Long term Stability of Cantilevered Bridge on Implants in Maxillary Posterior?

I have a patient with a narrow maxillary ridge in maxillary left first premolar, second premolar and first molar areas.  In order to place implants in the first and second premolar sites, I will need to do a ridge split.  In the first molar site, there is only about 2mm of vertical bone height.  I would like to do a sinus lift in the first molar site in order to place the implant, but the patient has declined.  As an alternate treatment plan, I am thinking of making a 3-unit implant bridge with the first molar cantilevered off the splinted premolars.  I have never done this before.  What would you recommend?

14 thoughts on: Long term Stability of Cantilevered Bridge on Implants in Maxillary Posterior?

  1. Craig Wright says:

    If your house is on fire, you call the fire department first to put out the fire. Then you call in the remodeling contractor! It seems like there is much before implants or replacements are done. In any event, it is unwise to cantilever a distal molar! IMO

  2. Kaz Zymantas says:

    Craig is correct. Get his mouth as disease free before you proceed with implants. It would be highly contraindicated to have a cantilevered molar off of 2 anterior implants.

  3. michael Pollak says:

    Agree with above posts. Implants should only be considered once the patient’s caries, perio and removal of hopeless teeth has occurred. Don’t have the full mouth series to evaluate, but based on above radiograph, Pt. has a lot of dental issues to address. As well his medical history/age/financial situations are unknown to us, and would affect the type of treatments proposed.The type of opposing restoration/prosthesis planned will also impact your treatment plan. I think a small premolar sized pontic could be cantilevered from two premolars, provided the opposing occlusion is adjusted to minimize forces on the distal cantilever, if another implant supported bridge is considered (or is an RPD). Good luck with this case.

  4. WJ Starck DDS says:

    Another option would be to replace #15 with an implant, either as an immediate placement or secondarily after a socket preservation graft. Then you could fabricate a 3 unit bridge from #13-15 (after placing an implant #13 of course), then replace #12 with an implant/crown, or, if money is an issue, cantilever a pontic anteriorly to replace #12

  5. Matthew Watson says:

    Your patient has a train wreck at work. How about simplify the case and place the 2 implants then restore as a premolars and a molar. Then do same on lower and give him/her less to maintain yet have 1st molar occlusion.. for future possibility, remove 15 and graft some bone in the sinus area using a membrane and allograft along with some prf if you are using the technique. Hopefully your patient is ready to do their homework . Good luck!

  6. Michael says:

    A cantilevered 1st molar off of 2 natural, osseo-compromised teeth would be a horrible idea. Off of 2 implants? Don’t even think about it.

  7. Prof. Dr. Peker Sandalli says:

    I have inserted may be thousand small diameter implants (SDI) they are very successful. Please use 2.2; 2.5; 2.9 and 3.0 mm width 2 SDI one piece implants from OCO BIOMEDICAL at the region of the premolar teeth, and save left second molar tooth with root canal treatment or extract and insert a screw cylindirical 2 phase implant with the immediate technic. A bridge on the implants will be perfect. Have a good case.

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