Establish Harmonious Plane of Occlusion with Implant Replacement: Correct Procedure?

Just get rid of the patient! - the easy way From what I understand you did the right thing, so there is really not much else you could do from my pov! Tell her to have her nephew solve her oral situation. :-)

Good advice mattH. I doubt nephew said it that way. Patients sometimes hear what they want to hear. Tell her good bye

Dude , u r totally right.The nephew probably never said that!!Explain to the patient that if u dont adjust the antagonist u will have a huge problem in the lateral movements and either u will overload ur implant or u'll have it out of occlusion.Its both wrong!u r doing the right thing.

New grads know very little regarding implantology. It is ideal to move the opposing tooth into its proper plane of occlusion, mainly to provide enough restorative space for a natural looking and functioning implant prosthesis. While you can make one without crowning the opposing tooth, it remains unknown until you try it, whether this will cause any problems for the patient. I advise placing the implant, and after it osseointegrates, place an abutment and temporary crown. Make sure the abutment is at least 3 mm tall to eventually support a final crown that is short or tall. Have the patient function in the temporary for a month and have her back to see if it bothers her in any way. If not, proceed and make her final crown in the compromised occlusal scheme. If she doesn't like it, prep the opposing tooth. A single tooth that is not in perfect occlusion will not be a huge deal. The problem is that later, if she does need to crown the tooth that has drifted, she will probably want to remake the implant crown to its ideal dimension.

Well a harmonious Occlusion is perfect but in some cases if its just slightly supraerupted and there is sufficient space for Implant crown do not adjust the opposing tooth ..Reason: 1]Extraction was done quite some time ago .[Upper Supraerupted] 2]There would be a loss of Bone in Height and Volume so the crown Root Ratio may be unfavourable.I know Implant is like an Ankylosed Tooth and we should not worry about C:R Ratio But a longer implant and shorter crown is a favourable thing for long term success.So if the opposing crown is not creating a stepped Occlusion and there is sufficient space for Implant crown don't adjust the supraerupted. Ofcourse don't worry about what the other Dentist told the Patient. Dr.Ashish www.drashish.com

In a perfect world yes we should all aim for a perfect occlusion scheme but I also tend to agree that for a single tooth in this instance there is probably not a problem with the occlusion. I do agree that retention of a crown on a very short abutment may be a major problem. This is easily solved though by doing a screw retained crown. Make it right and you will never see the access hole or the final restoration. It is also retrievable so if things do not wirk out and you have to adjust the opposing tooth you can simply remove the implant crown, add to it and refit it.

Call the new grad and ask him to restore the implant after the proper healing time. The new experience will be a very good teacher.

could not agree more with dr callan... let him go through the motions and after explain why he is grinding a perfectly healthy tooth.... and he will

If patient is already taking apart your treatment plan then the relationship is bust. Dont treat her to save yourself the future hassle.

I can understand the perspective of this patient and I have seen this kind of concern expressed before. No doubt the tooth will have to be plastied fairly significantly which when you think about it, is truly a somewhat destructive procedure. Also likely, is that if a minor plasty is done it may not make enough difference to make it worthwhile. An alternative to grinding down the upper tooth and possibly onlaying or crowning it, is to orthodontically intrude it. This is not all that easy but with light forces over enough time it is possible. The person that is concerned enough about not wanting an adjustment in order to preserve the natural state is often the person most willing to undertake an orthodontic alternative. This approach may very well be endorsed by the young graduate also.

Call me old fashioned, but I think that occlusion is still important....and a topic not often well-covered in the modern dental curriculum. Without an occlusal analysis to see if there are any prematurities or other harmful contacts, it is premature for the new graduate to unequivocally state that any odontoplasty is not necessary. The intrusion idea is a good one, but perhaps time and $$$ consuming. In addition, despite the behaviorist view, often significant muscular TMD problems do have an occlusal component.

As prosthodontist I have grinded hundreds sound occlusal surfaces and edges. Of course - nothing happened. It is hard to understand why some of you are worried more about implant then natural tooth. It can be overloaded in new occlusal scheme - caries is not likely; hypersensivity is not so danger as mobility, an so on... Probably this patient doesn't want to be treated. She just wants to rent a dentist for making a tooth. refer to your best collegue ..

In Dawson's text very early on he shows a diagram of upper molars that he has marked for occlusal reduction. If you present your case with slides on the computer and mounted models of the interference caused by hypereruption as a result of early tooth loss,and no opposing replacement,the patient will more likely be convinced. If a patient is still skeptical,I suggest a second opinion.Patients are used to this today.They may come back.Anyhow I wish them luck.Totally non-adversarial.

If you're going to treat this patient why not do it right all the way including occlusal issues. No one knows when an occlusal compromise will or will not cause problems for a specific patient so just do it the way we all know is right and then you feel better and the expectation for long term success is better. It seems like such a small issue to reduce an extruded tooth to create a level plane of occlusion!!

We had a similar situation wherein the upper tooth had migrated in the lower arch ...we had no other option but to do an intentional RCT and then crown the tooth..we then went on to place an implant in the lower jaw.

To the inital question: This is SOP for any restorative case. I remember when I was in dental school that we had a special lecture on just this issue and the management of said condition.