How to rehabilitate the maxillary arch?

As Usual this is a compromise case .......... the question is a lot more complicated ....... the lowers ? how much do the want to spend etc etc What I use often in these cases is a 5 to 5 format , so place two implants in the second premolar area and restore with molar sized teeth . Then you look into the lower left , and one implant there ..then lower right second premolar But the case is fund dependant .. Hygiene treatment Finally an cosmetic look at things

Global tx plan goals ? Aesthetic ? Function? Perio ? Cost ? Demands of patient ? This could be a double all-on-4, a prostho-implant-perio full mouth case also...

Full upper and lower dentures. Implant supported or not.

Mx - fix the periodontal problems. Crowns of incisors looks abrased. Needs estetic correction. No problem for patient to prepare for splint bridge with cantilever on 15,25. No more antagonists in lower jaw. Mandib. extract 32,31,41,42 may be 33, 36,46. Periodontally treat the rest of teeth, after extractions (minimum 1 month - the time for periotherapy) prepare teeth for split bridge with cantilever or not depending to correspondent with upper. Good hygiene ant 10 years waranty. Than will time for implants

Full mouth extractions, dentures supported with locators. Easiest to maintain low risk.

I personally would do all on 4 upper and lower. The patient has severe perio. I would be thinking long term. If you put three implants on the maxilla after sinus lifting both sides and restoring it, that will be a lot of money if those front teeth are going to be lost. Remember people are living longer. So this person may live to 100. That's 40 more years! As long as they have no major health issues and you emphasize the importance of waterpicking etc around the implants, you could probably fit all 4 on the upper in front of the sinuses and avoid doing the bilateral lift (I would have to see at CT). Present it as a health rejuvination. I guarantee you will change this person's life for the better forever and they will refer you many more baby boomers that are going to need this sort of treatment. Just make sure you work with a good lab and you get a bone reduction guide, etc. Good luck!

Initially perio surgery/weekly hygienist and OH instruction. Then: Telescopic preps with gold copings and a metal accrylic/composite prosthesis. This needs to be removable for OH maintenance. When jiggling forces from individual teeth are removed and they are splinted with a removable bridge the increase in individual tooth stability is remarkable. Implants should be left as last resort.

Agree with most comments :-) Many thanks for sharing the dilemma we all come across. This periodontal condition is gross, advances and difficult to manage. Emphasise on eradicating any risk factors like smoking and poor oral hygiene and consider full clearance and upper and lower all-on-4 or 6 with stringent oral hygiene regime and regular reviews. May consider more than 4 implants on both upper and Lower, especially lower considering great bone volume. Plan ahead with three dimensional analysis of bone with CT Scan. On uppers, 4-5 implants within existing bone, with angulated distal implants are far more appealing than three implants with bilateral sinus lifts both to control stability on the long term and esthetics on the immediate short term. Key for success is patient motivation, regular reviews and adequate hygiene around 'all-on-4 or more' prosthesis.

Upper on 6 and lower on 4 locators make this case easy and affordable.

Maxillary metal to valplast with perio cleanup and ext 19 and 30

Important to listen to the patients requirements and not impose an idealised plan. The patient is complaining of an inability to chew and it could be considered to be inappropriate to extract any teeth other than the grossly decayed lower right molar. If you advise a clearance and things go wrong you might be asked to justify you TP I would be conservative and get the OH and perio right and then replace posterior teeth, preferably with implants if funds permit.

No brainer. All on 4 top/bottom acrylic with multiunit abutments; Group function implant protected occlusion. Use Versah burs. Easy. Next question?

It's difficult to understand the periodontal situation without a full rx and the amount of bone avalaible without a cbct.All on four is a radical treatment but we must consider more options when the patient has some safe teeth.In the upper jaw maybe could be possible treating just the distal areas with tilted implants,and in the lower jaw saving canins and premolars implants in the molar area....

You mentioned nothing about the teeth mobility. I have seen many times when X rays do not correlate with clinical situation. Probably, some of the teeth might be salvageable to avoid their full extraction.