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Using Cantilevered Pontics in the Posterior Maxilla?

posted in Surgical Placement of Dental Implants, advice

« Using Implant as an Abutment for a Removable Partial Denture? | Xenogenous Block Graft Cracked: What Should I Do? »

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I just took a course at a national meeting in which the lecturer gave several examples of maxillary full-arch fixed partial dentures. In some of these cases, he only used 6-implants to support the fixed partial dentures. He had long spans and cantilevered pontics on the distal replacing the second molars.

I talked with my oral surgeon who is very conservative and careful. His recommendation is not to use cantilevered pontics in the posterior maxilla because 80% of the occlusal force on those pontics will be transmitted to the adjacent implant. Since the bone quality around the most distal implants will be at best Type III and more likely Type IV, he says this will lead to significant bone loss and eventual failure around that implant. He says the safest approach is to use a shortened fixed partial denture with no distal cantilevers. I would appreciate guidance on this. What do you think?

5 Responses to “ Using Cantilevered Pontics in the Posterior Maxilla? ”

• Paul June 19th, 2009

  
  

  1st molar to 1st molar is plenty of teeth (70% of function is 1st molar forward)

• Dr. R.B. Stanton June 23rd, 2009

  
  

  I agree with the above. In the past, I have cantilevered first molar pontics on a round-house 6 implant FPD to avoid sinus lifting with zero failures so far, but if you could actually place the implants in the first molar area, I would stop there.

• Richard Hughes DDS, FAAID, FAAIP, Dipl.ABOI/ID June 24th, 2009

  
  

  Good point Dr. Stanton, but I would suggest to have the 1st molars out of centric, if cantilevered. If the 1st molar are implanted then go ahead. Sometimes it’s too hard to place and restore implants in the 2nd molar area due the lack of clearance.

• Dr Sharon Goodwin August 15th, 2009

  
  

  I really appreciate this discussion on cantilevering first molars on a 6 unit roundhouse in the maxilla to support a roundhouse and avoiding a sinus augmentation procedure.I have a patient who smokes 30 cigarettes a day and would like a fixed implant supported FPD.He has enough bone to place as far back as the second bicuspid.If he is a heavy smoker and there is even more risk of implant failure at 30 plus a day vs 15 cigarettes a day,then would it still be acceptable to do a molar cantilever or just cantilever a half unit off for esthetics? Or failing that as the patient has a broad smile line-place an RPD (with resililent attachments from the distal of the second bicuspid abutments) to replace first and second molars even though this maybe a little “clumsy”? Thank you

• Richard Hughes DDS, FAAID, FAAIP, Dipl.ABOI/ID August 16th, 2009

  
  

  Sharon, You are correct that smoking will cause this case to fail, if dental implants are used. Your prosthetic choices sound logical.

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