Case: 10 Implant Mandible, Immediate Loading, CAD/CAM

If the patient is so knowledgeable that " ... required extraction of all teeth in the lower jaw, immediate implant placement, and immediate loading with a CAD/CAM bridge prepared in advance on a digitally manufactured analog model" what comments are you expecting?

I like the concept, however some of the implants are not parallel possibly due to using extraction sites and available bone it seems. Correction seems to be done in angling the abutments. Any thoughts on staging this with provisional minis during the healing process? Immediate placement has some risks in an expensive case like this. Concern about hygiene long term in a splinted restoration. If you don't get the occlusion just right vs provisionalization with a temporary appliance the patient has a big adjustment period with little room for error. One advantage in dentistry unlike orthopedics we can make transitional appliances mounted on an articulated with anatomical parameters. I do like using the anterior teeth as a tooth Bourne guide in a tissue Bourne guide however flapless placement can be very tricky with little margin for error especially without depth control. Blind procedure trusting the extraction sites as guides. I have used many computer guides but I like a landmark like the lingual plate to visualize. Also now the crooked teeth have been duplicated in implants why not stage and correct this. Interesting case please post lab website link. Thanks for posting.

I respectfully beg to differ. This most certainly is a case question looking for answers. 1 Why is the practitioner anonymous? 2. Where is the documentation for natural dentition slaughter? 3. Why was there no preoperative occlusal plane correction 4. Or as CRS has pointed out, far less risky provisionlization, observation, correction and only then final execution? 5. Where is the five year ( at least give me one) follow up? Readers of Osseo News are well served by observing such cases of "Cowboy Dentistry"

this is actually an advertisement for AB dental devices ltd. Looks like there's a provisional implant FPD in the maxilla as well. Hopefully both arches will be restored at the same time and correct the occlusal plane discrepancies. In the future I would hope that advertisers would state as much.

you need to show implant placement pano and one question why only 2 implants in the symphisis (type 1 bone)?

I would like to add that Osseo News provides an invaluable service to its readers. All dental procedures are fraught with pitfall and misadventure. To that extent we can be made aware of them here they hopefully may be avoided

I completely support the Osseonews explanation and have to say that thanks to this website we can see how some authors are describing their cases in meticulous detail and provide very accurate information in their posts, but some of them are not.

Like LDSDDS I question the mandibular clearance. Need pre-op xrays for reviewers to judge. The photos and 13mm implant length don't suggest much loss of bone height. Can't judge any other parameters as none posted. Seems like a rich patient dictating tx -> sometimes a recipe for problems. Also question the selection of a rigid roundhouse - technically exciting for technicians but ignores the clinical reality of mandib flexion in function - try to defy nature -> you will lose. Something has to give, particularly in a heavy bruxer such as this. It might be loss of bone around implants, loss of porcelain or even prosthesis or component failure. The lab should have delivered a splint with the bridge. . Agree with CRS that staged tx might allow for correction of occlusion, and should have been looked at before surgery (maybe no time because it looks like this case was required yesterday). Would suggest that space will appear under the ant part of bridge as tissue shrinkage occurs. This has happened in the maxilla. Really great for hygiene !!! Hope that lab is not dictating to clinician. Critical biological considerations seem to have been overlooked or ignored.