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Treatment Plan for Fixed Partial Dentures?

Last Updated: Dec 07, 2009

Anon. asks:

I have a 70 year old female patient in excellent health missing #6-11 [maxillary right canine to maxillary left canine]. She has a heavy bite and fractured the natural teeth supporting two bridges from #6-8 and #9-11 [maxillary right canine to maxillary right central incisor and maxillary left central incisor to maxillary left canine]. I anticipate a problem with porcelain fracture because of her heavy bite and history of fracturing her prior bridges. My treatment plan is for free standing maxillary canines with UCLA type PFMs and a bridge from #7 -10 with abutments in #7 and 10 sites [maxillary right lateral incisor and maxillary left lateral incisor] with two pontics replacing the maxillary central incisors. I plan to use Nobel Biocare Groovy Regular Platform tapered. These would also be UCLA type PFMs. I would appreciate some input regarding my treatment plan.

2 Comments on Treatment Plan for Fixed Partial Dentures?

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bandito

12/8/2009

First you need a CBCT to assess the bone volume. Second we would need to know where most contact is in CR, CO as well as excursive contacts. Most times it is reasonable to do 4 fixtures to support the 6 teeth. However, where to place these is dependent on above conditions. I would consider placement at 6,8,9 and 11 and also consider wider platform for 8,9 if biotype and bone indicate it. If bone or nasopalatine canal doesn't permit it then consider lateral incisor positions. I personally would be hesitant to do a four unit bridge on fixtures at 7,10 in the type patient you describe. If you are able to get 6,8,9 and 11 then options for a six unit fused prosthesis versus two 3 unit bridges exists. That decision is dependent on bone/length,diameter of implants.

Dr. T

12/9/2009

I think well design posterior and anterior occlusal schemes to protect the anterior implants and fixed bridges are essential to the long term success of the case besides sufficient solid bone volume. In fact, I'd like the idea of having #6, and #11 as a free standing. However, the two implants don't have to be at the #7, and #10 position. They can also be placed at #8 & #9, #7 & #9, or #8 & #10 positions. Cantiliver bridges will be as good as fixed bridges as long as the implants are anchored in solid bones.

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