Face...Meet Palm...

[Brett Hansen CDT]

I got this case in a few days ago. I understand this patient had been wearing a flipper for many years. They are now going to a fixed bridge to restore their missing dentition. The person who placed the implants did not provide us with a preop model nor was a waxup/stent done to aid in the placement of the implants. Check out these pics and let me know how you would restore this nightmare.

 

[Markyboy]

If patient has been wearing the flipper for years I would get an algenate of the upper arch with the flipper, pour up a model and start from there. Patient is used to the flipper.
If not, waxup approval before framework.

 

[Brett Hansen CDT]

From talking with the restorative doctor, the patient had normal occlusion with the flipper in place that he has had for years. I will ask the doctor to see about getting model with the flipper in place, but I don't think it will be much help due to the placement of the implants

 

[rkm rdt]

What's wrong with that? Perfectly placed at the cingulums.

 

[Markyboy]

I would start waxing for a screw retained bridge. Hygiene and occlusal load may be an issue.
It usually isn't as bad as it looks once you start waxing. This one might be.
Share your concerns with the Dr, show them the waxup... cover your butt.
Good luck

 

[Marcusthegladiator CDT]

I don't see any out of the ordinary issues a couple custom abutments wont fix.
I think you just wanted us to see your wife.

 

[Brett Hansen CDT]

Ha! Nice Marcus. I have been exposed! My concerns are the occlusal load. The forces on the implants are gonna be similar to a cantilever I think. We are definitely going to do a screw retained prosthesis. I was thinking of having custom Ti abutments fabricated through Atlantis and then waxing a metal framework with screw access holes..possibly leaving the cingulum areas of the the restoration in metal around the access holes.

 

[Jo Chen]

Ha! Nice Marcus. I have been exposed! My concerns are the occlusal load. The forces on the implants are gonna be similar to a cantilever I think. We are definitely going to do a screw retained prosthesis. I was thinking of having custom Ti abutments fabricated through Atlantis and then waxing a metal framework with screw access holes..possibly leaving the cingulum areas of the the restoration in metal around the access holes.

Why make it more complicated and costly making separate abutments?
Non engaging UCLAs, one piece screw retained restoration.

 

[Brett Hansen CDT]

I was coming back to ammend my previous post. Thanks JoChen, that is the route I am going now.