Full contour zirconia hybrid: are sinus lifts indicated?
Last Updated: May 23, 2016
I have treatment planned this patient for extraction of remaining maxillary teeth and then 6-implants and a full contour zirconia hybrid. Do you think I will need to do bilateral sinus lifts? Should I install the implants at the time of extraction or should I extract the remaining teeth and allow the sites to heal before installing the implants? Do you think I will need bone grafts and if so, which material would you recommend? Any other recommendations for how I could restore the maxillary arch?
12 Comments on Full contour zirconia hybrid: are sinus lifts indicated?
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rsdds
05/24/2016
take a ctscan before committing to this case that's all i can tell you.
Jawdoc
05/24/2016
I think if you even need to ask such questions while wanting to do what uve professed uve supposedly planned to do, uve totally skipped the basics of dentistry, while just rushing ahead to do what u've already decided on. In which case, your question is rhetorical. Overly ambitious & underly- equipped. Apologies. Just my 2 cents' worth. I stand by my statements but I'll also stand corrected if new facts come in.
Izabela Turek
05/24/2016
Hi. Gap filling implantology ( single implants) is completelty different branch of implantology compared to a full arch rehabilitation. It is not simply multiplying the implants and connecting the short spam bridges in to the full arch. Different science happy to full arch prosthetics. You are asking for a big trouble. Remember, placing an implant it is like sighning a marriage certificate with the patient, you need to look after him for the rest of your/his life. Maintaining the complications/repairs , etc will definitely cost you much more than initial patient's fee. You cannot skip the learning curve for the full arch cases before going ahead on your own. My advice- find a centre where full arch cases are being treated on a daily basis then take your patient with you and watch/learn through the whole of his journey.
Yassen Dimitrov
05/24/2016
Wow wow, easy, doc! If I was you, I'd stick to a "classic" Misch approach-you're right, but 7,not 6 implants.
1. Stepped approach- let tissues, heal to get rid of the present infection (Zavyalov's right), don't do any "cowboy" surgery. With the denture, you'll be able to restore VDO, esthetics, everything, and show the patient the new smile, even modify it, if needed.
2. A premaxilla, "too short" for "tilted implants". Therefore- definitely bilatetal sinus lift.
3. Being a Misch fan, I'd restore the upper with implants as follows: 16, 13,11,21,23,26,27.
In position of 27, because 37 needs also an antagonist! And in the upper I prefer to avoid cantilevers.
mwjohnson dds, ms
05/24/2016
it is such a pleasure to see other posters recommending caution. I agree with everyone! This is an extremely difficult case to treat. Monolithic zirconium is not a magic bullet restoration for the novices. Neither is a large full arch implant restoration for beginners. It seems that you want to be both the surgeon and the restorative dentist. Are you fully trained in both specialties? Remember, you will be held to the standards of a specialist in both disciplines. There is a reason for specialists and this is one such case. If you are interested in restoring the fully edentulous individual take lots of courses. Make lots of dentures (restorations are based on denture technology) Learn where the denture teeth go. Understand vertical dimensions, lip support, centric occlusion, excursive movements and the list goes on. That's only the restorative aspect. Then you ask about sinus augmentations. What material will you use, have you thought about angling the implants to avoid sinus procedures? If so, which implant system will you use? What abutment and what angle? How much bone should you remove to have enough interarch space for the restorative material?
As you can see, there's a lot of decisions to be made in treating the fully edentulous patient. Once you can answer all these questions with confidence then you're ready to tackle on of the most difficult restorations in dentistry.
LSDDDS
05/24/2016
Immediate upper denture, reline in 3-6 mos.
Suppose the patient does well?
If not a few locators?
Attachment loss on lower evident.
Full upper might better preserve lower dentition
Why not keep it simple?
Remunetation is seldom worth aggravation.
CRS
05/25/2016
Very well said, I like to rely on my prostodontist for design of the prosthesis, I can pretty much place the implants according to his plan. Sometimes staging the grafting and extractions to allow healing so that the bone is preserved can be done. Fully mounted case with face bow and wax up to determine finish line and vertical dimension. Most importantly enough room for the fixture planned, lip support and speech. These are done in several steps with periods of provisionalization. The disease also has to be removed. Complex case. If you want to fly the big jets a good copilot and flight plan needed, otherwise it will crash and burn✈ï¸ðŸ’¥âœˆï¸
Alex Zavyalov
05/25/2016
Colleagues,
Please follow the Comment Guidelines and refrain from posting your comments if the only reason for commenting on clinical cases is just your desire to criticize someone and act as a mentor. Add value which can be helpful practically. Skip the case if you do not have something to say related to the post description.
CRS
05/26/2016
Okay If someone gets hurt by constructive criticism and good advice that may keep them and an innocent patient out of trouble it I feel it should be posted. Just because a poster thinks they can handle a complex case does not mean they should. If their feelings are hurt by facts then I think that the practice of implant dentistry may be too much for them emotionally. Now read the posts although very descriptive the truth is there, good judgement and knowledge of limitations is very important and wise not shaming. A certain amount of maturity and judgement is required that's what our patients expect and trust us to do. When I am unsure if a treatment I listen to my colleagues advice, all I care about are the facts not the delivery. I can separate my feelings. I have shortcomings in certain techniques so I refer for the best interest of the patient. I see a lot of mishandled cases and untoward results that I get to fix. I would rather see it done right the first time. Unfortunately I feel that there are a lot of mentors that are not truly honest which really does not help the situation. In medicine, residents and attendings get consultations, weigh the facts and advice and thru judgement and reasoning formulate a plan. In dentistry it seems to be different since this process is not taught. Dentists tend to be critical and judge mental, myself included. We are in the Wild West of dentistry now, time will tell as more of these stretch cases surface, trying to avoid referral to the appropriate practioners. At least the case was posted for advice. I do care. Thanks for reading.
A
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Jim
05/25/2016
Just a quick comment.....if you have to ask so many detailed questions about the case and don't already know the answers, it would be best to refer to a specialist.
mwjohnson dds, ms
05/26/2016
Well said CRS. A. Z. Doesn't want mentoring by responders yet that's exactly what posters are asking for. If we keep our patients best interests at heart then honesty about the difficulty of some cases is absolutely warranted. That's how we keep newer practitioners out of trouble until they gain experience to handle more challenging treatment
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Alex Zavyalov
05/24/2016