3rd year dental student seeking help on complex case

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Posted on By Alexa Brown In Esthetic Therapy (General)

Hello everyone, I’m new here and have a few questions I’m hoping I can get help with!

My patient is a 71 year old male with diabetes and an HbA1c of 10.2. His main concern is esthetics and wants a “pretty smile again”. He is a heavy bruxer and has a high caries risk. He’s missing 14, 19, 23-26, 30,31 and has an FPD from 18-20. Right now he wears and RPD on the mandible but he doesn’t want anything removable again. He also has a few fractured teeth. 8 is fractured on the lingual and he has a PFM crown on 9. He says he wants the crown redone and wants his teeth bleached to match the ceramic FPD. I need to come up with a few treatment plans to present to my faculty.

My thoughts were an implant supported RPD?
I was also wondering if a 6 unit FPD from 22-27 is doable? Would that put too much stress on the canines? Or would it be ok since the crown to root ratio of a canine is quite high. I was also wondering if it’s ok to put a crown on 8 since it’s fractured on the lingual and composite would not stay since he’s a bruxer. My faculty likes to stay as conservative as possible so I wasn’t sure if that was a good enough reason.

The other option would be all implants.

Also, if I were to do implants in the anterior, are there any specific rules as to what it can/can not oppose? Would it be ok if it opposed and all ceramic crown?

I know we learn “like opposes like” so for #14 I would have to do a ceramic FPD as well. Just wondering if I could choose and implant for that option instead.

Sorry for the long post, would love to hear everyone’s comments and opinions though. Thanks so much!

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2 Comments

Hi! Responding to your question without radiographs & photos. Please keep in mind the precautions for Diabetic HbA1c 10.2. Considering good bone support and healthy perio. Easiest treatment plan crowns 8,9 ok fixed bridge 13-15 fixed bridge 22-27 or 21-28 IMPLANTS 30, 31 Occlusal equilibration Hopefully I m correct with the missing teeth :-)


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Ideally you could present case with pics just like a lecturer would. It hard to help without pics and radio. Thanks


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Henry Schein
Salvin