Use of cantilever to replace maxillary premolars?

First premolar implant avoid the cantilever.

The best way to go is what crs says. If there are limitations by the patient you should have in mind several factors. 1. The type of occlusion 2. The size of the premolars 3 The position and size of the implant placed.

In implant rehab , just like in natural teeth there are do´s ant don´ts, this is a case for the later, biomechanically it does not resist analisys so just don´t, sleep better at night cheers

Try to get in the habit of recommending the best possible treatment for your patient. A cantilever, even a small one, without cross-arch stabilization, is not the best for your patient, since it creates undesireable forces that may make the case have a shorter lifespan than possible. Two implants are a better alternative, as long as you select a diameter that will allow the recommended distance between the implants and between the implants and the teeth. Do not use wide implants and end up eliminating interproximal papillaes. Good luck, and thanks for sharing your case with us.

Why would you ? In the long run not good at all , Implant would be my choice

As a periodontist that has placed over 8000 implants, and rebuilt many cases, here are my comments. 1. Why are you not placing an implant in the first bicuspid area.? It is one of the best sites in the maxilla normally for implant placement as it is in the pyramid of bone described in the literature between the second bicuspid and mesial of the cuspid- where we can place our longest maxillary implants. That is the best treatment for this patient. 2. If you ever in your crown and bridge do cantilver, always create a rest on the tooth that is furthest from the abutment after the pontic, so the pontic is not a pure cantilever but has a stop, I say this for crown and bridge because abutment teeth can move within the periodontal ligament. Implants are immobile unless failing, so the issue here is the length and diameter (width ) of the 2nd bicuspid implant. If it is long and of good width (eg 4.7 mm diameter and perhaps 11.5 or 13 mm long,) you could place a pontic but the occlusion should be very light. Light contact in centric and none in excursions.I still prefer a 2nd implant for this patient. 3. This has nothing to do with cross-arch splinting. That concept goes back decades to very periodontally involved teeth, when we needed to do cross arch splinting to keep a failing dentition supported with the prosthesis. Today, with implants, we do not save as many periodontally compromised teeth, where we have adequate bone to place implants, or can create adequate bone width and height. We connect the implants to natural teeth using semiprecion attachents, so there is a little give for the natural tooth being compressed in the socket during occlusion. . 4. Further, I would add that in both periodontal cases and in implant cases, after the surgical and restorative phases are complete, if you are not controlling biofilm, you are going to have bone loss around teeth and periimplantitis around implants. So you need to be sure after all your work the case does not fail later because of inadequate biofilm control. I will discuss that on another "comment" in the future. Dr. Howard Marshall

I will only add to the above comments a personal experience. For cost reasons (I had already placed and restored inplants distal and had an implants 9 and 11) I did a first pre-molar cantilever on a 74 year old woman. She does have a strong bite. But thought I could get away with it. Worked for about a year and then she cracked the pontic at #12 position. Now I have had to place the implant in # 12 and eat the remake. I knew better-no cantilevers.

Use mini implant to support cantilever if cost is the problem. I've done this for years without failure.

Would be handy to know dimensions of implant you placed. Anterior cantilever to replace the 1st bicuspid should not prosthetically be an issue. If you have sound canine guidance then fabricate your 2-unit bridge so that when/ if you lose the guidnace on the canine (as you will when the crown undergoes normal wear) have it transition onto the mesial marginal ridge of the 2nd bicuspid, in normal occlusion the 1st bi actually does very little. I have also restored sevreal dozen cases like this over the last decade and no issues. One thing I would do is go screw retained if thats your plan not cemented as you will find the bridge debonding otherwise.

I agree with Carlos, do the best treatment and help the patient finance it. I have a similar situation with a patient, I would have installed two implants but I placed the anterior first for esthetics since it is free ended and I can place the other implant in the future when her finances are better. The problem is you painted yourself into a corner by placing the distal implant first so if you only placed one crown there will be an esthetic hole. You could provisionalize the implant and let her come back for the anterior crown when finances allow, sometimes time is all you need. Remember you are driving the bus. When she gets tired of looking at the hole she will agree or cut her a deal and place the second implant. In the long run you will be happier don't cantilever this.

It is possible and advantageous to place a UR5 as an immediate implant when the UR4 is missing to maintain bone height and interdental papillae with a provisional UR5 & UR4 . The objectives is good initial torque and decrease occlusal forces by decreasing inclined planes , narrowing occlusal width and keeping it out of occusion in all relations , using a 8 um shimstock strip . Wait for 8 weeks and load ! This way you will preserve gingival papillae and have a better aesthetic result without undergoinging elaborate gingival procedures . Obviously , and normally there is more bone height available in the UR4 than UR5 but not always ! We also know that a mesial pontic is better than a distal pontic .

Let me be honest I have never cantilever a single implant and I don't plan to do it soon, but you have to wonder If there are DDS doing all on 4 maybe we should consider research for a case like this.. Good discussion!!!

Saw a case where I cantilevered a 4 of an Implant at Upper 5 , all was great bone levels as they were 23 years later . Cantilever work better with Implants than teeth ( where I would never use them . This is also about money and compromise ..... sure everyone should drive a BMW ........ but some can only afford a LADA ..