#7 immediate load/comprehensive esthetics

126 Rating(s).

Posted on By Jason Witons In Anterior/Esthetic

Good morning,

This pt was sent for #7 treatment as Maryland bridge is failing. Full comprehensive therapy is likely has better alternatives. He is currently scheduled For CT scan. I plan to do a Wax up to see potential finished tx plan and demonstrate alternatives

If bone is adequate in #7 is this a good immediate load case as a removal temp will not be needed.

Alloderm could be done to generalized recession areas.

Ridge augmentation to LL and implants replacing missing teeth 18-20 can be done.

once CT is done I will update. Please advise on thoughts at this point.

Thank you,


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Hi Jason. With the limited information provided, my guesses/suggestions are as follows:
1) Is that decay on #8? If so, is #8 vital? Endo?
2) I doubt that the CT will show that area of #7 has adequate B/L width, even with a narrow, 3mm, implant, which will be necessary given the limited M-D distance available between #'s 6-8. Therefore, plan for bone augmentation in area of #7.
3) This patient has extremely prominent roots and very thin tissue, ergo the generalized recession. I would plan on also doing a CTG in area of #7, either separately or with your bone augmentation.
4) If the above is in fact necessary, I'm not sure immediate provisionalization would be a good option. Maybe you can re-utilize the bonded bridge during healing.
5) This patient will definitely benefit from root coverage or at least widening of the zone of attached/keratinized gingiva as it's not clear his recession patterns are stable.
6) Lower right and/or Upper left can both be options for implant therapy, but post the CT results first and we can revisit potential approaches.
Looking forward to your follow-up


What a surprise, I completely agree with Henry. Hope to see you in Florida this February. regards and good luck Maurice Salama


Jason, mount these models in CR and check the occlusion before loading implants . His anterior teeth are in harms way. Recession and wear could be one of the reason for that. You may have to treat other teeth to get the balance. Regards.