All on 4: Opinions and Critiques?

I just performed an All on 4 today. The Patient did not want to have a sinus lift bilateral and wait 6 months before placing implants, so i tried my best to obtain a good A-P spread so we minimize the cantivaleria. What do you think about the position of the implants,direction,angles? I want to become better by hearing from others that are more experienced than me. Thanks

drjanoshuat comments:

I think it is a good work. Could you later share 3D x-ray from the implants as well?

And have you used guide or free hand?

Oanca Alexandru comments:

Hei Dr,i will take a CBCT when he comes for control and i will post it.It was free hand.Thanks for opinion!

40yrvet comments:

The angulation of the posterior implant on the (Left?) is greater than some multiunits can compensate. The access opening will be tilted distally making insertion or retrieval challenging, and may introduce undercut into the prosthesis making seating difficult. Recommend a night guard, and minimize cantilever.

Oanca Alexandru comments:

Hei,yea it looks more then 30 degree,maybe 45.Clinicaly it didnt appear so angulated.Thanks for opinion Doc. comments:

which is the diameter of the anterior implants ? seems to me there are to wide for the anterior region

Oanca Alexandru comments:

Hei,the implants on anterior region are 3.5 x10 mm.Hard to belive,but the radiography is one of the worse:(,the pacient moved or something.

Mark Huels comments:

While it is hard to tell with a pano it looks very good to me. If the multi unit abutments are at tissue level--not above but not too deep--seating the prosthesis should not be a problem. You may have to seat the off angle first.

sb oms comments:

A-P spread looks maximized - good. Angle greater then 30 degrees not a big deal. This reduces cantilever so from an engineering standpoint well done. Can't tell much else from 2-d. Are these buried under a removable denture for integration? Highest risk case for maxilla with fixed implant restorations in mandible. Consider botox to massters two to three times a year to reduce bite force. Remember, no proprioception from full arch mandibular implants.

DrVinayak comments:

2 pterygoids would have improved the prognosis in a great way but looks ok