Looking for some advice on an implant supported bridge

[Brett Hansen CDT]

A doc called me today and wants to know the best way to proceed. The patient has 5 Zimmer implants(with abutments and crowns) at 19,20,28,29, and 30. The patient is currently wearing a flipper to fill the anterior space between the crowns. She is wearing a full upper denture. The patient hates the flipper and wants to use the implants she currently has to restore her mandible with an 11 unit bridge.

How many implants would you advise the doctor use for this bridge? I was thinking that 19,20,28, and 30. Would any of you advise using fewer implants or different sites?

What do you put in the unused implants?

 

[TheLabGuy]

I'd be worried that this patient has an anterior bite. Therefore without some sort of implant support anteriorly (8 and 9 possibly) you will be creating a teeter-totter for this patient if you just use the posterior. Possibly creating a dehiscence of the current posterior integrated implants. I'd be more comfortable doing fixed on the posterior only and creating a RPD (maybe horseshoe palate) for that anterior and using that fixed work for retention of the RPD...or as Carl Misch calls it an RP-5. Let us know what you come up with

 

[Brett Hansen CDT]

Good point Rob. Do you think the fact that the patient is in a full upper denture that this will lessen problems created by not having an anterior implant?

 

[TheLabGuy]

Good point Rob. Do you think the fact that the patient is in a full upper denture that this will lessen problems created by not having an anterior implant?

Sure, the muscles may be use to a more balanced occlusion. I'd be interested in seeing the denture (looking for wear, slides, parafunction). Since the patient is already in a denture I would see if the patient would comply to have a palateless overdenture made with the implants all splinted together with metal.




Many ways to go here, but to truly answer your initial question I think we need more information.

 

[rhicks3302]

Pictures of mounted casts would be give a better idea of what you're up against. What are the diameter of the implants? Whatever you decide, use all the implants. Why not?

at least 1 anterior implant would be nice. That's a pretty sizable anterior space/anterior cantilever. Some would also be concerned with mandibular flexure if the implants were all connected, depending on who you're talking to.

I agree with Rob. The old denture is a smokin' gun. Check out that current denture for old fractures and gross wear. That will give you some idea of the parafunction involved if any and what you can get away with.

Agree. Lots of options here. From an attachments retained overdenture (RP5),Bar-supported overdenture (RP4). Screw-retained Fixed hybrid (FP3). Conventional cement retained implant bridge. More info needed.

I'm curious about the implant crowns and 'a flipper'?

Bob Hicks

 

[Scuff75]

I agree with the previous posts, really need to see the arch form and the distance of the anterior span in relation to the implants. Since the patient seems to want a fixed mandibular restoration I would encourage her to consider implant(s) being placed in the canine/lateral incisor area - depending on the arch. Without seeing the casts we are having to make some pretty big assumptions - that she doesn't need a denture flange for lip support.

If she looking to spend as little as possible - I would go with a new complete denture on the maxilla with a hybrid on the mandible supported by 4- 5 implants at 19, 22/23 (new),26/27 (might not be needed),28 and 30. I would possibly sleep the implant at site 20 to improve access for hygiene.

If she is willing to place two implants I would consider doing three fixed units on the mandible (existing implant 19, existing implant 20, cantilever 21) (Implant placed at 22, pontics 23 - 26, implant placed at 27)(existing implants 28, 29 and 30)

Two options anyway.

 

[thetoothfarie]

From the point of view of a removables tech

If I understand correctly Pt. has a FUD she tolerates, 2 posterior implant bridges, and a lower ant. flipper she hates. Pt. wants lower ants. restored fixed.

Please keep in mind that a plastic FUD will not be able to stand up to all that creamics. Please have the restoring doctor consider redoing the FUD and using some porclain teeth as 'stops' so as to not beat up her upper and lose verticle.