Will these implants be able to take up the occlusal forces as they are distally inclined?

Hi, non-axial loading isnt ideal but isnt the be-all and end-all of this case. The fixtures are fairly well placed and if intergrated, then fine. The 2nd molar looks like it needs to be extracted. The 1st molar has supraerupted- it would be ideal to place a crown? or at least reduce the occlusal height to get better balance and space for the implant crowns. As for the bruxing, two words- occlusal splint. Im not a fan of splinting implant crowns together, especially where you have one fixture for one crown, but im interested to hear what others say.

They look great, remember panorex can be deceiving. They are lined up with the fossa of the maxillary teeth. Now leave the third molars as spacers for the vertical height of occlusion and remove and graft #2,3,4 which are non restorable, you can temp them to provide a guide for the implant crowns then remove them and use the implant crowns as guides for the maxillary implants. You can take your time doing this staging or wax up the posteriors with ideal occlusion (mounted models) Remember that th molar implants don't to be lined up with the uppers since you'll be removing them eventually. A bite splint is a great idea to stabilize the occlusion. Check for canine rise and balance in the final crowns, you can also keep the patient in provisionals while everything is settling in. Well done I wouldn't splint th crowns it is very possible that the bruxing is being aggravated by a lack of occlusion on one side. This is a nice way to go restoring one arch at a time, the patient will have buy in when they see the new mandibular provisionals. The molars need to go possibly keep th premolar you 'll see how the mandibular implants integrate. Very nice case!

I would not worry about the curve of Spee or Wilson. It means nothing for practical use. In any case, the patient will choose to masticate on the other side (to save the implants), and their loading will not be maximum. Nevertheless, I would splint the implants, because of a long-span defect, powerful natural antagonists and shorten the overerupted molar. The patient has naturally fixed occlusion and bruxism for the implants is not a big issue here.

The over eruption of the the upper 6 may an issue . Peter

I believe you will be ok. I suggest adding one more implant at # 28. I also suggest a crown for #3 and adjust the level os Spee the classic way. Give the patient a night guard. A female patient came to my office yesterday. She is physically bigger than me (6'1"" and 190 lb). She broke two screw retained pier abutments, she came to my office aprox two years ago and destroyed on the sane side a fixed detachable pros (hybrid). Bruxind can bean real SOB to mitigate.

Hoping that all here understand the limitations of diagnosis with the limited records here... Note the deep wear pattern of the Lowe third molars. That u worn Distal cusp looks like a balancing side contact, which would stimulate clenching and grinding. How about removing these interferences along with any others found? John

my concern with this case is the diameter of the post implants 3.8 is division B implants and may fracture in the future specially with a bruxer...

I think the crowns should be splinted for strength.As aesthetics are probably not a big issue for the patient, the crowns can have modified emergence profiles to allow for hygiene and ging health. If the implants are titanium alloy (I think most are) then 3 x 3.8s should be strong enough to withstand bruxing loads - especially if the entire occlusion is balanced, and several shimstocks clearance to the implant crowns is left. A night splint is also a good idea, though how you get the patient to wear it is sometimes a problem. Need to treat the upper arch to get a good balanced occlusion and that could follow on the lines posted above by Dr L and/or CRS

Do not get distracted by the distortion on the PANX. I think you are in good shape for the restoration ,splint if possible and don't forget to reduce the occlusal table ,also try to use zero degrees anatomy to minimize lateral occlusion .You will be fine