replacement of failing fixed denture 5-12

31 Rating(s).


Posted on By edward shapiro In Implants

patient presents for consult. had fixed prosthesis placed by prosthodontist, endo's and grafting several years ago #'s 5-12. things are breaking down and there is mobility present. he is a class 3 that was restored to a class 1. long teeth 7-10. he hides it well. i am posting snapshots of several images of cone beam. my concern is the distance from incisal edges of 7-10 to the facial bone. several options: 1. extract 5,6,11,12; graft as necessary; place 4-6 implants and restore with a fixed hybrid partial; would have a substantial lingual ramp for screws due to placement of implants. concerned with the transition between fixed hybrid and natural teeth. 2. extract 4 and 13 and extend fixed hybrid for better aesthetics. 3. graft facially 5-7 mm of bone to allow more buccal placement of implants and then have the option of conventional fixed denture over implants. would still have long teeth but not bulk of material on lingual.unsure if his lip could accommodate the thickness or he would like the esthetics of upper lip. not sure the patient will want to go through GBR across anteriors. patient coming in tomorrow morning with his spouse for consult. thank you for all your input.

ed shapiro

initial panorex

buccal defect


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3 Comments

How many hybrid cases have you and your surgeon completed?


Reply

i do both surgery and restorative.


Reply

Ed; To me this is a GBR case. You can do with Ti-mesh if tissue is adequate in thickness. Tenting screws or mini autologous blocks can be added or BMP-2.
Many options here....just clean surgery is you best friend.
good luck Dr. Salama


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