[ACEsthetics] Clinical question on implants # 6-11

This morning a patient called and said she had snapped her anterior bridge off at tissue height. 

He denied any trauma... i think she bit into something hard with enogh force to snap the abutments.

No pulpal exposure!!! on any of the 4 abutments

She has 4 abutments,  #6,8,10 and 11

I made the prosthesis as a part of a recon some 15years ago.  

She wears a bite guard and is v compliant with 3 m recalls. 

 All the other 22 restorations are doing well at 15 years

SO here is the Q  

 A intelligent patient... well read and does her due diligence.  

Q1    Do endo on 4 abutment teeth, then posts, surgical crown lengthening and a 6 unit 4 abutment FPD

Or 

Q2:    Extract roots, pack bone, do immediate implants placement, immediate or delayed loading 

          And do SIX  individual implants /crowns   ( with guided surgery )

OR

Q3     Extract roots, pack bone, do immediate implants placement, immediate or delayed loading 
          And place THREE or  FOUR  implants and make a 6 unit splinted prosthesis.   ( with guided surgery )

Interestingly when we consider 4 endo, surgical cr lengthening, 4 cores + a 6 unit prosthesis over implants

 . the implants provide a longer clinical life and will be expedient and cost a few more $$

As I debate this in my own mind,  I reach out to you for input

Biggest Q is that before implants,  the only choice was to endo, core and a FPD.  Today we have the option of  implant supported prosthesis

We also know the ROI and long term value for the patient favors implants

4 endo + core + FPD  vs  4 implants +  FPD.  vs    6 implants and 6 individual crowns 

 Thank you

Arun

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Arun Nayyar DMD,MS.  Atlanta, Georgia

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