These 3 Bio-horizon implants were placed in the fourth quadrant a few years ago. Screw retained prosthesis since there was no clearance. The opposing 16 was also reduced to improve clearance. Screws have fractured and come loose twice. This time around the patient came to us a few months after the prosthesis came loose and so the 15 and 16 have supra-erupted making the clearance even worse. Any suggestions for prosthesis type?
this is lost cause.
your options are limited.
to properly crown the implants your only option is to RCT upper molars and premolars, crown lengthen and crown 14, 15, 16 to increase occlusal space. but that also shortens the root/crown ratio. if 14,15,16 have short root to begin with then these teeth would have guarded prognosis after you crown them.
there is no way to crown lower implants without sacrificing upper teeth.
Most likely the fault of patient. usually, finances delay the restoration of implants. and patient doesn’t understand upper teeth will supraerupt w/o lower dentition. So they wait and wait. or they dont like the dr who placed the implants or they try to find less expensive restorations.
good luck.
I’m not sure if you inherited this case but remember that the last person who touches it—owns it.
Your options are very limited and the patient needs to understand very clearly that perhaps implants are not an option any more unless you first level the occlusion in Q1 with 3 endos and 3 crowns and 3 CL’s. Patient may have not had the big picture explained to them at the beginning but if you do anything for them now, it’s now yours to own. Who wants to be married to that? Not me
Worst case scenario–remove implants 44-46. Give some concession credit to the patient for the implants and start from scratch
good luck, my friend
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I agree with both suggestions though I would lean heavily towards removing the implants and redoing them in a more favorable position over removing otherwise healthy teeth. I might not be the sharpest tool in the shed but I will never deviate from the hard truth that an implant is and never will be as good as the tooth it was meant to replace. I would avoid removing restorable teeth whenever possible… Regardless of the route you choose crown lengthening is going to be necessary on 16 and 15, evident by the now uneven gingival margins, then if you remove only the implant in the 45 position you can make a two implant supported bridge.
Take the middle fixture (#29) out of the equation- Crown lengthening #3, #4 with full coverage crowns #3, #4- Fabricate a 2x implant retained bridge #28-30. I don’t think this problem is nearly as big as “we” are about to make it out to be.
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Just refer to nearest orthodontist, and you will gain space in 3 month
intrusion is the most difficult move in ortho. if patient is young maybe. but im sure this is an older white gentleman and bone hard as rock. not soft like Asian ladies. So most likely ortho is not an option. according to textbook you can refer pt to OS and have them perform a segmental osteotomy. which i’ve only read in textbooks and never seen an actual case, even during residency.
dr scotty, i agree implants are not to replace healthy teeth. implants are used to replace missing dentition. and usually a better option than bridge or RPD.
Probably a lot more than 3 months, especially too true multiple teeth but I hope intrusion could be an option.
Was thinking the same thing. Maybe with some intrusion, if possible.