I dint know.
Frankly that is why I am spending $4000 to go to Dr Chasolens in office "Implant Prosthetics" course at the end of March.
Lab Guy is going to be there so I will report back on his misbehavior.
Its fortunate this case came now to help give me a better understanding or prepare me for the course.
Ive been doing work for this client for the last month and a half.
Ive gotten 3 cases from him totaling 38 units. Its a whole different world of dentistry from doing single units.
As far a the facial lip support, I think the entire facial could be brought out more from the incisal edge all the way down.
But to do that I would need to extend the bridges past the ridge (from 1st bi to 1st bi) and the occlusion so far from the implants I would think that would put alot of torque on them.
Hes an old man and his lower arch is smaller than his upper.
First of Dr Chasolens course will be very very informative. I have not heard him speak but I have seen his posts on DT and the man knows more than most. I was first alternate for that course but I have some other plans that month that prevent me from going. I believe he is having another one in Oct that I may attend. I will hit you and Rob up after the course to ask you guys some questions.
As for this case I always like to hear how the conversations went when you received this case. Of course you are following the directions of the client and assuming the patient wasn't dictating treatment then you probably are fine. On severely reabsorbed arches when they are looking for proper facial support Implant retained/supported appliances are the most difficult to fabricate with out some sort of trade off.
One way to do this case in my opinion would have been to mock the case up with the UCLAS based on your frame wax up in "Full Contour" You could then send this to the client to try in and evaluate the following main criteria for a successful case
1) Verify accuracy of the master model
2) Verify incisal length and plane of occlusion
3) Verify lip support and facial contours
4) Verify CR and VDO
All of this can be done in resin that you can eventually cut back and cast.
When I see cases that go from a denture to a fixed restoration on arches like this even if the VD is correct you will be able to see a nice horizontal crease under the patients lip from lack of support.
Sometimes on these cases where the feeling of a fixed restoration is desired and the need for a buccle flange is necessitated a better appliance is a bar with an over-denture. This will get around the hygiene hurdle of ridge lapping and give all the needed facial support. Off axis load to the fixtures seem to not be as much of a concern here especially with the nice placement this case had.
Like I said Al the case you produced is beautiful all of this discussion is based on "What ifs" all I wanted to do is to create dialog to explore ideas that I know come up on these big cases.