Planning hybrid on 4 implants?

I treatment planned a patient for an implant supported fixed detachable prosthesis [hybrid] in the maxilla.  I originally planned for 5-6 implants spaced around the arch.  During implant installation, I was only able to place 4 BioHorizon 3.4/9 implants in the #5, 9, 11 and 12 sites sites because of bone deficiency in th maxillary right anterior.  Will these 4 implants be able to support a hybrid?  I would also like to cantilever the first molars and second premolars.  Or should I do bone augmentation in the maxillary anterior and place additional implants?

4 thoughts on “Planning hybrid on 4 implants?

  1. carlos boudet says:

    There are guidelines and protocols established to allow predictable success in treatment planning an implant supported hybrid, and I do not think that you have followed any in this case.
    I think anyone will tell you that four small diameter 9MM implants are not adequate to support a full arch hybrid in the maxilla, much less cantilevering to the molar region.
    You had the advantage of a CT scan to treatment plan the case and you did not use it properly.
    I would suggest that you utilize one of the companies that help you treatment plan a CT guided case, and this will allow you to tap into their experience while treatment planning and learn how to do these cases at the same time.
    I would also suggest using a CT derived surgical guide and do a few cases guided. These larger cases have easier surgery that way.
    I do not want to sound harsh in any way, but just because you can place implants in the bone, does not mean that you are prepared to do cases like this. For the sake of your patients, you should get some training if you plan to do these cases.
    Good Luck,

  2. Ana Mateos says:

    I understand that the primary goal was to make a hybrid prosthesis, but just for the sake of thinking outside the box…it might be feasable to make a removable implant supported prosthesis instead. This prosthetic option allows you to have mucosal support while gaining retention from the implants, avoiding more grafting.
    Treatment planing is a complicated process, and 4 implants for cantilevering molars and premolars is extremely risky. The All-on-4 tecnique by Nobel requieres longer and regular platform implants, and they are placed at a 30-45 degree angulations. These have the added expense of multiunit abutments. Even on those type of prosthesis I would not cantilever a full molar.

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