Screw retained hybrid bridge or PFM crown and bridge?

i recommend u extract the remaining natural teeth & insert implants one in place of the R.premolar and one in place of left premolars and construct a fixed prosthesis for the full lower>>> good luck

It seems to me that the dentist did not initially have a clear prosthetic treatment plan; otherwise, the implants should have been shifted more distally to molar area to equilibrate mastication forces.

I like the idea of PFM/Implant Crowns and Bridges because it'll work as is and simpler to do given what you have to work with. To do a hybrid prosthesis, you're going to need additional space for the metal framework which you may not have, since you already placed your implants.

As far as the lower job, I suggest you make 2 telescope copings on 47 + 37, extract 43,34+35, no need for them (43 is too vestibular and will affect aesthetics)and they can complicate things in the future, then make a full lower pfm bridge 37 till 47 and done. I think these extractions are going to be easy, proof that those teeth will offer little or no additional support, rather rely on the integrated implants than risk including what looks like amalgam reconstructions with little or no root support. As far as the uppers, I would start by making a temporary bridge to splint them... also a removable partial denture with correct VD, then see if splinting the teeth and completing occlusion worked before deciding final upper job. if you place single unit crowns as is they will not last for sure.

Very simple, wax up the case and determine where your bridgework will be, remove the natural teeth place the implants between #20-21 leave Them buried and temp the integrated implants. The natural teeth have short roots and are failing. When the second implants are integrated then add them to the temps. Let the patient sit in good temps, then remove the third molars and possible place 1st molar maxillary implants with lifts. Single crowns. I think you have to plan for the maxillary teeth to fail in future. The most important thing is a good surgical guide, it will save you.

Extract all the natural teeth in the mandible and consider placement of immediate implants at the molar extraction sites and restore with a full arch prosthesis. I prefer screw retained but could be dont with cemented. this will allow you to do sinus augmentation bilaterally and place two implants bilaterally

I have a doubt. For those colleges who suggest inserting implants in posterior sides and a full arch restoration. What about the flexion of the mandible bone? I remeber reading in Misch book that mandibular bone flexion when opening movements could affect integration if using a full arch prosthesis.

I see as if you do a screw retained hybird bridge is ok for if u leave teeth between implant it is ok because it is not contrary forthe tooth hasphysiological mobility and it is better than porcelain free/with metal about maintenence of implant, bone and soft tissue so the loadind bearing implant will be less so i see good option. thanks

Sometimes we need to revisit the basics and take a second look at our treatment plans. Radio-graphically this patient has moderate to advanced periodontal disease with obvious subgingival calculus. Initial evaluation should always include the periodontal stability of the natural teeth. With this, and other information, a comprehensive treatment plan can be designed. In other words, the long term suitability of the natural teeth should have been evaluated before the implants were placed. This evaluation may have dictated some different positions for the implants.

if crown height space is 8-10mm and everything else is wnl, i would approach this case like this 1- ext 21 22 27 and immidiate place implants 2- torque in abutments or posts modify or grind in mouth to achieve parallelism. 3-make a chairside temp and place pt in soft diet for 3 months. 4- after 3 months if everything is ok proceed and make a conventional pfm round house bridge you should be able to cantilever to the first molar. then worry about extracting 17 and 32... i take a cbct for all my cases

you should do a full wax up to see verticle dimension, and the size of the teeth which will give you the ultimate idea as to what type of restoration to use. The implant placement will also have an affect on the type of restoration.

Remove mandibular teeth ...make a roundhouse bridge on the implants. Mandibular flexion due to the ansiotropic nature of mandible.. where distal stresses are produced during opening as the condyles move towards each other, are minimal for this span of bridge. As and when upper posterior teeth are restored then add independent molar mandibular implant restorations. Implant dentistry should be a prosthetic discipline with a surgical component,this planning is coming too late

Extract the lower natural teeth, place more implants and restore with two or three bridges.

What´s wrong with placing a single extra implant in the lower left central region and 2x 6 unit cement retained pfm bridges 6-1 and 1-6? (obviously after extracting all of the lower the natural teeth). You can just do a screw retained temp directly fabricated on titanium tubes for now. Graft the sockets when you take the teeth out leave for 3 months then restore.

At the risk of sounding like a dental school professor, I would like to suggest something. We all know that implantology should be a prosthetic procedure with a surgical component, but we keep getting cases posted where the implants have been placed and the question is asked, how do I proceed or what are my options? I think that this case should have had the implants placed with the final prosthesis in mind (and there are several ways to restore this). By keeping the teeth you complicate the restoration, and since you already did endo on the remaining teeth it would be difficult to justify to the patient that now you want to extract them and make a totally implant borne prosthesis. Better presurgical planning could have avoided this. This is the constructive criticism that I would like to share. I am sure your case will turn out great. Good luck!