Full arch management on Younger patients. Why do we turn an FP1 patient into an FP3 patient?

166 Rating(s).


Posted on By Ace Jovanovski In Implants

How do we approach management of full arch cases in younger patients?

RE-wording the question: What can we give the younger patient that maintains/mimics the architecture of the bone and teeth, without having to compromise?

What are the risk factors associated with keeping compromised/carious teeth---what is the likelihood that the restoration will have to be remade?

In the past, I have edentulated many patients, with alveolectomies, that I would now likely would have to think twice about doing, thanks primarily to the collective body of work that the Dental XP family has shown on the forum posts. DENTAL XP is revolutionary, in the real-time sharing of information with like-minded individuals. It has dramatically impacted the way I treatment plan, and has LITERALLY changed my practice. So, thank you, Everyone!!

I have difficulty transitioning a dentate FP1 patient into a FP3 final prosthetic situation, just because the companies tell us to remove bone. Each case is unique.

>>>What approaches would you take in a younger patient, in his 30's, with a high caries risk situation?

Timing ?
Strategy?
Final Prosthetic design?

I am curious to approaches people would take.

-Ace

IntraOral

Add to Favorites
Add a comment to the discussion on Full arch management on Younger patients. Why do we turn an FP1 patient into an FP3 patient?


Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.

6 Comments

Smile


Reply

Maxillary Occlusal


Reply

Mandibular


Reply

Great case to ask the question
I to am concerned with the number of cases I see that we simply significantly reduce healthy bone and placement FP3.
Firstly, this case has dreadful OH and we then expect him to clean around fixed prosthesis better???
His diet also needs attention-although you could argue without teeth there is nothing to decay. His peaks of refined sugar will undoubtedly have life effects and potentially affect healing and future stability of implants.
For me if he cant improve oh then why are we considering implants?


Reply

Barry,

I think you nailed it on the head! I couldn't agree with you more. You are very observant, and obviously have come across similar situations.

We have the responsibility as a profession to advise our patients. We shouldn't have to make such a drastic alveolectomy in order to "fit" the patient into a hybrid.

We have many "work-at-home" professionals in the computer/IT world. A sedentary lifestyle, and add chronic consumption of sugary carbonic beverages (Sips all day long), poor OH.... perfect storm. Conventional tooth-borne crown and bridge would have a high likelihood of recurrent decay, and re-treatment.

As for hygiene.... Traditional hybrids, as well as now the zirconia hybrids, have challenges for maintenance--- especially the underbelly (intaglio) surface.

>>>A well-designed final prosthesis is KEY!<<<<

The smaller the ridge-lap, the easier the maintenance .


Reply

Ace; Great post and question for our FORUM. I would select some of the very best, stable and least decayed teeth in both arches and provide a coping fixed restoration while performing PET/SRT Submerged roots to maintain 3D ridge form on the remaining teeth/roots. This buys you "TIME" and provides a fixed restoration while limiting the transition to FP3 type hybrid restorations with significant bone reduction. Here I would utilize teeth #4/9/13/14 and in the mandible #20/22/27/30 as abutments with gold copings to protect from washout and decay. Then perform SRT in strategic locations to preserve the ridge form. Down the road if the patient needs to convert to an implant supported prosthesis you could place implants as All on X and maintain the ridge form as well through SS. great post. See PET All on X case below. Dr. Salama

PET Full Arch
Temps


Reply


Augma Bio
Ritter