Hard & Soft Tissue Problems

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Posted on By Charles Payet In Implants

This patient came in last week for a consult. The 5 existing implants, which I'm pretty sure are Biomet 3i Encodes, were placed in 2014 by a periodontist. The lower canines were prepped and a 6-unit temp bridge placed at the same time. Those teeth are now non-restorable, and he only has 2 teeth on the right with which to eat. Initially, I thought it a straightforward case - extract the canines, level the ridge, place 2 implants at the lateral incisor or canine positions (leaning towards canines to allow 3 separate bridges), etc.

On closer look, however, there are a number of problems, including the maxillary arch, which also needs rehabilitation.

The more immediate concerns are:
1) very minimal attached gingiva around the implants; I'm surprised that the periodontist who placed them didn't address this, unless they planned to do so prior to restoration.
2) very thin (possibly non-existent?) bone on the buccal of several of the implants.

However, I'm very new to reading and understanding what CT scans do (and don't) show.

Restoratively, there will be some challenges/compromises if he can't do the maxillary arch at the same time.

He is eager to move forward since it's difficult to eat, but I don't want to rush into restoring him without being sure that the existing implants aren't too compromised.

CT slice #18
CT slice #19

CT slice #21
CT slice #28

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