i am working on a case with my surgeon and we don’t see eye to eye with the planning of a case. Patient only wants fixed case. there are several issues which i think may be a problem as to where the surgeon would like to place the implants.
i have attached photos (he is wearing a full upper denture), scan and the surgeons stent he would like to use. my feelings are that the anterior implants are much too lingual, which will create an unfavorable cantilever, as well as making the area almost impossible to clean. there is limiited interarch space, so im thinking of doing a screw retained chrome cobalt framework with feldspathic porcelain. i dont feel there is enough room for all zirconia, and reducing the bone any further is a problem as well.
as you can see. he is a Class III relationship, with moderate ridge resorption, both on the anterior and posterior, giving him a narrow, small tapered arch form. his lower arch is going to be restored with conventional C&B..19-20 implant splint, 21-28, 29-31 implant splint (cantilever #29 due to severe bone loss).
i feel the anterior implants are being placed way to lingual as seen on his stent. i also think , based on Misch Prosthetic guidelines, that a tapered ridge should have at least 7 implants. i am concerned of broken /fractured implants and screws, as his ability to to keep implants clean. im thinking in order to make a screw retained case, he needs a block graft the the anterior. otherwise an overdenture is the best option, although patient does not want removable. another thought is making a substructure framework, and than make a prosthesis that can be screw retained ith set screws. unfortunately this option would probably be too costly.
would like to here your input!
please note that lower model are prepared for the provisional he is wearing, but you can still see the relationship