Canine-to-Canine Implanted supported Fixed partial Denture?

I have treatment planned this patient for extraction of #6-11 [maxillary right canine to maxillary left canine; 13-23] and replacement with an implant supported fixed partial denture. I plan to use implants in #6 and 11 sites to support the fixed partial denture. I plan on making a provisional implant fixed partial denture from #6-11 and take it out of occlusion. #12 and 13 [maxillary left first and second premolars; 24, 25] will bear most of the occlusal force during that period. Would it be better to place conventional implants in #6 and 11 sites and let them osseointegrate while I place narrow diameter implants adjacent to them in the maxillary anterior and have them support the provisional fixed partial denture? After the implants in #6 and 11 sites osseointegrate, I can explant the narrow diameter implants and proceed with the restoration of the implants in #6 and 11 sites. Any comments on this plan? What do you usually do for a temporary in the anterior region during the osseointegration phase?


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14 Comments on Canine-to-Canine Implanted supported Fixed partial Denture?

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CRS
8/17/2014
Good case for an all on four, not enough quality bone in the canine to canine alveolus for conventional implants. You'll have to place them deep and have long crowns. The mandibular teeth are not far behind.
Mike ainsworth
8/18/2014
It all depends on the width you have to play with and the quality of the remaining teeth. On the opt I would suspect you could find room for 6 - 8 implants and ultimately use a cad cam bridge. Either using an immediate or delayed protocol.
Alex Zavyalov
8/18/2014
"...I plan on making a provisional implant fixed partial denture from #6-11 and take it out of occlusion...." It's unclear how you can take out of occlusion the whole prosthesis.
DrT
8/19/2014
What is your plan to restore the posterior occlusion? Also, is the perio disease under control in the maxilla? Thank you.
MMontana
8/19/2014
You need to establish posterior occlusion; specifically bilateral, first molar occlusion. All-on-4, six or eight implants, whatever as long as you balance the forces. The treatment you propose limits the functional load to a small area and thus magnifies the pressure on the area in function.
Timothy Hacker DDS FAAID
8/19/2014
Do all on 6 implants - 4, 6, 7, 10, 11 & 13. You can set up your provisional over denture on locators Make your Hybrid 4 months after implant placement. Follow same protocol on lower.
brian
8/19/2014
Thank you Dr Hacker, I will follow your plan of All-on-6. (4-6-7) & (10-11-13). Bone seems most viable in these regions plus we can avoid the sinus lifts. Ultimately a hybrid spanning from 3-14 should be sufficient. Can I immediately load the implants I place with a locator retained overdenture? Will this not impact osseointegration? Thank you.
CRS
8/20/2014
If you are doing an all on four or six the point is that it is immediately loaded per protocol with adequate reduction for the framework at surgey. The time to plan the prosthesis is at implant placement if reduction is inadequate the prosthesis will break. The only way to tell if the reduction is adequate is with the provisional. If you are planning a hybrid then bone has to be added to prevent long crowns. If you just place implants with no regard for the final prosthesis you will end up with locators and a denture to make up for the lack of soft tissue, bone and transition line. I would advise picking a prosthesis and working with a surgeon who understands the treatment protocols and the type of surgery required. It is determined by the final prosthesis, the trick is knowing what to do with the bone quality during implant placement. If you load the provisional on locators osteointegration will be compromised and the denture can cause bone resorption if not balanced the lower teeth will also help. This is a complex case and the treatment parameter need to be respected. I like Omar's advice below with a little grafting it us more conservative, keep the patient on a full liquid diet advance as tolerated and see what you get.
Dr. Omar Olalde
8/19/2014
Stop. Don't do that. This is a case in wich you have to be very carefull in the planning. 1. If you do an early loading with a provisional prostheses, you have to decide that at the moment of the surgery, to identify the quality of the bone. 2. If you decide to do a provisional from canine to canine it must have a hard-solid structure, not flexible. Because of that flexion, you wil have micro movement in the implants, so the implants might not be osseointegrated. So you need a metal or zirconia structure (for a provisional???) 3. As the Doctors above wrote, your provisional won't be out of oclussion because you don't have posterior stability. I would place 6 or 8 implants for a full arch restoration and use a beautiful Removable provisional prostheses. Part of the succes of these cases depends on the patience of the patients.
Dr. Vipul G Shukla
8/21/2014
Dr. Omar, Well said. This is a full upper case, not just the anterior quadrant. Judging by the perio issues seen here, it may be worthwhile to stay with a LOCATOR supported overdenture. I have never done a provisional denture that actually used the LOCATORs in the first three months. Too risky. My plan: 1) Make preparations to make an immediate upper, have it ready on day of surgery. 2)Extract all uppers, clean sockets 3) Place implants in a minimum of four locations on the upper. First molar and canine sites are best. Healing abutments as well. Graft as necessary. 4) Deliver the immediate with chairside hollowing for the healing abutments. 5) Reline after 3-4 months and include LOCATOR attachments underneath, and LOCATOR abutments on implants. Inexpensive treatment, plus you can always add two more implants at a later date and convert to an "All-on-six Hybrid" Your thoughts?
Timothy Hacker DDS FAAID
8/19/2014
Dr. Omar, my sentiments exactly.
Tuss
8/20/2014
If you only restore canine to canine and are considering immediate loading then really high chance it will all fail. You also have not taken into account lack of posterior support so any and all chewing function will be on anteriors which are not designed for that - consider what happens to natural teeth. You need to go back and work the case for a full arch rehab
Richard Hughes, DDS, FAAI
8/20/2014
Dr Hacker presented a solution for the logical placement OD the implants for this case. Omar gave sound advice as per provisionals.
Dr Rob
8/28/2014
I would certainly feel a lot happier using 8 implants in the maxilla and this may be one of those cases that looks better (thus avoiding the 'long crown' aesthetic/mechanical issue) when treated with a removable denture as opposed to a fixed one????

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