Multiple Anterior Tooth Replacement. Which way did we go?

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Posted on By Maurice Salama In Implants

Multiple Anterior Tooth Replacement.Patient presents with a broken bridge on 3 failing endo treated teeth. This is 2nd conventional bridge that has fractured in 2 years. Patient wanted an implant solution. Low lipline. Which way did we go? Which way did we go? Dual Zone, SVG, Delayed or PET? Which way would you go? Thanks Dr. Salama

Post op at 3 months
Preop fractured bridge

Preop frontal view
Post op frontal view at 3 months


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12 Comments

12 weeks healing with provisional.

12 weeks
12 weeks


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I would think that this was accomplished with PET. Looks beautiful. The multiple implants should have given you a better feel for success in this case with the history of stress on these teeth with subsequent fractures and failures. What torque was achieved? In evaluating these cases for proper candidates, when is a periapical lesion a contraindication? Such as the case seen here. THe lesion is larger towards the lateral from the central seen on the sagittal CBCT. And the axial view shows the lesion thru the cortical plate above the lateral but the central shows good apical bone. How would you handle this?

sagital view
axial view


Reply

Excellent case to discuss Maurice. Two point of view:biological and from the biomechanical.
From the biological point of view, an alternative could be using an implant site, on 7 and 9, with P.E.T. and the submerged root 8. Otherwise, socket preservation.
From the biomechanical point of view, I would suggest implants placement in the two centrals incisor and cantilever pontic in lateral incisor .
The incisal guide would be in the two central incisors and the lateral would not have any function. This appears in an article by Xavier Vela and Xavier Rodriguez C.
(Xavier Vela-Nebot, Víctor Méndez-Blanco, Xavier Rodríguez-Ciurana, Maribel Segalá-Torres, Jaime A. Gil-Lozano.Implant Positioning whenReplacing the Four Maxillary Incisors: A Platform-Switched Treatment Option. The International Journal of Periodontics & Restorative Dentistry.Volume 31, Number 4, 2011

best regards
Alberto Miselli


Reply

Alberto; yes, good ideas.....this case 3 adjacent shields with innediate implants and provisional and NO BONE GRAFTS!!!! Low lipline so 3 adjacent implants....if not then middle implant would ha e been SRT.


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Nice case! I agree with Alberto in every single word.
To discuss a little bit I would say that, although a low lip line, I would have place 2 implants. Probably in the 2 central incisors. (PET in central incisors and RST in the lateral)
Why? Because I think that central achieving papilla between implants is not and easy task. If we place 2 implants in the central incisors we are going to have some kind of papilla (This case is extraordinary) But if for any reaon we do not achieve a great papilla, as far as there is no other central papilla to compare (Importance of simetry) the results could be OK from a patients point of view.
On the other hand achieving a papilla between implant (central incisor) and the lateral (RST) without implant is going to be "easier"
Another thing about placing 2 implants, is that is at any time we have problems in those 2 central incisors, we still having the possibility to place a new implant in the lateral area (The later I place an implant the better!! Hehe)
Despite This looong comment, congrats! Outstanding work! It was just to try to start a discussion with our friends in the forum!!


Reply

Beautiful!
An another case showing PET superiority!
If there was not PET, I would go for two central implants with cantilever on the lateral incisor.
And with PET - three single implant crowns, as done in this case.
Great tissue, all without any grafts and big surgeries!
Cheers
Snjezana


Reply

Mo,

Just solid work- hard&soft tissue dominance- few questions- age of case as far as shield design- what is your implant diameter here - I would bet you went down a bit to allow optimal inter implant distant.

Do you have radiographs?

Cheers,

Richard


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Richard;
For you my friend. Here you go....
regards Mo

PA preop
PA 3 months in temp


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PET Therapies are changing the direction of our profession, it is now a routine procedure in my office but it does require training and not for the novice....


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Mo,

Just solid work!! Yes PET therapy is Being utilized worldwide - just look at posts in last 10 days


Cheers,

Richard


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Great solution the PET! I think will be more papilla creeping in the time between 1.2 and 1.1
All best Maurice!
Enzo


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3 PETs with 3 implants. What a lovely case! Delighted to see such incredible results without grafts. Maurice are these all conventional shields or C shaped? I have found that in some of our cases we are unable to reproduce the interdental papilla without the C shaped shield. What has been your experience?


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