Prosthetic options mandibular bridge?
This patient presented with a mandibular denture retained with 3 balls on failing natural roots. He has a history of heart stroke. The surgery was very difficult because of the excessive bleeding. I managed to place 7 Superline implants and I avoided the canine and second bicuspid socket because of periapical pathology. I did not graft the scokets beacuse I wanted to shorten surgery time. What do you think is the best option for the final bridge? A splinted bridge or 2 piece bridge? Screw retained or cemented? I am concerned about distal angulation of the implants in 4 quadrant. Would you have placed 8 implants? What would have you done differently? Thank you.
3 Comments on Prosthetic options mandibular bridge?
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nowinskim
10/29/2020
Screw retained splinted bridge. For the next time I encourage you to do prosthetically guided implant placement - first think how you want to end the work, not the other way around.
tpmf
10/29/2020
in the future, do not start a case unless you have the restorative outcome already treatment planned. The restorative work is best discussed with the patient after the initial work up. As a dentist you think in 3D as you work. Put that skill to use while you are looking at the position of your platforms. Very nice case by the way.
mwjdds, ms
12/17/2020
The implants appear to be reasonably placed. I agree with the other posters, plan restorative first then place implants according to plan. However, you did a nice job with these.
There most likely is minimal interarch space so a conventional screw retained hybrid type restoration won't work. My thoughts are a screw retained three unit bridge on the posterior two implants on either side with possibly a cantilever into the anterior space. The three anterior implants can retain a screw or cemented bridge replacing the incisors. I like to break up a fixed crown and bridge case if I can for ease of insertion and maintenance/repair in the future. Ideally, on a patient like this I place implants at 3-6, 3-4, 3-3, 4-3, 4-4 an 4-6 to retain three bridges. If you want, a 7th implant could be placed at one of the incisor positions to shorten the span.
Hope this helps
