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Treatment planning for tooth #8
Posted on 08.06.2012 07:32 PM
By Simha Kukunooru
In Implants
Patient is a 52 year old male with non-contributory medical history. Implants # 5 and 9 were placed 10 years ago. He has an FPD from #4- 13 with #3 as distal cantilever. He presents today with symptomatic #8. Upon clinical examination, a sinus tract was noted on the buccal of #8. Mobility could not be assessed. Patient has a low smile line. Radiographs reveal internal resorption #8 and radiolucensy around the middle-third of the implant #9.
To be conservative, I am planning on sectioning the FPD on #7M and #9D and extracting and grafting #8, followed by delayed implant placement and crown.
Please suggest on treatment planning the case?
Thank you
Simha K
7 Comments
omid moghaddas says on 08.08.2012 05:51 PM
dear simha
that plan is ok ,but also there is a luscency at the mid area of the dental implant adjacent to tooth number 8,which i think it could have a fenestration at the labial so you need to augment it also.
Simha Kukunooru says on 08.09.2012 04:36 PM
Dr. Moghaddas,
I did notice the radiolucency around implant #9. I was wondering if it is the incisive fossa. Either way, I was planning on evaluating the it intrasurgically and graft it.
Thank you
Simha
Wendy AuClair says on 08.09.2012 01:07 PM
Hi Simha! Have you done a CT to assess mesial-distal space? It looks from the PA that the #7 root and #9 implant are tilted toward each other. I would also be hesitant about leaving #7 as a lone terminal abutment for such a long span bridge. What is the bridge cemented with? Can you tap it off and just remove #8 and graft, turning 8 into a pontic? If not I would consider removing 7 and 8; it will make the prosthetic situation easier to manage. - Wendy
Simha Kukunooru says on 08.09.2012 04:27 PM
Hi Wendy,
The prosthesis was cemented 5 years ago by a dentist elsewhere, so I have very limited information about the prosthesis. I am definitely concerned about splingint implants to teeth. My initial treatment plan that I proposed was:
1. Section the prosthesis mesial to #11, and temporize from #4-10.
2. Extract #7 and 8 + Immediate implant placement #7 + implant placement #10 + graft #7- 9.
3. Single crown #4
4. Implant-FPD from #5- 9 with implants #5, 7 and 9 as abutments.
5. Implant-Crown # 10
If Tx cost was not a limiting factor, what do you think about the above treatment plan.
-Simha
Wendy AuClair says on 08.10.2012 08:11 AM
I think that would be a good plan. I would make sure the patient knows that they would be losing their molar on #3, though, and make sure they are ok with that. If you wanted to be even more conservative, what if you sectioned 5M and 9M, EXT 7 and 8, place implants 6 and 7, and do a 3 unit cantilever bridge 6-8? That way you avoid the esthetic concerns of placing adjacent implants 8 and 9, you are preserving the majority of the patient's bridge, and it will also be easier for your restorative dentist and technician to match #8 to #9. I have seen Dr. Salama do some soft and hard tissue grafting to plump up the pontic area with fantastic results.
Simha Kukunooru says on 08.10.2012 08:21 AM
Sounds good. Thank you for sharing your ideas.
Wendy AuClair says on 08.10.2012 09:47 AM
Share some photos and let me know what you and the patient decide - And keep in touch with your old co-residents! :)