Implant Supported Fixed Partial Denture: Which Option Provides the Best Aesthetics?

Your third option is the least desirable as you will likely lose the papilla. Cantilevering #10 is usually a non issue. You should also consider whether your patient has a low or high smile line and where the bone is. I usually ask the lab to create three holes on the surgical guide (8,9, and 10) and make my final decision after I reflect a flap. Or order a CBCT image and u will know for sure.

Dr G: You will get the best esthetics from a three unit implant supported fixed partial denture from the right central incisor to the left lateral incisor. Assuming that the available bone is adequate for placing implants in those sites. While cantilevering a lateral is not a big issue, the implants placed in the two central incisor positions are likely to give you problems with the interdental papilla between them. Also take into consideration the soft tissue and gingival exposure.

The differing emergence profiles of individual implants play a role in this advice. As aforementioned, standard shaped emergence diameters would impinge on the incisive papilla. However, the conical headed implants which are designed to have the body top sit 2-3 mm below the bone crest and the 2.5mm abutment stem reach up from there to the goblet shaped inferior abutment surface (Bicon 2.5 series) are specifically designed to allow greater soft tissue circulation and support along with the emergence length of about 5 mm during which a beneficial profile will meet the bottom of your final crown. Designs such as the Bicon 2.5 would suggest 3 separate implants for this case. John

It's interesting to hear these comments on this case. I presume,like me, those responding to your question haven't seen the radiographs to determine what bone loss has occurred. Nevertheless, I agree with Karl Misch when he says "don't use cantilever pontics on implants", and if at all possible don't use a bridge. You haven't mentioned whether the patient is male or female and whether esthetics is of major concern i.e. whether the patient has a high lip line or not.As a general rule I prefer free-standing implants and no splinting, for best oral hygiene and maintenance.

It depends on the amount of space you have, but idealistically the #8 and 10 positions will give the most predictable and best esthetic outcomes. If implants are placed within 4 mm of each other, assuming there is no immediate provisional placed into the implant, there is a higher risk of black triangles forming due to the microgap that will form from the abutments. Platform switching might make things more manageable. However, I can vouch that you are better off doing 8-10 and not 3 implants or two implants directly next to each other.

High lip line, thickness and quality of the gingiva, and quality and quantity of the bone as well as patient desires and expectations must be known prior to considering treatment options. Some times a fixed bridge is a better option. A cosmetic wax up could be a good aid in treatment planning. Prosthetic options could be evaluated then shown to the patient for approval. The benefit of bone grafting could also be evaluated with a diagnostic wax up. Grafting can be used not only to provide more bone for implant placement but also to provide more attached gingiva or to plump out a defect that would otherwise leave a problem in doing the prosthetics. Do the wax up yourself as you can learn much about the problems that you may face when doing the prosthetics. This can also be a help in planning the implant placement as to the number, size,position, and angulation of the implants when you do the surgery.

dear sir, u had not mentioned the smile line which bears 1st importance of esthetical repair.2nd the width to avoid black triangle formation. my ideal choice is 1-------shoot CTBT.2------------MEASURE the width n select implant3---------my choice is three implant 2.7 of 10mm.n kee 4mm ideal abreast. ur space is ideally created4--------------tell lab to try in on three holes keeping all in straightline