Dr. C. asks:
I removed a 6-unit bridge extending from #1 [Maxillary right third molar) to #6 [maxillary right canine]. The bridge had given the patient over 20 years of service. But with only those two abutments, I had to wonder how a design like that could have succeeded. Both #1 and 6 are salvageable. The patient wants an implant bridge to replace #2-5. If I place a wide platform implant in #2 site and a regular platform in #5 site, will that be enough support for a 4-unit bridge extending from #2 to #5? Or should I place a third implant to support the bridge? Misch recommends placing an implant in #3 site when making an implant supported bridge including that area. Thoughts?
Proper Implant Bridge Design to Replace #2 to #5?
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I have treated many patients like your description, it’s succesfull as long as your implants length and width are not compromised. But is that what I prefer? no, thats what I do in case I dont have proper bone for a third implant, or the patients economical situation doesn’t allow one.
-Besides you’ll never gonna need to replace #1 but in case you lose #6, you can change your 4 unit(supported by 3 implants) bridge to a 5 unit one as #6 a cantilever.-
You can do what you are proposing, no problem and if you loose n6 you can replace it with a single unit implant. Just be carefull with he occlusion and more with the discclusions.
Why would you argue with Misch?
Depending on the bite force, I think it would work but, if it were me, I’d place implants at 2,3 and 5.
I think the clinical crown length of the teeth to be restored over the implants and pontics athhached to it, as well as the mesio-distal width of the supposed bridge, in addition tothe type of occlusion and if there any bad habbits like bruxism, all these should be put into consideration when you are taking your decision wether to repace the edentulous area with two or three implants, good luck to your case.
With softer maxillary bone and length possibly compromised by sinus proximity, I would opt for more implants rather than fewer, at least 3 and possibly 4 implants depending on the many variables that must be considered. I would never consider a 4 unit implant supported bridge using only two implant abutments, #2(17) and #5(14).