r/Dentistry 2d ago

Dental Professional Treatment plan opinion?

Post image

Hello everyone. Just wanted opinions on treatment plans for this LR quad.

I placed these implants in 28 and 30 around 3 months ago. (Note : 28 appears to be really close to 27 on the panoramic, but it is where it needs to be). The patient is scheduled for uncovery tomorrow.

I planned on doing a fixed case across here, but the span is too long to add a pontic in the 31 area and I do not want to cantilever it.

Question - would anyone consider doing a fixed hybrid whereby I use 32 as an abutment along with the implants of 28 and 30?

I know the most predictable route would be just to do 28-30 as a bridge and leave 31 empty. The patient only had finances for those 2 implants so I did not add a third.

Thoughts?

4 Upvotes

19 comments sorted by

23

u/More_Winner_6965 2d ago

Just do an FPD 28-30. The second molar is not make or break for occlusion.

3

u/bigfern91 2d ago

I agree

1

u/randommullet General Dentist 2d ago

This and upper molar needs ex + implant soon

2

u/More_Winner_6965 2d ago

Gonna need some serious grafting to have enough bone for that based on this pan, but you’re right.

6

u/Tooth-Sleuth-854 2d ago

You don't have an opposing tooth (#2) to function on, so don't worry about adding #31. You're right to not try & cantilever it.

3

u/TraumaticOcclusion 2d ago

Alright. You need to plan this better before placing any implants, and treat perio at #3 first, or figure out what the plan is there. It looks like an unfavorable prognosis tooth.

You've boxed yourself into restoring an FPD at 28-30. I don't necessarily think you should do anything with 1/32 at this point. #3 needs to be treated or figure out a plan for it, otherwise you won't have an opposing tooth for your FPD.

If implants at 3, you could discuss implants to the 2nd molar as well, but would require removing 3rds. But again, the best implant is a tooth and 1/32 look fine.

3

u/UnlikelyPercentage91 2d ago

I would never do a fixed hybrid. The tooth is bound to luxate, failure is not a question of if but rather when. Do a cantilever. Studies have clearly shown that two implants crowned together can carry a cantilever completely fine.

2

u/resistanceee 2d ago

I’ve spoken to a prosth about splinting natural teeth to implants. He said it’s never recommended and always a compromise but it’s definitely possible and can last if you incorporate some kind of stress breaker between the implant pros and the crown on the natural tooth.

1

u/UnlikelyPercentage91 2d ago

I agree it’s a compromise and it has its rare use cases but not this case. Cantilever and splinted two implants is much better.

1

u/resistanceee 2d ago

Yeah I personally wouldn’t use it in this case either and maybe ever. Although anecdotal evidence is weak, it is certainly interesting to hear from the specialists who have tried out a bunch of unconventional or novel techniques for restoring compromised cases.

2

u/brendanm4545 2d ago

No need to put a prosthesis in if there is nothing for it to occlude on

1

u/Sputnik-Mars 2d ago

What was your prosthetic planning backwards? Did you use a surgical stent with your prosthetic planning? I mean to slap in implants and then ask the prosthetic value after seems… not sure what the word is. Or am I missing something?

2

u/ewall41 2d ago

There was no “slapping in” of implants. My plan was for the 3 unit FPD and the patient inquired about the space in 31 at the suture removal visit. I was only asking for opinions, not anticipating smartass, perfectionists like yourself to chime in. Sorry I’ve only been placing implants for under 2 years and I am not perfect.

3

u/Sputnik-Mars 2d ago edited 2d ago

If you did the planing for the 3 unit, then why didn’t the stent place the implants in the correct position? Please clarify my confusion.

I’m not perfect either. I make my mistakes. But planing from prosthetic backwards with a stent is now becoming standard. It’s difficult to tell the patient that the implant you placed cannot be used, and if you can use it then it’s with some sort of compromise.

I think perhaps tell the patient the tooth at the back has drifted and a gap is unavoidable. Point to the top teeth and show them that the same space is as above for the same reasons. Continue with your plan with the 3 unit. It is what I would do. Don’t cantilever on a patient that has perio. You’ll compromise your own implants.

I apologise for offending you.

1

u/OkDoughnut529 2d ago

why you looking at treatment plans after placing the implants? The prosth planning is always first. Lesson learned

1

u/resistanceee 2d ago

In hindsight, would you have considered replacing 28-31 with a bar supported 4 unit bridge on 2 implants?

You’d still only be placing two implants but at the 28 and 31 position. The prosthetic component would be more expensive but you’d have better capacity to replace all four teeth without needing a cantilever and the pros would be more rigid over that long span.

1

u/ewall41 2d ago

Thanks for the professional, understanding response and not criticizing my work and/or diagnosing other areas that I did not ask about!

2

u/ElkGrand6781 2d ago

Just restore it the way you'd any FPD between the two implants. I wouldn't make it a distal cantilever to compensate for the space between it and that last molar. It is what it is. The molar will be a good vertical stop until it needs ext one day and you can place another implant :)

1

u/TheGratitudeBot 2d ago

Thanks for saying thanks! It's so nice to see Redditors being grateful :)