Implant Placement on Class III Occlusion with 5mm thickness bone: suggestions?

I have a young lady with Class III Occlusion and approximately 5.15mm thickness of bone buccal-lingually. She is missing teeth 7,8,9 and 10. I want to make a her a Hybrid restoration supported by 2 implants at sites 7 and 10. Would you recommend a Bar to support this restoration? I have attached the CT scan. I definitely do not want to place individual crowns with implants 7,8,9 and 10 due to severe angulation of abutment and high potential of either implant failure or persistent abutment screw fracture. Any suggestions? Thanks.

21 thoughts on: Implant Placement on Class III Occlusion with 5mm thickness bone: suggestions?

  1. Montana says:

    Inter-arch space for removable is probably inadequate and you certainly want to avoid resilient attachments as they are relatively large and will suffer overload from the opposing dentition. Telescopic bar design is nice and you can include a lingual press-pin attachment, but again space may be an issue. Out of the box would be a fixed bridge with a detachable gingival mask, allowing proper hygiene when the mask is removed.

    Obviously grafting the site would improve your outcome but it’s a challenge and a half. If you are trying to place without grafting, then split ridge is an option, but your best sites for placement are the lateral incisors, which is also the worst site to split as the adjacent canines complicate the procedure.

  2. Ken Moylan says:

    Canine to canine fixed bridge…should be good for 20 years. I place a lot of implants but sometimes they are not the best option.

  3. Anon

    I did consider ridge splitting but the canine concerns me and I did offer to refer her to an Oral Surgeon for block grafting since I dont do that in my practice, but she declined. You guys bring up a good point about limited interarch space for hybrid restoration. The traditional fixed bridge quite honestly did not even cross my mind even though Ive placed many in the past!!

  4. Stephen Cave says:

    The right dental lab can make a very esthetic bridge in a ridge deficient case with the use of well matched gingiva colored porcelain. Ask me how i know!

  5. Stephen Cave says:

    We have used gingival colored porcelain in anterior implant supported bridges to aid in eliminating triangles and long anterior teeth.

  6. MJFDDS says:

    Maybe start with some ortho and retract the mandibular anteriors to eliminate some of the class III relationship? Looks like there is some space to do so?

  7. Anon

    Any of you have used the Versah/Densah osseodensification burs?If so, have you been happy with results?
    Looking to expand about 2mms. Ideally would like to place 4.1mm diameter implants but may just place 3.7mm. . thanks

  8. Peker Sandalli says:

    I think the best solution as to me to insert 2 implants lateral incisors, I prefer OCO BIOMEDICAL one piece 3 mm width mini implant, and to do a bridge between two canine teeth.

  9. Alejandro Berg says:

    As usual i would say. First design your prosthesis, after that, models and scan them, plan everything digitally and get a guide, a good one (paltop ultra precise is my choice) and then you can get everything, i mean personalized abutments and or healing caps, temporary if needed…… And you will know how much and where to graft.
    Best of luck

  10. Dr. Mario says:

    I think the best would be to do a bone block augmentation. Just mention to her what are the options available, I am she will appreciate the option to have a nice and aesthetic work. This option would not be the cheapest or easier but it will depend hat are her needs and expectations of this dental work.

  11. Peter Fairbairn says:

    Protocols and materials have moved on and with a more minimally invasive approach . Have numerous cases with half that width and use expansion place a 3.25 mm implant , graft with a stable synthetic and load at 10 weeks no need for soft tissue grafting as the improved new host bone will lead to improved keratinised tissue …. Have a nice case I may post here , who came over from NY with only 1 mm , did not want any donor site issues and a very high lip line . Just followed usual protocol and have great outcome . Now loaded 2 years and perfect as very demanding lady . New osteo-inductive synthetics seem to help , biology over carpentry , I guess

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