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.RickOn 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 abutmentsShe has 4 abutments, #6,8,10 and 11I 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 yearsSO here is the QA 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 FPDOrQ2: Extract roots, pack bone, do immediate implants placement, immediate or delayed loadingAnd do SIX individual implants /crowns ( with guided surgery )ORQ3 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 inputBiggest Q is that before implants, the only choice was to endo, core and a FPD. Today we have the option of implant supported prosthesisWe also know the ROI and long term value for the patient favors implants4 endo + core + FPD vs 4 implants + FPD. vs 6 implants and 6 individual crownsThank youArun--
Arun Nayyar DMD,MS. Atlanta, Georgia
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--
Dr. Rick Coker, DDS, FACE
Director, Academy of Comprehensive Esthetics
www.tyler-smiles.com, www.tylersleep.com
http://www.google.com/profiles/riccoker.
903-581-1777
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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