Immediate implants and retained over-denture: advice?
Pt presents with unrestorable fractured anterior (8-11) maxillary bridge and wishes to extract remaining teeth and have maxillary denture. Pt understands that his mandibular arch with also need treatment but wants to address his maxillary arch first due to his inability to smile. Pt still given treatment plan for mandibular arch. The mandibular arch will be restorations, ext’s, and partial denture and in the distant future implant retained over-denture(locators). For maxillary arch, Pt presented with tx plans: (1.) full arch maxillary ext and immediate denture. (2.) Full arch ext with immediate denture w/ placement of implants (delayed) and implant retained over-denture. (locators- RT-x) 3. 9-11 implant bridge. CBCT scan taken prior to tx plan presentation to make sure patient is candidate for implants. Pt chose option 1. Pt only has high blood pressure(controlled), non smoker, non-diabetic. 65yrs old.
First I have to say this is definitely not my first rode on placing and restoring implants(especially over-dentures). My practice patient base is 90% dentures and implants.(think general dentist doing prostho and placing implants that are within my skill level. I have a wonderful surgeon for the more difficult cases) I have probably successfully treated over 200+ over-denture patients and I have developed a system that I love and is very predictable. I am no expert but I am no novice either. I have placed implants immediate and delayed, but never done full arch immediate with so many extraction sockets and I worry about maxillary resorption.
My maxillary sequence is usually to take CBCT and not promise patients implants until I have extracted the teeth and determined whether I would need bone grafting of not. I wait about 6 months and then take Dual CBCT scans with patients denture to determine position of implants and then either freehand or 3D print my own guides using blue-sky. My implants or choice are Nobel Biocare or Megagen.
My question on this patient is… after looking at the the CBCT, I like the positioning of the patient’s maxillary teeth(centered within ridge, for possible immediate extraction and placement of five or six dental implants for immediate denture and then over denture. I have reviewed a fair amount of literature and it does not address the grafting of adjacent extraction sockets. I would assume that grafting would include jump gaps as well as adjacent sockets and then coverage with cytoplast or membrane of choice (which I have used many times before)? Literature also suggests that maxillary bone tends to resorb more than mandibular bone. If you were performing this case, would you immediately place and would you graft adjacent extraction sockets? My post-op will be to leave denture out for 4-6 weeks regardless. Thank You very much for reading all of this and would welcome your advice.
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