Full-arch Dental Implant Rehabilitation of an Edentulous Maxilla

Why not try an expanded platform? Just remember that you might want to discuss the restorability with whomever is going to restore the case to decide if you prefer an external connection or an internal one. Most importantly, try to avoid the implants with less prosthetic options since you are probably limited in getting good parallelism in that type of a ridge. Good Luck.

I think you meant to say that you were planning on an implant rehabilitation of the mandibular arch with an opposing existing maxillary complete denture. However you restore the mandibular arch with implants, the maxillary complete denture then becomes the weaker member. Occlusal scheme to be used is as important if not more so than how many implant fixtures are used. No mention was made of redoing the maxillary complete denture, but not doing so limits the treatment approach. It would probably be wiser to treatment plan the rehabilitation by first establishing the correct vertical and centric position, proper lip support and occlusal plane before commiting to a hybrid or PFM restoration in the mandibular arch. The patient is probably complainig of an ill fitting lower denture, but using the existing maxillary complete denture will unduely dictate the final restorative approach. The patients needs may be better served by providing retention and stability of the mandibular denture using fewer implants (for retention only) and using linear occlusion with no interceptive contacts anterior or posterior which will enhance the overall prognosis of the final prosthesis.

If you are placing 4-5 implants in the anterior mandible and splinting you should have adequate strength in the commercially pure titanium implant fixtures. You will have cross-arch stabilization and you are opposing a full upper denture.

D. Schwartz-Arad, G. Chaushu Full-arch restoration of the jaw with fixed ceramometal prosthesis International Journal of Oral & Maxillofacial Implants Vol. 13, (pp. 819-825) 1998 G. Chaushu, D. Schwartz-Arad Full-arch restoration of the jaw with fixed ceramometal prosthesis: Late implant Placement. Journal of Periodontology Vol. 70, (pp. 90-94) 1999 D. Schwartz-Arad, N. Gulayev, G. Chaushu Immediate versus non-immediate implantation for full arch fixed reconstruction following extraction of all residual teeth: A retrospective study Journal of Periodontology Vol. 71, (pp.923-928) 2000

you have to put at least 7 implants and you can use attachments reverted in the 2nd premolar. In the oclusion try to think like a total removable. Don´t put excentric movements, only centric and in the excentric lateral movements do it in group with lateral incisor canine an premolars in the protrusion put a slghtly overpass of the incisors that the movement is iniciated with the incisors but terinated with de distal-vestibular cuspide of the superior premolars. I think that it is probably better to expand the alveolar bone with osteotomes and even do a traumatic or atraumatic sinus lift before or during the surgery. The narrow implant of 3.3 mm is ok but you have to put at least 11,5 or 13 mm of length to have more surface contacting the bone. Use good screws, try torquetite of nobel biocare. And don´t forget use external hexagonal implants and not conic and not internal because it causes less problems to the implants and its better to solve a prosthethic problem rather a implant failure.

To Dr. Rui. I think you didn't understand.The case is about a mandibular rehabilitation. I think a protocol with 5 to 6 implants inter-foramen is a good choice. I don't think you can't put regular implants in this area.

Dear colleagues, For ridge expansion I think that it works much better working with ridge expander drills operated with the motor. They provide much better directional and torque control and are far less agressive for our patients. There is a german manufacturer - I do not recall the name right now - and a spanish one - BTI expander drills, the ones I use - with a branch in Philadelphia; I also once heard a conference of Dr. Ernesto Lee and to expand the crest this is by far the best option. Best regards, Dr. Adrien Deume

Dr. Deume - I was very interested in your comments on expander drills. I have a case coming up that would indicate the use of the drills. Can you give me any more advice on which ones to get ? I place NobelBiocare and Imp[lant direct fixtures and they don't have expanders designed for their implants. Thanks, ATB

Narrow implants in the mandible for a fixed case is really not a problem per se The bone to metal contact is good, density is far better than maxilla You need to over engineer the case if you intend to do the same in the upper All simple biomechanics Splinted (not across midline in mandible ) Narrow occlusal table /low cusp form Longer implants in the anterior Restore only to first molar etc I would have little concern with 3.5 mm implants in this case as described Nothing unusual here Place 6to 8