Restorative options for implant retained prosthesis for partially edentulous maxilla?
I have a 58 year old male patient in excellent health who presents with a failed 8-unit maxillary fixed partial denture that originally extended from #5 to #12 and was supported on natural tooth abutments #5, 7,11,12 (maxillary right first premolar, maxillary right lateral incisor, maxillary left canine, maxillary left first premolar ; 14, 12, 23,24). I had to remove the fixed partial denture and extract #7 and #11. #5 and #12 have been endodontically treated. What kind of restorative options do you recommend? I could do single crowns on the remaining #5 and 12 and then place implants to support a fixed partial denture from #6 to #11? What do you recommend?
(click image to enlarge)
![]implant retained prosthesis](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/05/sn-case-px-e1336330706240.jpg)
11 Comments on Restorative options for implant retained prosthesis for partially edentulous maxilla?
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Leal
5/7/2012
My recommendation:
single crowns on 24, 25, 27, 14, 17
Implants:
26 -> 5mm wide + summers sinus lift
15 + 16 with lateral aproach sinus lift
13 + 23 + 21 + 11
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Not my recommendation:
PFM bridge 14 elements on the five teeth remaining
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Would also do it:
PFM bridge on 17 - 14; 14 - 15 - 17
implants on 13 + 23 + 21 + 11
Good luck.
gerald rudick
5/8/2012
From the two dimensional panorex film, it seems that there is a good probability that implants would do well.
I would make the patient a removable treatment partial denture; repair and graft the bone; when the grafts are mature, place the implants....take your time.
Barry Franzen
5/8/2012
Consider a Radica Provisional on remaining teeth. Prep teeth and retrofit the Radica provisional. Place implants and stage treatment. You can prep the remaining teeth and add what ever implants you want with a fixed provisional. Extract additional teeth if necessary and add implants while modifying the provisional. A fixed provisional gives you stability and the queability to evaluate the final prosthesis on a modifiable form. Great esthetics. No removable provisional. You can utilize guided surgery for placement and the Radica is radiopaque.
Mike S
5/8/2012
Likely that you've lost ridge width from resorption, bringing the buccal inward. You may still have height but need to augment the buccal. Ridge-mapping or CBCT will be helpful. Beware of high smile line for aesthetics. Good luck.
Dr teeth
5/8/2012
All good ideas. The radica fixed temps is a nice way to see where you need to place your implants and the 3D bone volme you need to do it.
Tooth 14 does not look so good, I would not use it for a bridge, and maybe remove it later, once the implants are all in and ready to go.
rana
5/8/2012
I have recently extracted teeth # 23 and 12 and grafted the sockets with allograft.
For some reason the tomo images do not upload into the website. My concern is the lack of labial bulk of bone. What is the thinnest implant and what brand should I use?
Theodore Grossman DMD
5/8/2012
CYA...get a CBCT immediately...
David Nelson DDS
5/9/2012
Ext #5 Immediate implant, implant at #4,Implant #6 #11. Mini implants in the anterior (2-4 implants)to help retain the temp partial - keep or cut them off later. Cantalever distal for #3 fpd on implants 4,5,6,11. FPD #13-#15, single crowns on #2 and #12. Did a case almost exactly like this, with mini implants, the temp partial is stable and although I rarely do it you can incorporate them in your final prosthesis. Dr. Gordon C. likes doing this, but I wouldn't make it a common practice. Best of luck.
Frank Avason
5/9/2012
I would start with a diagnostic waxup of his upper arch. Granted you have 5 solid remaining max teeth, but it appears from the PAN you have had supereruption of his mand anterior teeth. How does that play into your restoration of his upper arch? What is his lip line? How much teeth does he currently show in full smile? What have you provisionally replaced his lost anterior teeth with? Many questions need to be evaluated prior to the surgical phase. IMO, it's best to look at him from a restorative aspect to evaluate his surgical options... Hope this helps.
Richard Hughes, DDS, FAAI
5/10/2012
Dr Avason, gave excellent advice. A classic work up is the way to proceed ( study models, face bow transfer, try in, surgical guide etc.)
Seth Rosen
5/16/2012
Dr. Avason is dead on. Don't jump in until you have a clear idea of the restorative options. I have done tons of these that look so different in the mouth from the bench top. I usually will have a wax up done and a sit down with the lab. Always get your estimate lab fees too, had one that I almost stroked when I saw the lab bill ($12,000!!!!).
