[Diagnostic / Planning]  Max Ant TX plan


I posted the question about anterior placement (place in LI or CI position) on the Facebook group a few weeks back but here are some of the images from my planning.

The pt had a trauma falling off a ladder. The teeth were fx through the roots and the B plate was damaged. I extracted the teeth and did some socket and B grafting and placed him in a socketed max temp RPD. I took a new CBCT and are planning case with OneGuide. My original plan was implants in #12 and 22 with bridge 12-x-x-22 but it looks like I have better bone for implants #11 and 21 with cantilever pontics, x-11-21-x.

1) Do you think this is a good plan?

2) Would you splint crowns 11-21 together for 4 unit or make separate implant-cantilevers?

3) Would you place immediate temp crowns or keep using flipper for best result?

4) should I place longer implants?

any and all advice appreciated.


mike b

by Mike Budrewicz at Mon, Apr 2, 2018 5:27 PM

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Ho-Young Chung Replied at Thu, Apr 5, 2018 8:18 AM

Hi Mike,

I would also do a wax-up.  This would allow you to check aesthetics and occlusion.  A lot can be seen on an articulator that can't be seen on CBCT and photos alone.  

Also, for future posting, please flip the pdf images of treatment planning to the correct orientation.  I had to flip my head sideways to look at the first 6 images.  

There are pros and cons of 12-x-x-22 vs x-11-21-x.  It is easier to get draw on 11-21 implants but then now you have a cantilever.  harder to get draw on 12-22 implants but then you don't have a cantilever.  For both options, you must consider occlusion.  The lower incisors appear to be supra-erupted.  These are all things we should consider carefully before taking on any case especially a bit case like this one.  Anterior implant dentistry especially multiple units present far more challenges than any single implant case.  

Keep us posted.

Ho-Young Chung

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Mark Kwon Replied at Wed, Apr 4, 2018 3:14 PM

Hi Mike,

 thanks for the upload. 

Here is my thoughts. 

1. You could place implants x-11-21-x. Four units. 

2. Place long implants if the space permit. 

3. Immediate depends on bone quality and initial stability. 

hope that helps. 

- Mark Kwon