All on four or All on more??? What would you do?

Did you place any graft to fill voids at placement? How did you provisional case? Did patient wear full lower denture or did you do some sort of immediate load? Your restoration connects both distal implants behind the mental foramen, dont see this very often, what was the rationale? I will connect one abutment distal to foramen and leave the other side cantilevered-per Misch text. Looks like you have achieved a great result.

Dr. Claiborne

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I use 6 or only 4 implant after extraction, grafting and immediate loading. 4 when there is little bone above the alveolar nerve and a little arch...It 's very important to have a good amount of bone between implants and enough space for a proper hygiene is always difficult in these rehabilitation and use a temporary and a permanent prosthesis screwed ...

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i think 6 fixtures is minimum. as a periodontist i dont operate this patient immediately because of 1. inflammatory gingival tissue 2. poor keratinized tissue. but results are good because you are dr salama. thanks for sharing
Ali

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Thank you all for your responses. Very good discussions. This case was treated with Immediate Extraction, Immediate Placement, Imnmediate Grafting and Immediate Loading. I agree that dealing with inflammed tissue is NOT ideal and more challenging but leaving the patient with a removeable denture would have caused some resorption and patient difficulties as well as loaded the areas of bone grafting. I also agree with screw retained and less implants for hygiene. This patient desired a fixed bridge style restoration and we were capable of doing this immediately without a transitional phase in a denture.
thanks Dr. Salama

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What will be your final prosthesis for each arch?

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Paul; The lower will be fixed bridge on the implants, one abutment-one time cementable without ever removing the original abutments placed the day of surgery. Upper arch will be natural anterior teeth with lingual bonded retainer for splinting effect and posterior fixed bridges on implants following sinus lift.
regards
Maurice

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Maurice. Nice case. What will be the design and materials of the mandibular prosthesis. One Piece / Zirconia frame or will you restore in segments?
Immediate implant placement is my preference as well. However, I feel occaisionally I may have compromised ideal implant location to do so. If you were to have done as a staged approach, would you have chosen different implant positions?
Chuck

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Chuck; I do not think we would have altered implant positions much here. The case will be a full arch cadcam milled framework to allow for full arch splinting which I am a big fan of from my Penn days. I sometimes feel that staging the case poses more dilemmas in these situations as we lose "landmarks" with resorption not to mention patient management issues.
Mo

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Maurice,

Did you feel more comfortable with the immediate placement in this case because the position of the teeth would not change significantly on the final result? In cases like this, what type of guide do you use to ensure you have enough room for restorative materials, especially if the final restoration is one that requires more room for prosthetic components? Thank you in advance.

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Mo. Great case.I couldn't agree more! Milled framework is a game changer.
Chuck

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Definitely lower full-arch fixed. Nice job.
I would feel even better if you put in #29 after healing.

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Now...only standard abutments and fixed bridge....No Hybrid, no bone reduction, pink ridge....avoided. Dr. Salama

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would go with all on more,and fixed bridge.

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