Topic

[Diagnostic / Planning]  sinus lift or not. 16


Hello

I have here a 60yo healthy female. with good OH. 

She has a DB root fracture on the 16 bridge abutment with a deep localized pocket. My main concern is continuous infection leading to possible failure of the the existing 17 implant.

Treatment options:

1- split bridge at 15/14 junction. exo 16. leave empty or removable denture. (Pt, does not like that)

2- Hemisection of the DB root and GBR the defect, and hope we don't have a food trap. (substandard) 

3- split bridge at 15/14 junction, exo 16, GBR, implant 15 and unscrew 17 crown and place a new abutment and a cement retained three unit bridge. I don't think the angle of the 15 will allow for parallelism to place a screw-retained bridge. 

4- split bridge at 15/14 junction, exo 16, GBR, implant 16 and implant 15. 16 can be screw retained, but 15 would have to be cement retained with temp bond. 

I like option 4 but Now concerns are...

 - I have just about 8mm to place an implant in at the distal corner of the implant 16. Should I (1) use CASK kit to raise the sinus and place a 5x8.5mm. or (2) use CASK kit to raise the sinus, allograft/PRF, and place a 5x10mm implant. Both have their pros and cons. I prefer not to place any allograft in case it gets into the sinus. But the 8.5mm might not be strong enough. can I splint a screw-retained 16 to the cement retained 15?

What to do...what to do....


Any advice is appreciated.

regards

Keyhan



by Keyhan Alavian at Sat, Apr 15, 2017 10:47 AM

1263 Views | 3 Replies | Avg Rating : 5.00

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Replies


Likes : 2

Mark Kwon Replied at Wed, May 3, 2017 6:11 PM

Hi all,

All options above have pros and cons as you have indicated.

For me i would consider option 3 or 4.  If pt prefer independent crowns to be able to floss in between then separate implants #15,16 would be favorable.  If i want to do 3unit implant supported bridge then exo 16, Implant on #15 and make 3 unit bridge to #17. 

I think we can place fixture on #15 area to accomodate for screw-retained bridge work by starting the osteotomy palatally.  It does not have to be perfectly parallel to make implant supported bridge work.  Using non-engaging abutment connection ,  some off-angulation can be compensated.  Also there's option of using Multi Unit Abutment connection to achieve passive fit.  If Cementable must be done , you can always use occlusal vent-hole to allow excess cements to escape.

Good luck,


- mark



Likes : 1

Keyhan Alavian Replied at Tue, Apr 25, 2017 5:03 PM

Hi
Thank you for your response. I played around with the angle of the 15/16 implant to get them parallel (option 4). I think you are right. It may be possible to have a screw retained splinted crowns for 15 and 16 (picuture below). However, I just don't see how a I can parallel 15 with the 17 implant for a screw-retained three unit bridge (option 3). I think it may have to be cement retained. I have a feeling patient will not appreciate screw-retained crowns as much as I do and would prefer a cement-retained bridge to avoid surgery involving sinus elevation. 
I look forward to hearing your comments.
regards
keyhan



Likes : 1

Thayne Blunston Replied at Sat, Apr 15, 2017 2:35 PM

Keyhan,

I can't quite see the angle of the #17 implant but it looks like there is lots of bone over the #15 area to angle the proposed implant more palatally to enable long axis loading of an implant bridge.  Then you can consider extracting the #16, implanting the #15 and doing a cementable zirconia 3-unit bridge from the #17-15.


Cheers,

Thayne Blunston