[Diagnostic / Planning]  Lower full arch - guided surgy-cantilever

Case is full lower arch . 6 implant fixtures are now in place. Patient is 74 yr old female , on blood pressure medications.

 She  now has a temporary metal reinforced prosthesis.   Note the cantilever segment in acrylic has cracked indicating stress level is significant .

My concern is the large cantilever at the lower left side.  This was created as a result of implant fixture  failure at #36 region . 

Best option appears to be  to place a new implant at 36-37 region, then complete the prosthesis. I am preferring to complete this in segments, rather than a fixed full arch .

My other concern is the health of soft tissues . Tissue response around these abutments is certainly not favourable . I have contoured the abutment profile, and will see her next week to inspect tissue healing and response.  I would appreciate any suggestions as to how to help  improve soft tissue .

by Madeson Basie at Thu, Jun 29, 2017 6:06 PM

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Mark Kwon Replied at Tue, Sep 26, 2017 10:29 PM

Dear Madeson,

so sorry for delay!

i do come up here regularly and get email alerts for new posts but this one totally slipped by! Omg

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Ho-Young Chung Replied at Mon, Sep 25, 2017 2:38 PM

Hi Madeson,

Our apologies for not seeing this post.  Not sure how or why but none of the faculty members saw your post until now.  

Dr. Kwon and Dr. Jin will have more to add.  Here are my two cents.

I think going abutment level in this case would be best.  Dr. Kwon is currently working on other concepts (as in not using MUAs) but for this case, going abutment level would allow you to bring back patient every 6 months for removal of prosthesis and maintenance (retorquing screws and hygiene).  I would not advise to go fixture level even with non-engaging abutments.  That is a lot of fixtures to have a passive fitting prosthesis.  That might be why you are leaning towards going with segmented bridges.  That might be favourable as well but inter-implant distance between the proposed bridges might be an issue with hygiene and emergence profile.I agree with you placing an implant at 36 site.  Having such a long cantilever would most likely pose future problems.  

I am assuming by now you have placed another implant and are waiting for it to integrate.  Best of luck.

Ho-Young Chung