The patient in this case is 80-years old, but very healthy. the pt just had a new upper complete denture made recently from another dental practice and doesn't want to replace it. Besides, all her lower anterior teeth are splinted with a pfm bridge which she has for 20 years and doesn't want any tx for them. current tx plan: implant-supported mandibular partial denture (lower right second and third molar exos first) With regards to the tx design, my question is if I can place an implant at the first molar site on each side of the mandible to support the denture? If the lower anterior bridge/teeth have any issues in the future, I can still take them out and place a few implants anteriorly to make it all-on-6/4. I only had experience with implant-supported complete dentures before and the implants were apparently placed more anteriorly. Thoughts?
tim comments:While some may disagree I think you have a really good plan as I assume you also plan to extract #21. Having implants in the first molar region will provide excellent support and retention for the partial. We can speculate but the truth is we have no idea how much longer her lower anteriors will last. In the event that you should transition her into a hybrid type restoration having two integrated implants ahead of time makes the conversion much easier because the lab can design the denture/provisional fixed to the implants on the model.
Andy K comments:I will also do the same plan as placing 2 implants around lower first molars area / #19 & 30. But instead of using locator/ any attachments, I will just make PFM crowns and treated as additional 2 molars. That way the stay plate can have posterior support. Hopefully she is willing to deal with several periapical infections that will affect her health & implant survival.
WMickDDS comments:Restorative space may be an issue. Tooth, acrylic, housing, & abutment all add up. Be aware of space requirements. An 80 year old may have xerostomia issues and the related caries. If there are ANY questions about longevity of anterior bridge (caries, periapical abscesses, or 50-90% bone loss), consider the idea of ONE restorative plan and go directly to the hybrid. It appears that she may pay for an implant assisted RPD, then pay for the hybrid in the very near future.
Aquiles comments:I’d be a bit wary of removables and that much bite force. If that’s what you are asking. I always go a fixed route now. Also looks like a dead tooth 21 you might want to take a close look at. But if you are gonna go through the trouble go fixed. That’s my .02.
Dr. JD comments:I guess I see this differently. The mandibular teeth are a disaster of decay, bone loss and periapical lesions. I would think that saying adieu to them should be the first priority. Fixed or removable will be for you and patient to decide.
Lalaali comments:if it is a implant-supported mandibular complete denture case (two implants), is it Okay to place the implants in the posterior region?