Mitchell, a dentist, ask us:
I have a patient with a severely atrophic mandible. I planned to have 6 regular platform dental implants placed to support a bridge.
Even with a CT scan we could only get 5 narrow platform dental implants
(3.25/10) in the mandibular anterior. Most of the bone is cortical. Do
you still think I can do a bridge or fixed-detachable (hybrid) on 5
narrow platform dental implants?
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If there is no distance between the mental foraminas to place 6 implants… only five, try the nobelguide technique and place 4 regular, so you can do the arch recostruction.
best wishes.
Some of the factors to consider before deciding on design of the prosthesis are:
-Crown-Root ratio
-extent of facial cantilever
-opposing arch
-parafunction
-little old lady vs. football player
-h/o natural teeth problems due to excess forces e.g. fx, wear, mobility
-narrow vs wide arch form
-Class I vs II vs III occlusion
-Length and A-P distance of the implants
-quality of bone
If you decide to do a fixed case it would help to limit cantilevers.
An alternative would be to do fixed in the anterior and an ERA RPD. I have done a # of these and they have worked out well as a compromise vs all fixed or removable. This was published by someone but I don’t recall the reference. Good Luck
Nobel and 3i’s NN are too risky for a fracture. The walls are too thin. They blow out. You cannot bridge on Straumann’s external connection NN. Try an astra or a Thommen Medical SPI Narrow Neck 3.5 internal connection.
Anonymous, I would like to know what the difference is in the different brands. My understanding is that in the anterior, you would like to have an regular implant in the ABCDE position for the best solution and keep things balanced as you aren’t able to get 5 between the foramina. ABDE or ACE, depending on the factors mentioned by Dr. Haas. I really never gave much thought to the different manufacturers and those are good points. Astra and Thommen are thicker? Now I have something new to research. Thank you for bringing up that point. Bill