Sometimes.....

Affinity

Affinity

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Thanks! The Dr wanted a narrow occlusal table, so I normally wouldve made it a bit fuller.

I have a cantilever case Im doing on a molar for an asst., but its not an implant.. I think Im going to tell her I dont recommend it and that she should get it eventually cut off and an implant placed. Usually the opposing has super-erupted and leaves little space to take completely out of occlusion witout making a bird bath.
 
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gallagerdental

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I guess I'm getting a little cynical too. One size implant fits all. Keeps specialist's stock down. I smell a future lawsuit, if patient got a qualified second opinion and a good lawyer.


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Baobabtree

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Just remade one last week due to breaking the top of the abutment off. It wan't quite as extreme as your photo, but along the same line, overextending to fill in the space.

The Dr placed the implant. This is the 2nd one he has placed like this. The 1st one I "refused" to close the space. It ended up in being for a engineer, who understood my concerns of fulcrum and occlusal forces, and was ok with it. That case is still doing well.

On this remake, he said to charge him full price, and to make it narrower (a canoe) and light occlusion, and if this one fails, we will do the 3rd one and not close the space, like we did the other patient. He did say I would be charging him full price, if it was needed. At least he is realistic in that regard, as far as my time and labor. Poor patient, though. Possibly 3 times for 1 implant :(

Thanks Car, that cantilever is 15mm from the centre of the implant to the contact. I raised my concerns with this Doc who by the way likes doing cantilevers on a single implant. Pointed out about the fulcrum and loading concerns, to be fair he said he would take full responsibilty for it should it fail( I think it is going to fail as it is only a 10mm long implant 'supporting' the whole thing). The same day he took the imps for this case, a patient we had made a cantilever bridge 6 months previously on a straumann rc ucla had sheared at fixture level. Go figure. I would have thought if there is room and bone for 2 implants would it not be better to provide the best foundations for long term success.Banghead
 
lcmlabforum

lcmlabforum

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Thanks Car, that cantilever is 15mm from the centre of the implant to the contact. I raised my concerns with this Doc who by the way likes doing cantilevers on a single implant. Pointed out about the fulcrum and loading concerns, to be fair he said he would take full responsibilty for it should it fail( I think it is going to fail as it is only a 10mm long implant 'supporting' the whole thing). The same day he took the imps for this case, a patient we had made a cantilever bridge 6 months previously on a straumann rc ucla had sheared at fixture level. Go figure. I would have thought if there is room and bone for 2 implants would it not be better to provide the best foundations for long term success.Banghead

Everyone tries to save money, esp. if insurance have a toothloss clause and will not cover the second implant.
So people will find out. Laws of physics trump laws of economy in the long run.
As for the narrow occlusal table, since you cannot limit the mesial distal distance, people fall back to
what they have been taught about "Normal" implant occlusion, namely, have narrower B-lingual width.
That would limit the lateral cantilever in the B-L direction, which is usually the most destructive
when they are from non-working interferences (or even working ones!).
In this case, being not a conventional occlusal loading situation, trying to 'apply' that principle
is like a Hail Mary . . . for lack of a better word.
Good luck,
LCM
 
JMN

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I've done so many 3-unit bridges on quadrant models that I don't even bat an eye at a single unit implant case with a posterior tooth for a stop.
No kidding, it's more like "Hey he actually captured a posterior stop!"
 
JMN

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Thanks Car, that cantilever is 15mm from the centre of the implant to the contact. I raised my concerns with this Doc who by the way likes doing cantilevers on a single implant. Pointed out about the fulcrum and loading concerns, to be fair he said he would take full responsibilty for it should it fail( I think it is going to fail as it is only a 10mm long implant 'supporting' the whole thing). The same day he took the imps for this case, a patient we had made a cantilever bridge 6 months previously on a straumann rc ucla had sheared at fixture level. Go figure. I would have thought if there is room and bone for 2 implants would it not be better to provide the best foundations for long term success.Banghead
It helps some of them turn on the light bulb when you point out the teeny tiny screw is what transfers a great deal of the force to the big huge implant. Yeah, it's not totally true, but sometimes you just have to lie to the kids.
 
lcmlabforum

lcmlabforum

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Awww, you mean Santa is not real?
Implants and screws can fail after they are placed?
:)

LCM
 
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