Full upper implants: restorative options for this case?
I installed 8 implants as seen in the maxilla as seen in the panoramic radiograph. The patient refused to have #11 extracted [maxillary left canine;23] so I sent her to the endodontist for root canal treatment. What are my restorative options for this case? Should I incorporate the maxillary canine in a long span fixed partial dentures with implants? Should I just put a single crown on the canine and build implant fixed partial dentures around it? Are any of these implants non-restorable?
8 Comments on Full upper implants: restorative options for this case?
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dr.absi
9/9/2014
The canine alone
CRS
9/10/2014
I am assuming that you placed these multiple implants with a surgical guide and a restorative treatment plan in place. Sometimes patients want to keep a single natural tooth so that they have one of their own teeth present. The safe thing to do is to keep the implant prosthesis out of contact with the natural tooth and plan that the natural tooth could fail in the future so that it can be replaced as a Pontic or implant. I would also advise to make this restoration screw retained for retrievability. Keep this patient in temps for a long time to make sure everything will work! This is an advanced case. Good luck. Would not hurt to get a prosthodontic consultation from a trusted colleague. On the other hand a well restored natural tooth can be a sure thing vs an implant!
Alex Zavyalov
9/10/2014
All implants seem to be restorable if proper angulated custom abutments are made. I would do 3 blocks. Right: a two-implant-molar bridge. Middle: from right implant/canine to left canine/natural.
Left: three united implants. The single molar is supposed to be covered with a crown.
Dr SSG
9/16/2014
Dr Alex....why would you connect the implant bridge to the canine with endo and further more use it as a terminal abutment?
Im not so crazy about that canine at all...i would really not have opted to save it...but we do try our best with patient demands.
My suggestion would be 4 blocks.
- Upper right molar area splint 2 molar implants.
- Upper left molar area splint 2 molar implants
- Then connect upper right premolar implant to what looks to be upper left midline/left central implant.
- If the canine must stay?..then bridge over it connecting 2 implants as terminal abutments.The canine stays in the middle with a primary coping and a telescopic component over it..the design is referred facetiosly as the natural tooth being "a dead pet".
I would certainly inform patient that if and when the canine is lost then its their dollar to replace or redesign the bridge.
The case will be fine over engineered if anything...which is always a good thing.
Now that you are giving this patient such serious fire power in the upper... make sure you watch that lower bridge very carefully...it is splinted across the midline...mandibular flexure on opening often results in distal abutment failure.
Btcdentist
9/10/2014
Great case.
Looks like the vertical stop at #16 is where her bite ends. Because there isn't alot of interocclusal space.
I would go with screw-retained implant bridge.
I understand some patients are stubborn. If patient is adamant on keeping the canine. I would put a separate crown on it and build your fixed partial dentures around the tooth.
3 screw retained FPD'S: implants at 3 -4 molar- premolar
implants at 6 (angled)-9-10 canine-to canine
implants at 13-14-15 premolar to molar.
Best of luck followup
rsdds
9/15/2014
whatever restoration you decide to use will take a beating from an opposing natural dentition.. leaving that canine instead of using a long and wide implant in that area will hurt the case in the long run. The canine is a key implant position and you broke that rule to satisfy your patient who has no idea how implant dentistry works..
jbg dds
9/16/2014
I am going to say this as gently as I can, in hopes that others who read this post might find it useful....You indicate that you have placed these and now are asking restorative options....please consider in the future starting with the end result in mind and working backwards...one should plan the restorative first and let it guide the surgery.....that said your placement looks good and you should be able to get a satisfactory result
Don Rothenberg
9/16/2014
We have all had patients who "demand" something or other that will comprise the long term prognosis of the case. We all know that the canine (#11)... Will be a problem. The weak leak!
All the above ideas will most likely work.
What we should all learn from this case is that patients can be difficult. Perhaps the endodontist might have recommended removal of #11.
All you can do at this point is get a good informed consent. Document well and make sure your patient knows how you feel about keeping the tooth. Thanks for sharing this case.
