Re: [ACEsthetics] Clinical question on implants # 6-11

John Kois recently said that you do anterior implants for reputation, not profit. They're almost always money losers due to the time involved. 

John Highsmith DDS

Clyde, NC

AACD Accredited Dentist

LVI Clinical Instructor

Diplomate, ICOI

Fellow, Misch Implant Institute

DrHighsmith.com

On May 27, 2013, at 6:14 AM, Guy Moorman wrote:

Arun, naturally my opinion does not match these horses but I have done endo abutments on teeth with adequate ferrule.  I do use the Flex-Flange post placed passively but countersunk into the abutment tooth.  I use the titanium ones for this since there is no threading of the post.  They can be made passive by moving the drill up and down in the prep to a set point.  If there is adequate ferrule, I have used the same bridge.  I did that to my mother on a bridge 5-6-9-10.  She snapped off 9 and 10.  Of course she was 80 when this happened but it was still there when she died at 94 so they can be serviceable.  No ferrule…implants.  I thought with my partner going off for 13 long weekends to learn implant placement we'd be able to cut the price of implants.  He refuses to try one in the anterior.  I'm slowly moving towards sending all to my excellent perio surgeon.

 

Guy W. Moorman, Jr., D.D.S.

The Swamp

Douglas, GA 31533

912-384-7400

 

 

 

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From: acesthetics@googlegroups.com [mailto:acesthetics@googlegroups.com] On Behalf Of ARUN NAYYAR
Sent: Sunday, May 26, 2013 6:17 PM
To: john highsmith
Cc: Rick Coker; Ace
Subject: Re: [ACEsthetics] Clinical question on implants # 6-11

 

LOL:

 

John... that is a brilliant analogy   endo abutment vs implant abutment.

 

I recall years ago a dental school Chair in Germany would not permit his staff to use teeth with endo as abutments for a bridge.   

Then years went by and I was teaching the world about no posts in posterior teeth and there was a huge issue until we did lab research and clinical data that proved they made good abutments.   He invited me to come to his Univ and share the info with his Faculty and they started teaching endo molar teeth as abutments for an fpd.

In retrospect, i believe endo access technics became conservative and cast post almost obsolete.  We stopped teaching a cast post in posterior molars and premolars in 1980!!

 

I still favor an implant as an abutment.

 

Arun

 

 

 

 

 

On Sun, May 26, 2013 at 4:35 PM, john highsmith <johnhighsmith@mac.com> wrote:

OK, what if you have 2 potential bridge abutments (not necessarily 6 and 11, but any bridge) that have endo that looks decent. 

Seems risky either way. The implant is at some risk due to the endo teeth next door. The bridge is risky due to the endo abutments. 

Sometimes you can't win.....

 

 

John Highsmith DDS

Clyde, NC

AACD Accredited Dentist

LVI Clinical Instructor

Diplomate, ICOI

Fellow, Misch Implant Institute

DrHighsmith.com

 

 

 

On May 26, 2013, at 1:53 PM, ARUN NAYYAR wrote:

Thanks Craig and Rick

 

So the input is

 

1.  Implants over endo abutment teeth  

2.  conv and mini implants + Locators/ ERA attachments supported by an interim partial and loaded at 6m

 

Rick... the tissue is the issue!!!   Fortunately she does NOT have a high lip line

So the tx plan will include, implant supported interiam denturem load at 4months with prov,  reshape and buildup the prov and train the tissue from month 4 - 6  for proper proximal and facial contours

 

Arun

 

 

On Sun, May 26, 2013 at 12:51 PM, Rick Coker <riccoker@gmail.com> wrote:

I would probably recommend that you remove the teeth, place four implants- #6, #8, #10,and #11 and place two mini- implants at #7 and #9, and make an immediate removable partial (flipper) with ERA's on the implants. Let the patient wear this for four months, then engage the implants for impressions and make your fixed bridge with those implants. 

 

Of course, you could always just do a immediate partial with transparent clasps. But the endo/buildup/ and fixed bridge method is just fraught with complications and the threat of failure again.

 

Rick

 

On Sun, May 26, 2013 at 11:34 AM, ARUN NAYYAR <arunnayyardmd@gmail.com> wrote:

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

--

Arun Nayyar DMD,MS.  Atlanta, Georgia

 

 

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Dr. Rick Coker, DDS, FACE
Director, Academy of Comprehensive Esthetics
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Arun Nayyar DMD,MS.  Atlanta, Georgia

Private practice limited to Prosthodontics -   Imagix Dental Group

Former Director of Fixed Prosthodontics -     MCG School of Dentistry

Principle Research Scientist ( Adjunct )       @  GaTech -GTRI

Clinical Director -     Center for Dental Technology @ GaTech - GTRI

 

 

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Arun Nayyar DMD,MS.  Atlanta, Georgia

Private practice limited to Prosthodontics -   Imagix Dental Group

Former Director of Fixed Prosthodontics -     MCG School of Dentistry

Principle Research Scientist ( Adjunct )       @  GaTech -GTRI

Clinical Director -     Center for Dental Technology @ GaTech - GTRI

 

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