Opinion in Off Occlusion Cantilevers in Immediate Load in All on 5 cases?

Last Updated August 06, 2018

Not too long ago, I was I able to finish my very first All-on-5 case, in which two implants in areas #26 and 28 were placed four months prior before placement of 3 subsequent implants in the area of 20, 23 and 24. Upon conversion of the immediate lower denture to a temporary bridge, I left 2 teeth cantilevered in the area 29/30 knowing the fact that implants were nicely integrated in areas #26 and 28, and only one tooth in the area #19. Although I was aware of the fact that cantilevers in the temporary prosthesis can lead to the fractures of the prosthesis, I had to make sure that all cantilevered areas remained in hypoocclusion. I was wondering if someone could share their opinion on leaving cantilevers out of occlusion (by 1mm) just like we do in immediate temporization techniques for single unit implants. I also know that NobelBiocare discourages leaving cantilevers according to their All-on-4 protocol, yet their scholar Dr Steven Bongard in his educational All-on-4 treatment concept clinical case video leaves at least one to two teeth in cantilevers on each side. Please note that I used 13mm NP and RP Nobel Replace CC Implants that torqued over 45Ncm in placement of implants #20, 23 and 24. What are your views and what do you recommend? Your expertise in this matter is greatly appreciated.

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