Full mouth implant supported rehabilitation: suggestions for treatment?

Rather difficult case to give the best treatment plan based on this X ray only. The problem is patient’s desire: cosmetic or functional rehabilitation mostly. They have different approaches. If lower prosthesis clinically has not failed, do not destroy it now. Make transitional upper removable prosthesis for accommodation.

A very good start would be to get a ct scan to determine where the best bone ht and width, an to remove the impacted teeth and graft. The case needs to be mounted for vertical dimension and waxed up. The nice thing is that implants can be staged between the rct teeth used as temporaries. If the case goes sour due to poor healing or smoking an implant retained vs... supported prosthesis can be used. A hybrid fixed appliance can also be used.

To be rather blunt but honest, if you are coming to this site with questions such as what you have posted for a case of this complexity, you should refer this case out for two reasons: 1. ethics, you obviously do not have the training to plan and complete this. 2. financial, you will loose money with this type of case if you are early in your implant career. Remember, it is better to be a hero and refer the case then to TRY to be a hero yourself and have the case fail in your hands.

The first thing you should do is take care of the pathology associated wtih tooth # 17. Based on what I can see of the radiograph, it appears that there is a unicystic radiolucency that is getting close to the inferior border of the mandible. The patient is at risk for further increase in size and a patholgoic fracture if not dealt with. I wouldn't even entertain any thoughts about rehabiliation of the mandible until this is taken care of. Please refer to an oral surgeon ASAP.

As Drs wrote. you should be aware of the risk of mandibula fracture on #17. I would take a periapical xray of it first of all.

A critical piece of information in this case is what is your personal experience in placing implants? Unless you have had extensive experience, I would strongly recommend referring this case to another more experienced practitioner. DrT

remove all teeth do all on 6 upper arch all on 5 lower arch avoid distal bone !!

Smokers have integration problems don't they? Your panoramic is intriguing, I love cases like these! They are truly challenging (time). I'll assume you are grounded in sinus lift and the bone regeneration methods. Bicon has consultants, materials, and implants that would make this case fun! I loved Dr.a solution of 6up/5low. With Bicon, maybe you can fit even more to help the person. You'll need a genuine "want to help attitude" and good patient rapport.