not placed correctly they typically do not cause the type of pain you are describing. It is usually a dull ache rather than a sharp pain. This occurs even when the implant is in the sinus. I will be sure to look at your adjacent teeth very carefully. It is very possible that you might have a problem on one of the teeth next-door. I hope not!
Look forward to seeing you 😀
My daughter was born without both of her adult lateral incisors. She’s 18 and on her second set of braces because the space for the implant closed up while she wore her retainer over the years after her braces came off. Now she finally has enough space between the teeth but is being told that her roots are still too close together for the implants and need to be moved apart through braces. Is that even possible? Is it more difficult than moving the teeth? She’s becoming so frustrated with the whole process and all the delays. Thanks so much!
Ugh…yes it is more difficult. It sounds like the teeth need to stay put but the roots need to be tipped out of the way. That would be the ‘right’ way to do it!
I currently have 4 crowns on the 4 front teeth following an accident(with 3 out of 4 having root canals). In the longer term I know I will need implants. I understand in this situation (from reading your very informative website) that a 4 unit bridge is often preferable over 4 individual implants. What worries me is if the central incisor fails first (and it probably will seeing as it is already a repair after falling on it while out running !) then the implant would not be in the optimum place for the longer term bridge I will eventually require (I understand the lateral incisors are the ideal place) . Would the right thing to do when/if this happens be you remove all 4 front teeth and do the bridge rather than just replacing the central incisor? What would your advice be in this sort of situation ? I know I am getting ahead of myself but I want to understand what the best thing to do will be when this happens.
Thanks for providing such an amazing amount of useful information on your blogs. You give me comfort that when/if this happens I will not be toothless and good aesthetics can be restored.
Well it is hard to predict the future for sure.
You have to have a diagnosis and treatment plan based on the prognosis of the others.
This is another method called socket shield that might be an option as well.
It takes a very skilled dentist to do this but is worth it on many occasions.
https://www.burbankdentalimplants.com/socket-shield-for-dental-implants-what-should-you-know/
What if I have one tooth that is questionable and the dentist wants to remove all 4 front lower teeth? Should I question this?
Lower front teeth often have this issue. Here is a post with JUST your situation!