[Diagnostic / Planning]  Incorporating existing implants into New treatment?

Hi Everyone and Happy 2018!

I've got a case where implant have been placed at the 12 (failing), 11, 21 and 26 in the Upper arch.

The remaining teeth now have failed endo or decay under resto's and it has been decided that all existing natural dentition will be removed and Implant supported, full arch therapy will be done.

1) Do I keep any of the old implants?  

The 12 will be removed no mater what but the location of 11 is such that if I need to remove bone for the transition line, it may be an issue.  The patient does not have a gummy smile.  Do I keep the 22 and 26?

2) Do I need to reduce bone?  I intend to do guided surgery and this will be my first!  If bone removal is needed, do I use the Nsequence system?  If no bone reduction is needed should I use the Oneguide system or does any of this matter?

3) Depending on the above, should I be expecting to give patient some sort of transitional that gets converted or should I plan to deliver final prosthesis at time of surgery?  I need to brush up on my notes from the courses but I have yet to do anything like this and have not approached a local lab about this yet either.

4) What's everyone's feeling on just exo of 23 and 24 and placing a 3 implant supported bridge with the 21 as a cantilever and placing implants at the 24 and 26 area and bridging those to the the patient has two seperate implant supported bridges?

Any help is really....well helpful.  Thank you in advance with this case and I will be sure to post the results and journey as well.  

Cheers, Sokhi

by Sokhi Sandhu at Thu, Feb 1, 2018 7:38 AM

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Mark Kwon Replied at Fri, Feb 2, 2018 8:51 PM

Dear Sohki,

this is quite involved planning. 

1. How’s overall tissue health? Any photos?

2. How are remaining implants ? Besides -#12. Hard to see with your cbct snap shots. 

3. What is your final proposed prosthetic outcome? Fixed lvl ? Mua lvl? FP1 vs FP2?

Remember bone reduction and delivering allonx type of prosthesis is not for all cases. 

N-sequence can be a powerful tool but it is not a solution to overcoming difficult surgeries.  I would not deliver final prosthesis at the time of surgery. 

Please provide complete records for me to make adequate Tx recommendations.