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Single restorations for narrow spaces with Biomimetic Pearl

Dr. G. Cubero

Degree in odontology from the Universidad Europea (2013), Master’s in oral surgery from the Hospital Virgen de la Paloma (2016), private practice in Madrid.


Small mesiodistal spaces due to dental movements or narrow teeth limit the placement of medium-diameter implants, and can damage the roots of adjacent teeth or hinder the prosthetic restoration due to lack of space.

One treatment option in this type of case is to place reduced-diameter implants with a prosthetic restoration, for which we always seek to choose screw-mounted or cemented and screw-mounted, as up to now most narrow implant systems required cemented, which could entail complications in the medium term.

Clinical case

Male patient aged 50 years, with no medical history of interest, who had teeth 22 and 14 extracted five years ago, came to the clinic wishing to replace these lost teeth.

After a clinical examination and confirmation of bone availability, the small amount of mesiodistal surgical and prosthetic space of both areas was noted.

Initial clinical situation

The patient refused any alternative treatment to gain mesiodistal space, therefore, it was decided to place two reduced-diameter Avinent Biomimetic Pearl implants (Avinent Implant system).

Details of the Avinent Biomimetic Pearl implant

The Biomimetic Pearl implant has the necessary characteristics of the ideal narrow implant:

  • Narrow apex to reduce the risk of damaging the roots of adjacent teeth.
  • Crestal microthread to reduce bone compression at this level.
  • Three different implant diameters (2 mm, 2.4 mm and 2.8 mm) with the same 3 mm platform.
  • External connection with a 2 mm transmucosal polished neck (that creates a gingival seal and maintains the biological width and safety margin against periimplantitis).

The placement protocol was the same in the two areas, 22 and 14, using Pearl implants with a diameter of 2.8 mm and length of 13 mm. The surgical sequence for placing the implant in position 22 is set out below.

An incision, full-thickness detachment and centered osteotomy were made, using only a lance drill with a 2 mm diameter for good primary stability of the Pearl 2.8x13 implant. In these cases the difficulty lies in the fact we only have one attempt. If we get the drilling direction wrong, trying to correct it with another drill would cause the narrow implant to lose stability.

Centered osteotomy ready for implant placement

The implant was then placed at 35 Ncm, verifying that the insertion axis was correct and that a minimum safety distance of 1.5 mm was maintained between the tooth and the implant, before positioning it definitively.

Details of the implant before its final position

The implant must be placed in accordance with its design and therefore its depth must reach the polished area, observing the biological space and distancing the prosthetic connection 2 mm from the level of the bone crest.

Once the healing abutment has been placed and screwed in, the soft tissues were improved with a palatine connective graft, as is standard for any medium-diameter implant in aesthetic areas. At the same time, this reduces the risk of recession and periimplantitis.

Finally the incision was sutured with the graft anchored at the vestibular.

Vestibular connective tissue graft
Suture and closing of the wound

Three months later, once osseointegration was complete, measurements were taken to make two cemented and screw-mounted super-polished subgingival zirconium crowns.

To carry out the prosthetic restoration on the Biomimetic Pearl implant, we used a straight titanium base of 4 x 0.9mm, providing better crown-implant fit unaltered by glues.

The visible gap disappears when the final torque of 30 Ncm is applied to the prosthesis screw, which should only be tightened once, and the optimum fit checked on the final x-ray. It is possible to appreciate the excellent behavior of the periimplant bone, stabilized at bone level in the treated area if the implant has been placed correctly.

X-rays of both implants 14 and 22 with correct fit and stabilized bone level

The soft tissue and super-polished zirconium, with time and good hygiene, achieves fit and creeping attachment that further improves the crown-gum relationship.

Immediate post-op image
Details of the tissues a year after placement

The patient is satisfied, comfortable and content at the annual revision, with no loosening, discomfort or problems.

Extraoral photo one year after load


Avinent Biomimetic Pearl narrow implants, aside from their excellent behavior and design to facilitate cases of restorations with overdentures, are also an excellent option if the right protocol is followed for restoring missing teeth in mesiodistally compromised spaces, permitting screw-mounted restorations with guaranteed long-term success.