A 4-unit implant supported bridge was planned for 10-13 on 3 implants (Picture 1). The facial angulation of # 10 precluded a standard screw-retained option (pictures 2 & 3). Instead of resorting to a cement-retained option, an angled multi-unit abutment was placed on # 10 to reposition the screw access hole towards the palate (Pictures 4 & 5). In this way, a screw-retained bridge was fabricated with a multi-unit ti-base on # 10 and standard non-engaging ti-bases # 12 & 13 (Pictures 6 & 7). How would you have instructed the lab to design the restoration in this type of situation? Curious to hear everyone’s opinion based on previous experience.
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Exactly like this!!! Nice work.
Hi. I would have used a regular Ti-Base with a screw that can be accessed from the palatal at up to 30 degrees ( see Swissplus).
I would have tried an angled screw channel. If not then what you did.
I am starting to wonder if we ask too much of a cuspid implant that is splinted/bridge, as the implant goes anterior in protrusive and lateral in working movements. I agree with the angled screw channel as it looks like your central overlaps the exposed MUA. I also wonder if you/the patient has plans to go at least one more tooth/implant posteriorly.
Yes, that would be an alternative to this approach and would work well also. Great suggestion.
Yes, an angled screw channel would also be a great alternative to this approach. This was done ~2 years ago. At the time, I was not aware of how to digitally scan a case like this and have the lab use an angled-screw channel without them having to print an actual model. Since then I have learned that if you buy a specific scan flag for angled screw channel cases it will avoid the extra step of having to print a model.
In this case, the patient did not have enough bone to place an implant in site 14 and did not want a lateral wall approach. But your thought is very interesting and I guess we will learn about it over time.