22 Implants in the Maxilla and 18 in the Mandible: Any Ideas?

Dr. D. asks:
I have a new patient who presented with this large number of dental implants. I have never seen this many implants in one patient. It appears as though the maxillary molars have three implants – one for each root and the mandibular implants each has two implants — one for each root. I was wondering about the justification for adopting this kind of approach to the treatment planning for implant installation and restoration. Does anybody know of a reference in the peer reviewed literature recommending this approach? I count 22 implants in the maxilla and 18 in the mandible. What do you think of this treatment plan?

41 thoughts on “22 Implants in the Maxilla and 18 in the Mandible: Any Ideas?

  1. John Kong, DDS says:

    Wow, talk about over engineering the case.

    It must be tough trying to keep all 40 implants maintained. Though I question their treatment plan, I give the surgeon and the restorative doc a lot of credit b/c this could not have been an easy case for them to execute. I don’t know how it looks esthetically, but from the look of the PAN, it seems to be ‘working.’

  2. sergio says:

    I see even 2nd molars have been replaced with implants but still 10 or 12 implants would’ve been enough in each arch. I don’t know what the circumstances were at the initial consult appt. so I can’t say whether this was done out of unethical motive or not. A slong as the patient consented to it knowing this many implants are going in and they work, I don’t see the problem with it. I agree this probably took some skill to finish the case.

  3. John Manuel DDS says:

    With some short, small implants in a highly resorbed mandibular ridge, two implants for a first molar have performed well for me on several patients. Usually not enough clearance nor need for two on the lower second molars to my experience.


  4. Robert Wolanski says:

    I do not know of any peer reviewed literature that advocates this many fixtures> I have seen this type of case in the past. Knowing when and where it was done would be of interest. Certainly a testament to many older ideas, remember there was a time where we questioned “should there be one implant for every missing tooth.” I would love to see a ct of this case 🙂

  5. Junaid Ahmed says:

    I’ve seen this case at an implant meeting in Cyprus 6/7 years ago. The implants are Pitt Easy by Oraltronics (now owned by another company). The joke is that this case was referred to another colleague with a view to replace the missing third molars!! Would anyone like to take on this case?

  6. Dr. V says:

    This is an old xray that is going aroun, and a lot of ys is using it as a relaxing part of a lecture. It is an implant per root, and i’ve heard that the treatment was done somewhere in easten Europe. My question is, how di they take the impresions?
    If this patient showed up in your office, can you prowide us with recent xray (this one is from 2002)?

  7. ben manz says:

    Interestingly they all survival rate is 100% astonishing. Its not easy to place that many at molar site especially in maxilla so i am assuming a lot of immediate placements.
    I hope its not done at one of those hands on course where patient volunteer:)

  8. SG says:

    Wow, I would also love to see a CT scan, especially in the area of the fixtures in the lower molar region, to see how they were able to avoid the IAN…

  9. Baker vinci says:

    I would have loved to have been the” fly on the wall “of this torture chamber, when the surgeon was selling this case to the patient. He must hate money! Does this guy spend have of his day cleaning his implants? Bv

  10. Bill Schaeffer says:

    Dear Dr. D,
    If this is a new patient of yours as you claim in the first line of your post, why does the date stamp on the photo of the x-ray say 17th of July 2002??
    I suspect someone is telling fibs!
    Please prove me wrong by posting something of this patient from this year – some new x-rays or some clinical photos perhaps.

  11. naser says:

    hi every body i believe this xray had been taken for askull after hands on practical course in IMPLANTOLOGY
    or for ((showoff)}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}

  12. Baker vinci says:

    If these accusations are true , then I’m going to encourage the “gentleman”, to get a life and some counseling . In my office, that would be a 100,000 dollars at least for implants and more for grafting. I don’t discount unless the patient is poor and deserving. What is your point, for pulling this prank? Bv

  13. dr payal says:

    I really appreciate the doc who has done this case…he has tried to replace the ditto of wots lost…inbtwn i dont think cleaning of implants will be a problem as there doent seem to be interdental spacing or recession since its one on one…also the xray shows no bone loss…only if we culd see the recent one….still if the patient doent mind paying..we shudnt blame the doc

  14. Baker vinci says:

    I’m amazed that folks are applauding three implants for a single tooth. THIS GUY LOST ALL OF HIS TEETH. so you all are ok with him paying for immediate furcations. In my little opinion this aborts the premise of dentistry and implants. I will pay for the cbct, if the implants are in just relative fair repair. Give me your email and we can set it up, ok? Bv

  15. Baker vinci says:

    As I thought , when you call out a fraud , they typically crawl back under the wood work! Offer still applies, dr. D( deceitful ). Please prove me wrong , it would be a rather spectacular case, regardless of the poor tx planning at the posterior . Bv

  16. Baker vinci says:

    Since the D . Bag put this case up here, we may as well pick it apart. Aside from the intential furcation placements, if you are going to do nerve lateraliztions , the least the surgeon could have done was approach the inferior cortex. Every one ive done, I almost go thru the inferior border. Secondly, the only way that this could be done in my opinion would have been in stages and with computer generated guides. They most likely didn’t exist at that time. Thirdly , and lastly, this patient would never go to another restorative guy, unless the original dentist was dead, or trying to collect his/her fees. Go tigers!!!!!! Bv

  17. Baker vinci says:

    Dr. D or should I say mr. D, there are 35 responses from “guys” trying to learn on this site. Fortunately I write when I’m exercising , so no skin off my back. But ,pretty inconsiderate I might say. I’m voulenteering some implants for war vets, and if I can find the right candidate , I will do one of these. I’ll get the help of a boarded prosthodontist and show you how I think this should be done. All Money will not come out of my pocket, by the way . I have an implant company helping out. Your”dead” to me. That would be a figure of speech, for any foreign correspondents . Bv

  18. Robert Wolanski says:

    On Sept 27 I said I expected Dr. D to respond. I suspected this is a hoax as well. I also did ask the site who the moderator is if any. Yehuda informed me that Dr. Gary Kaplowitz is the editor, so I would ask him to investigate Dr. D.I would expect them to clean this up as it reflect on the quality of what they are trying to do.

  19. Fabio B. says:

    Fantastic…this is an ” ALL ON FOURTY “. !!!!!!
    I think and hope it’s a joke, a “photoshop miracle” 🙂 if it would be true i think the implantologist Who has made this performance, has to be immediately locked in a jail or in a psichiatric clinic….


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