Patient placed implants 7 years ago: restore this case?

Due to the anglation screw retained would be difficult perhaps an angled abutment to correct this. I suspect they were placed this way due to the angled third molar. I give you permission to restore, the patient was happily chewing a way on the healing posts for the last seven years. It is what it is!

You can have custom milled abutments made and cement the case.

Hi, the platform is too high for screw retained. Like Dr. Hughes mentioned, or stock abutments probably 15* prepped to be parallel impression and crown and bridge (3d year dental school) At NYU we thought solution for situation "KISS" I kiss it every time have situation cheers mike

As a lab guy, I would custom mill abutments to give you the best results. Custom milled abutments (depending on your lab) can be similar in price to your stock abutments and it is made specifically for that patient. With where it is located, you should be able to use either a screw retained zirconia restoration or cement retained restoration. All you will need to send this case to your lab for restoration is the impression copings. Communication with your lab would be helpful on this case. Call your lab to see if they can custom mill your abutments. If they can not, and you need further help, contact me at 678-639-0185. Good Luck -Jason

To add to my above comment, Nobel Biocare is one of the nations most used systems. I am sure someone close by would have the wrenches for that system. If you do not have the tools for the case, contact your local Nobel rep or your referring OMS and see if they could let you borrow the Nobel biocare tools for this case. Good luck, -Jason

Dr Shulman is right. Keep it simple. A stock angled or custom milles abutments can save a lot of implant cases. Don't critique the surgeon. Sometimes simple cases are not so simple.

I agree with the above comments. The case can be restored, but I'd consider tying the restorations together since the #19 implant should have been a wider platform as the platform width used can present increased risk of fixture fracture or abutment screw loosening due to overload. While I agree that we should refrain from criticizing the surgeon, since none of us were there, I think it is fair to point out as a learning exercise for the betterment of all of us that mistakes were made (likely from lack of experience) in this case that resulted in a suboptimal outcome for this patient: 1) The third molar is tipped mesially and should have been extracted prior to implant placement. This would have allowed the surgeon to place a more appropriate wide platform implant in the #19 position 2) I think it's fairly evident that no surgical guide was used and the tipped #17 misled the surgeon into placing these implants on the incorrect axis That's all. Happy implanting!

Go online or call Implant Direct. They sell what they call a "lab abutment" compatible with the standard Nobel tri-lobe connection. They are solid titanium. Order two of them, they are $80. They fit perfectly. Have your lab prep or "mill" them so they will draw appropriately and then cement the restoration of your choice. They have a two millimeter flare for a good emergence profile and the margin of the abutment can be placed just at the gingiva to avoid any cement entrapment.

One more thing. Contact Salvin. They have nobel wrenches to fit any torque driver for about $25. These days with so many systems out there you just have to start accumulating stuff in your tool box so that you can accommodate these patients

It is hard to give good advice based on this X-ray. I think it looks like that there is not much space to make two crowns (one premolar and one molar ) fitting in this available space. Clearly the implants are tipped forward but the question is how is the angle of implants to each other? Are they relatively parallel or not? The implants looks parallel on the Sagittal plan but what about the Coronal plan? 1- If they are parallel and there is generally no difficulty in the path of insertion for abutments , then my suggestion is to use Implant Direct - Replant System Fixture mounts . They have Trilobe connections and you can make two crowns (linked ?) on these two implants. 2- If the implants are not parallel( and you want to fit two linked crowns) then you need to have one of the abutments as non-engaging abutment. Just cut the engagement lock on one of the abutments or just buy a non-engaging abutment ( leave the other abutment as it is ). Remember the choice of the abutment must be done on the stone model and not in the patient mouth. To get less problem with path of insertion maybe it is worth to make a smooth plan on the distal side of second premolar and mesial surface of second molar.