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Ho-Young Chung Replied at Thu, Apr 6, 2017 10:16 PM
I place typically place 6 implants on the maxilla not for long term implant stability but for A-P spread of implants for removable cases. I'm almost always doing a bilateral SA4 for stability of their prosthesis.
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Chad Denomme Replied at Wed, Apr 5, 2017 5:12 PM
Guys thanks for the info
your comments about a bar for removeable cases is well noted. Superior stability but more reduction then fixed cases. I guess more specifically if I have a nice spread of 5 implants with locators no bar does this decrease logeivity or health if implants long term if lower occlusion is not ideal or the patient is a Bruxer.
Should I be thinking bar for greater stability primarily? Should I be worried about my implants long term if removeable with no bar on individual locators.
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Mark Kwon Replied at Thu, Mar 30, 2017 3:01 PM
Bar-over denture tx planning is quite different than that of locator tx.planning.
overall, locator planning is much more forgiving than bar or fixed solutions. Often requiring vertical bone-reduction to compensate for the height requirement for bar structure. Bar supported dentures, however, when done correctly, will provide superior stability over locator option.
Lab cost is no joke however =_=;;
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Ho-Young Chung Replied at Thu, Mar 30, 2017 12:07 PM
There is no really right or wrong answer here when it comes to choosing removable (bar or individual abutments) or fixed option. What I can tell you is that the maxilla is much more difficult both surgically and prosthetically than is the mandible. The maxilla is both more difficult in terms of technical process and patient expectations in respect to function and aesthetics. All these factors must be taken into account when considering the options for your patient.
For example, do you have enough room for a bar? A removable option with a fixed bar actually requires more space than a fixed option believe it or not.
Is the patient a grinder or clencher? Do you have adequate A-P spread? A bar needs to be 100% passive fitting and this would be easier at abutment level rather than fixture level (MUAs will take up more space so use the lowest height possible). Is hygiene going to be an issue for your patient? What is going to be your design for the bar?
These are just a few factors that one should consider for your patient along with radiographs, CBCT, patient photos and models. No right or wrong answer but these considerations will guide you to a successful treatment plan.