Need Help?

[ParkwayDental]

Ok so this patient just got two implants placed by the butcher somewhere around here, and he placed the implants in a bad location right on top of each other. The patient goes to the GP and he takes a impression for the study model to see what we can do. The GP wants a four unit bridge with out having to prep any of the current teeth. The implants are located so poorly here, I don't know how to go about this. I need some help to decide what to do? The GP said we might have to get another implant placed, but I hate to have the patient go get another implant placed.

So as of now we are thinking two custom titanium abutments on 2 and 3, and maybe cantilever 4 and 5 with a lingual rest on 6? I don't know what other option's I have right now and need some help planning this one out.

In advance it is greatly appreciated!!!!

 

[Affinity]

Definitely not a lingual rest.. The pt either gets another implant or teeter totters those two implants out with two cantiilevers.. My guess is theres NO BONE between them and they will come out together.. This surgeon should be turned in to the dental board... if that even exists haha
The pt really needs to see if the surgeons malpractice is paid up, and get his money back .. no joke!

 

[rkm rdt]

one piece screw retained with a flange

This may sound crazy ,but if the lower molar was to be extracted,you could make a pld and reduce the stress on the cantilever by contacting the 2nd mx molar. That md molar may not be around much longer by the looks of it.

Can you take a different pic of the md?

 

[ParkwayDental]

I feel really bad for this patient!!! I don't know who the surgeon is but he needs a beat down!

 

[Affinity]

How would a pld distribute the force differently though.. they are so close together it might as well be one implant.. it should at least be treated as one..

 

[rkm rdt]

It appears as though ther are no posts in the 3rd quad , so the pt will chew on the right side.By adding a pld,they would be able to chew on both sides and the contact would be displaced to the 2nd mx molar .

 

[CoolHandLuke]

one piece screw retained with a flange

This may sound crazy ,but if the lower molar was to be extracted,you could make a pld and reduce the stress on the cantilever by contacting the 2nd mx molar. That md molar may not be around much longer by the looks of it.

Can you take a different pic of the md?

i would do slightly different - not just with a lingual wing on the cuspid, but also a buccal tooth coloured clasp either on the cuspid or the molar, or both.

any way you slice it, this guy has a lot of issues happening at once, and the two little implants there probably arent going to retain the prosthesis for very long, seeing how low that upper molar is sagging, and how wide that lower molar is.

it is my opinion that the previous doctor be shot. and kicked in the scrote. then shot in the scrote.

this guy needs either a third implant or the canine and molar prepped with no attachment of the bridge to the implants.
but if we must use those implants, again i'd go with the clasp and lingual flange. just be real wary about the whole "implant bridge" thing with natural teeth as abutments.

 

[rkm rdt]

No clasps or wings on the implant bridge.The cantilevers are fine.I'm talking about a partial lower free end with the lower molar extracted.The implant bridge will then occlude with plastic 0 degree teeth.

 

[Affinity]

No clasps or wings on the implant bridge.The cantilevers are fine.I'm talking about a partial lower free end with the lower molar extracted.The implant bridge will then occlude with plastic 0 degree teeth.

I misunderstood.. I was thinking mx partial ..

You could always prep the cuspid and molar and do a bridge right over the implants.. just leave the healing caps on .. haha .. or make abutments on the implants also and cement them with flubber..

 

[stt672]

Hey Tyler, Like some others have suggested I would also do screw retained. How many MM's from mesial of #3 to distal #6? I would design with metal occ on cantilever. I would beef the cantilever up as much as possible to avoid metal flex and design mesial of #3 1/3 of occlusion metal also just for a stronger connector. I would make cantilever not to functional but more for esthetics and make the implant abutments to carry the load for function Good luck man. Bruxzirs have been coming back sweet------- Thanks!

 

[doug]

I'd like to see an xray of the implants before I even think of what could be done. Who knows what's under there? This whole case may be teetering on disaster under the tissue.

 

[REJ]

My crazy minimally traumatic solution would be a small diameter implant at the 5 site, could be like a imtec hybrid 2.9 since only occlussal not axial force needs to be accounted for not much implant is needed. Also it's a flap less procedure. Then either custom abutments to draw with the mini or screw retained bridge, if draw works. If you cantilever to use natural tooth that wing will debone fast since it is on PDL not bone.

 

[ParkwayDental]

I went to the GP this evening and sat down with him and the Surgeon we work with in our monthly continuing education classes, and we decided to send the patient to the Surgeon we know to see what our options are. The surgeon reccommended barrying the implant on number 3 and put a cap on it, and try to place a implant in the number 5 spot. He might have to do a bone graf to get some solid structure in there but we won't know until he takes some X-rays. We are going to explore every route before we jump in this. If we can get a implant in on number 5 we would just do a 3 unit bridge pull the 1st molar on the MD and make a LPD so the patient has some posterior occlusion.

By the way guys can you please explain in what you mean by flange?

It's sad to say we are starting to see more and more cases where the surgeon from who knows where just throws them in there before really doing a treatment plan! It makes it hard on everyone and as a lab we cannot make miracles happen every time. I really feel bad for the patient because they probably don't have a clue what trouble is going on!

 

[MasterCeramist]

Shouldn't this be in the face palm cases thread ?

 

[rkm rdt]

I went to the GP this evening and sat down with him and the Surgeon we work with in our monthly continuing education classes, and we decided to send the patient to the Surgeon we know to see what our options are. The surgeon reccommended barrying the implant on number 3 and put a cap on it, and try to place a implant in the number 5 spot. He might have to do a bone graf to get some solid structure in there but we won't know until he takes some X-rays. We are going to explore every route before we jump in this. If we can get a implant in on number 5 we would just do a 3 unit bridge pull the 1st molar on the MD and make a LPD so the patient has some posterior occlusion.

By the way guys can you please explain in what you mean by flange?

It's sad to say we are starting to see more and more cases where the surgeon from who knows where just throws them in there before really doing a treatment plan! It makes it hard on everyone and as a lab we cannot make miracles happen every time. I really feel bad for the patient because they probably don't have a clue what trouble is going on!

A flange with pink porcelain which can be done with a screw retained bridge.

 

[DMC]

Molar and Two Bi-cuspids. Three unit bridge with One cantilever.

What's the problem?

Looks workable to me?

OK, not perfect, but what is these days?

 

[Affinity]

It's sad to say we are starting to see more and more cases where the surgeon from who knows where just throws them in there before really doing a treatment plan!

Doesnt the GP refer pts to the surgeon? Its not just some guy in an alley, the word should get out that hes clueless, ie. no referrals for you!

 

[ParkwayDental]

Doesnt the GP refer pts to the surgeon? Its not just some guy in an alley, the word should get out that hes clueless, ie. no referrals for you!

This patient went to a surgeon somewhere out of town and walked in at the GPs office. He had no influence on this one. Yes they do recommend the surgeon we work with in our classes though.

 

[Affinity]

Tough call.. if the pt went to a surgeon that wasnt recommended by the GP.. Im not saying the dr should walk away, but should choose carefully (obviously you are) how to proceed on a botched implant like this...
Pt needs another implant..

 

[rkm rdt]

There is no rush to restore this case.

The patient needs to solve his perio problems first.