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Hobin posted an update
Patient wants #12 and #19 replaced with implants.
I was going to try to increase her VDO using a partial for #19. Would you replace #13/14 to gain more space as well? How would you approach this case?
Erick, Ivan and 2 others5 Comments-
Without having a lot of information and just taking a look at that cast tge plan on number 12 seems to have plenty of space the concern I’m sure for you is number 19. I would extract and graft number 18 and then number 14, potentially 13 and 14 could have crowns to open up more restorative space and you can even do some alveoplasty on 19 prior to placing the implant and place the implant deeper so you have plenty of restorative space. You could do all of those or just some of those as needed, which would be pretty straightforward.
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Can you provide any additional pictures of the case? Or even just of the models. Can we see some occlusal model pics?
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Sorry didn’t take many pictures prior to sending it off to the lab.
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One of the cardinal rules for implants IMO is to establish stable posterior occlusion. We’re already missing most of the molars on the lower arch. I think that seems like a good place to try to establish a good foundation.
The contralateral side is missing the posterior stops as well.
I think mounting the case on an articulator, and redesigning the case with stable stops on the mandibular arch. Can 19 and 30 be implant sites? You might need to open up the patient’s occlusion to make it happen.
For sure the opposing teeth would need to be reviewed. Do you have a pano? If some upper teeth are extracted to facilitate space, we’d need to see bone height availability.
My concern is that these cases can get a bit expensive. You want to make sure you’re spending the patient’s money on the strategic moves that will lead to more stability in the future–so that you can keep improving their overall situation. I’m concerned that the hypothetical partial on the mandible might be a temporary fix.
Thank you for sharing! I’d love to hear your thoughts.
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@ivan-chicchon thank you everyone for the feedback. It is extremely helpful. I added the pano
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