Implant size adequate?

I have a patient who wants to have implant(s) to replace missing teeth #12 and 13. Mesial Distal distance is about 11 mm. I don’t have enough room for two 3m implants. I plan to use a 4.3x13 mm implant for a single crown as shown on the attached pictures. Would it be acceptable? Patient don’t want bone graft for a bigger implant. What other options do I have. Thanks!

Steven comments:

2 3 mm implants, each 1 mm away from adjacent teeth and 2 mm between them, or 2 3 mm implants 1 and 1/2 mm from adjacent teeth and 2 mm between them

Aquiles comments:

I’d say the 13 is a bit aggressive. If you get resorption. Which you will you will be screwed doing the prosthetics. I’d go 11.5 and sink deeper. Just my .02

Tim comments:

That will work out just fine and I agree that you don’t need to go 13mm with the length of the fixture. I am not sure what Aquiles is referring too but I reserve 13+ mm fixtures for immediate placement when I might need the extra length to engage apical bone for stability, otherwise I see no rationale reasoning for just placing the biggest implant possible even though that is how I was trained 20 years ago.

Stefano comments:

Id def go 5x 10 or 11.5. Long implants offer no benefit in this case, wider will give you smaller inter-proximal triangles thus better hygiene.

Dean Licenblat comments:

I would not go bigger than 4.2 here. The literature suggests that anything beyond 10-11.5 in this case is statistically insignificant and you are more likely to go off trajectory and end up not where you intended. According to buser et al & Tarnow’s countless works, we should aim for a minimum of 1.8mm facially, 1.5 between fixtures and teeth and 3mm between fixtures. Considering you said the patient has rejected grafting, even at 4.2 it’s a stretch.

M. Ghasemi comments:

As per my experience, if you have enough room to place a 4.3 *11 mm implant place it distal to the medial tooth and make two crown( cantilever) and adjust the occlusion in lateral movement

Greg Kammeyer, DDS, MS comments:

one 5mm implant with GBR. You don't have enough buccal bone width. I agree, no need for a 13mm. I disagree with the cantilever....unless it's an esthetic issue, then i would place the implant more distally with the pontic mesially.