Study Club Member Ivan
Study Club Member
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Hey there Ahmad! Thanks for sharing this case! This looks like an excellent candidate for an overdenture case, my friend.
Is this your first case?
I like your plan. I see how the anterior segment of the maxilla is deficient in bone so placing 2 implants on either side is great. You have massive amount of bone in this case. Will you be doing anything with the opposing arch?
Would love to hear these additional details.
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Hello William, thank you for posting this.
This is a very common issue and it is great that you did not actually break through the labial plate. Although it looks very thin on the CBCT in that region, if you flapped it you might find that there is still bone covering the implant and that no exposure is present. (I am not advising you to flap it!)
I don’t think that the positioning will compromise the long term success rate 🙂By the way, did you do some guided bone regeneration grafting at the apical area of the site?
I would be interested to see what an intraoral photo of the implant looks like. I invite you to share if you have one! -
Hello Ash! Thank you for being part of the community. this is the perfect place to seek guidance on this.
The #1 reason I have found that this happens is because the implant hits the bottom of the prep. Especially in harder bone.
To avoid this, I always prep 1.5mm beyond the desired implant length. Can you tell us a bit more bout the case? Any x rays to share?
Would love to hear if @suredds or @javohiros has experienced something similar and what their take is on it.
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This reply was modified 2 months ago by Ivan.
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This reply was modified 2 months ago by
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Hey man, thanks for sharing here! First off, no I don’t think you’re going to have to take this implant out. I think it’s gonna turn out just fine.
Secondly, you might not have as much bone as you think covering the implant. If that’s graft on top of the screw, it might resorb a few mm.
Be prepared to remove and shape bone a little bit for the surgery. I would recommend the round-gold diamond drill from implant club. You might end up spending a good 20 min just shaping that bone so that you can securely and passively get a scan body/impression coping on.
The worst case scenario in this case might be that the platform is a bit apical and the gum recedes a little.
I like to over-educate the patients about gum recession during esthetic cases. It’s important they know this is a possibility from the beginning so they are not upset in the end. I tell them that they might have some gum recession and that there is the option of gum grafting. And I go into that pretty thoroughly. It’s good to cover your butt with esthetic cases 🙂
Don’t worry man, it will turn out fine!
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Thanks for the post William! I think in this case, you should plan a GBR like @restoredsmiles suggested. Also, the shorter implants are the way to go here so you still have 2mm safety zone before the nerve canal!
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More info (pics & x rays) be helpful if you have it William. But in general, it’s not a deal breaker. Most likely you can restore it and if it is an esthetic concern you can plan to refer out for soft tissue graft in the future.
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Thanks for sharing! Do you have any intraoral pictures or radiographs?
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I’m with @suredds, Old school wax ups are the best!
You can do a new school wax up just using blue sky bio. You can add a tooth within that software that somewhat matches the patient’s existing dentition. Do you know how to add teeth in the software?
8-9mm MD length sounds reasonable. It doesn’t have to be an exact textbook size, but it should fit harmoniously with the surrounding teeth.
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Hi Safanah, thanks for your post. Do you have any x rays or pictures to share?
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When I saw your question I called up Preat, according to them, no the different systems are not meant to be compatible with one another for the ASC screws and drivers.
If you get the components from a 3rd party manufacturer like Preat or DESS, they would all be compatible with the same screw head.
Also, I asked Todd Schoenbaum (author of Implant Prosthodontics) and he said he doesn’t think they’re compatible either.
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You’re very welcome! Hope it was useful!
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This reply was modified 1 month, 1 week ago by Ivan.
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This reply was modified 1 month, 1 week ago by
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Haha nothing gave it away!
I ask about the lower arch because of the occlusal plane. See how it goes up in the anterior teeth as those teeth super erupt?
I wanted to know if that occlusal plane will be corrected. It’s okay to leave it as is, but if the lower teeth were compromised also, it would be great to correct the occlusion with both arches.
It looks like you have decent bone volume. Will you be doing extraction and implant placement immediately? Guided or free hand? I just posted a video today of a simple surgery that looks very much like this case. Here’s the link: https://youtu.be/DnqevKAabYk?si=cEbU351oJ1lapkGb
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I like that you harvested bone chips. I think this case will be okay, it is not ideal that the threads are out of the boney housing, but I think if you monitor the soft tissue closely this may not become a problem for you. Its a good thing to keep in mind for the future.
I’ll bet this case goes just fine.
If you did want to consider hard or soft tissue grafting, I would send this one out to a periodontist before restoration. They may or may not recommend grafting. Its one of those situations where there is no right or wrong answer.
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Great to hear @Williamwy1994 ! It looks good to me. No need to worry. Actually a high five is in order!