Full Arch Implant Supported Fixed Partial Denture: Any Recommendations?

ct scan a must for this case.. if not you'll have to improvise alot. it looks like a straight forward case. 6-11 bridge span is too long i would try to place at least one more implant in the anterior area. good luck with this case

i agree that you need a c/t scan! acording to the quality and quantity of bone i would do all on 4 or all on 6 full arch rehabilitation avoiding sinus lifts. i think that your patient will love for giving him a painless treatment. but if you want to do sinus lift anyway try the hydraulic sinus lift or balloon lift by crestal approach. it is more difficult for the doctor than the lateral approach but your patient will experience less discomfort and less post-op complications.good luck with your case!

Hi there, the orthopantanogram isn't very clear and having a CT is good to check the sinues (particularly left side). But I assume this is a given- Consider grafting first then waiting before placing your dental implants on the right side (left side more favorable). The reason is that first molar position may be hard to get inital stability and/ or the ridge may be compromised and fracture. Additional risk of weakness is you may need a large window to fill up this amount of space. Cerasorb mixed with autogenous bone chips works well. The span is tentatively fine but depends on the length/width of your achieved implants and the anterior posterior cantilever of your anterior segement. Good luck!

This case is not as easy as you think. It is pretty clear that the anterior teeth also has severe bone loss. Fixed prosthesis is possible only after extensive bone grafts and appropriate treatment plan (if you are looking for an ideal result). Otherwise a semi fixed denture with ball / ERA attachments. If you like to have a fixed prosthesis with out extensive bone graft check out some videos on BICON website. May work for you. It is a suggestion. I am not employed by bicon. :-) scan is a requirement.

In cases like this I like to avoid the central and lateral positions if possible as its easier to get esthetics with a pontic there then to try and work with an implant that may due to the triangle of bone be at an angle making restoration more difficult. I will place implants bilaterally at the 1st molar, 1st premolar and cuspids and do a round house prosthesis. Patients function well with first molar occlusion so you dont have to go more distal then that. and ina female 6 in an arch is sufficient. Also ina case like this patient will have to wear a standard full denture for about 6-8 months before restoration can be done

I agree with Dr. J.A. that an All-on-4 or an All-on-6 (with pterygoid implants) would be the easiest and most efficient way to treat the case. However, I would not use these methods unless you have had appropriate training and have an experienced team to work with. You also need to restore the mandibular arch in conjunction with the maxillary reconstruction. Stick with what you know works best in your hands.

Hello Go for all on 4 or all on 6 technique best for this case

Tom B: Well said, everybody should stay within their comfort zone.

Hi, Fixed solution with that much tissue loss and obvious perio issues,a recipe for disater????!!! Ct is not needed i think the opg is fine, place x4 imnplants x2 r and l; in 3 and 4 poistions after extracting the junk and making a full immediate. Make sure denture eased well off soft tissue around implants . And wait 16 weeks expose and make a horseshoe locartor retained denture.

Dr K : thanks for submitting the opg and photo. The opg doesn't show which side is right or left, but assuming that we are looking at the radiograph as if we were in front of the patient, in the left maxillary sinus , there appears to be a lesion that may be consistent with a mucous retention cyst. Thee right maxillary sinus is not very clear and therefore I can't tell if this lesion is bilateral. I would recommend , like many others to do a 4 in 1 and fabricate a bar(s)/locator retained maxillary overdenture. The mandibular teeth need to be looked after as well particularly the overerupted 36 and obvious carious and perio lesions.Cheers

This appears to be a relatively straight forward case. Ext, graft sockets, F/. CT scan and surgical guide for all on 6. If it is in your comfort zone this is a perfect case for immediate loading(teeth in a day) I have grafted sinuses for 22 yrs but do not see the necessity here unless you intend to restore the mandibular 2nd molar areas. 1st molars can easily be cantilevered off the full arch maxillary restoration. The healing time after extractions can be used to level out and restore the mandible. Carefully planned, this case can make you a real hero in your patients eyes due to the efficiency with which it can be performed. t

This is a complete oral rehab case. Complete elimination of upper teeth due to perio, and immediate implants( if proper curettage can be established which i doubt)or extraction followed by immediate denture and come back later with proper bone and soft tissue healing. Lower 36 and 45 also have to be removed due to root caries and overeruption. The number of upper implants will depend on the type of restoration u r planning.With the bone loss and soft tissue loss,( u will get an idea about this in the transitional prosthesis) an upper fixed bridge is not an option ( Fp 1 according to Misch), u have to settle for a hybrid denture ( FP 3). If the option is hybrid, 6 implants (without sinusgrafting)anterior to the sinus supporting the frame and the occlussion can be cantelevered to first molar. But this can also be done with equal success with four implant retained, locator overdenture (removable Rp 5). Mean while endosteal implants to be placed in the lower 36 and 45 and 46 sites getting the first molar occlusion with the upper. The occlusal scheme suggested is mutually protected occlussion with group function on either side without any lateral interfering contacts. Doing the sinus grafting in this case is an overkill( since first molar occlussion is good enough) and CT can be an useful adjuct for diagnosis and if u r planning guided surgery for upper.

Nice case. I would do it this way: Take impressions, mount and have your lab make an upper temporary bridge from #5 area to #12 area. Have your patient come in and extract all upper teeth. I have a cbct in my office and that's when I'd take the ct as the metal in the upper crowns is going to make a lot of scatter. (If you have a close scan center arrange with them). Then take a peak at the scan, I'd try place your 3 anterior full size implants along with 4 temporary implants and do your anterior grafting after cleaning up. I like Milo 3.0 for temporary implants, they are one piece but have angle correction abutments. It looks like you may have some room in the 5 and 12 spots and you need to find at least two more spots in the anterior region for your temp implants. Fit your temporary bridge and be sure to tell your patient that this temp bridge is nice and light but lacks the strength the final restoration needs. I think your idea of where to place your implants is sound. I'd give her six weeks to heal up a bit and then do the bilateral lifts with simultaneous placement of your other 4 implants. If you instead make a full upper denture as a transitional, I can guarantee that she will not like it at all, and you have to worry about the grafts and implants getting pushed around. The only thing is that they love the small temp bridge, and they are going to want the definitive that small, so tell them from the get go that this is not strong enough and the hybrid has to be bigger. Great case, it'll be fun.

This is a classic "All on 4 teeth in a day" case. If the implant system you use does not do this or you do not have the skills to do it yourself, do your patient a favour and get them seen by someone who does. Don't get me wrong, I do a lot of sinus lifts and bone augmentations etc but (with the limited information available) it is almost negligent not to consider the All on 4 as the treament of choice in this particular case. I appreciate many reading this will hate me for talking about All on 4's but believe me they work extremely well and patients love them.

When the patient doesn'thave 46,and you cannot see any tooth distal to 15 (notice patient's picture ; thus you won't face aesthetic issues) then why you want to place a fixture in 16 area , without any occlusion , therefore without any efficiency?! unless you intended to place an extra implant in 46. I suggest placing your fixtures in 15,13 and 11 to support a 5 unit separate bridge, the same (21,23 and 25 ) five-unit for upper left quadrant , and a single implant in 26 to oppose lower left first molar.

I have modified a technique by Dr. LeClerq of Paris, to better suit my patients' needs. It is a variation of the thimble crown technique, where the framework is screw retained, but the crowns are cemented individually. This allows for maximum eshtetics, and also individual repair, should a crown fracture or come loose. My website has some examples. denturehope(dot)com Email me if you would like more information.

Great case for discussion! I think staging will be the important factor if you are going to do this with a conventional prosthesis. If the teeth are able to stand a few more months, do the sinuses and the posterior 4 implants first. Once integrated use these and a couple of 3mm minis in the lateral incisor positions to support a transitional prosthesis with partial palatal coverage. At the same time, place implants into the canine and central incisor positions. Once completed you have a traditional "old school" FPD on 8 implants (or 10 depending what the mini's look like) I do Agree that the lower teeth will need attention and from an occlusal standpoint the patient looks to be over-closed so a transitional prosthesis may be helpful in seating the condyles and establishing a proper occlusal scheme. P.S. I would use vital in the sinuses, and a combination of vital and easygraft in in the sockets depending on what the clinical situation is. Hope this helps.

Mike Heads is absolutely right. I know from my own experience that dental surgeons limit the treatment options they offer patients to the ones they can perform or are comfortable with and fail to mention other procedures which they are either unfamiliar with or positively hostile towards (usually quite irrationally). I find this attitude morally and ethically suspect. I get better and more honest advice from motor mechanics regarding my cars.

Dear Dr. If you are going to do large cases like these, definitely get a dental CT scan for the patient to check for sinus pathology and anatomy. If you have no training in sinus lifts, let a specialist do it...for the sake of the patient. I might add, there are techniques utilizing tilted implants. Of course, if you have no training in that, you are doing more a service referring the patient to a surgeon that has the appropriate experience and training to do that. G

Many options suggested. Limited available facts, e.g. ridge width in premolar and molar areas. After ruling out sinus and other pathology, this case could be done using Bicon short implants with Floor Transport sinus grafts for one or two, ideally 6.0x 5.7 mm implants in the molar areas and 4.5 x 6.0 or 5 x 6.0 mm implants in the first bi and cuspid areas. The goal in the sinus floor transport is to select an implant width, 5.0 or 6.0 which can engage the Buccal and Palatal walls and be held in place by a 6 or 7 mm Sinus Lift ("T"-bar) abutment tapped to engage B-L or M-D bone surface in a flush manner. It would be safer to wait for a full denture restoration until uncovering and loading 5-6 months after the bone graft, sinus floor transport, and implant placement appointment. The Sinus Lift abutments hold the Bicon Short implants up into the sinus surrounded by Syntho Graft and the bone heals rapidly into the "fins" of the implants as long as no motion is allowed.