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Fishorsealant

Best option here in my opinion is to leave the gap and save for implants.
Only concern would be space loss with the 7 drifting mesialy affecting future treatment. Even though I know this is unpredictable.
However I feel that the risk of this happening is still better than damaging healthy abutments.

davo10

Bang on, if 16 is present, then 46 is the first implant to consider. Tell him about post xla resorption and that the sooner he can have an implant(s) the better. If any of the teeth fracture during removal, split the roots and carefully remove with a luxator/periotome making sure to preserve the buccal plate of bone, if you break the buccal bone with forceps/surgical, an implant becomes a lost harder.

Your/our job is to lay out the options giving the benefits/drawbacks and then if asked, give a recommendation, but you can't make a patient chose an option. I always finish that conversation with "there is no right or wrong option, all I ask is that you consider all options and decide what is best for you"

Dianthus

I would also add to this that you have a choice in what type of treatment you yourself choose to provide. The best quote I ever heard was from a prosthodontist who said "I'm a dentist, not a lifeguard. I have the option of choosing who& what I put myself at risk for".
Also, when you're talking virgin abutment teeth, any pt who is shown an image of what an actual bridge prep/core entails, will unfailingly opt to preserve their healthy& intact teeth. So make the consent a very full& informed one.
'Re drifting- consider Essix retainers to preserve the space?

patem2ar

removable partial denture if not willing to place a bridge.its predictable durable functional.

SM35

The conversation I have here is based on the survival of the teeth either side of the gap...
Implant placement better than (>) no treatment > bridge > partial denture...

davo10

SM35 wrote: »

The conversation I have here is based on the survival of the teeth either side of the gap...
Implant placement better than (>) no treatment > bridge > partial denture...

Have to disagree with you there, no treatment after loss of three of four sixes means significant reduction in chewing capacity, drifting/tilting/over eruption of multiple teeth, significant difficulty in later pros treatment and probable cosmetic implications. If the patient can't afford implants now but might in the future, space/axial maintenance is important. Even intermediate marylands/ partial denture with a thin lingual bar connector should be considered before doing nothing at all.

Missed the last sentence of fishorsealants post about not doing RBB off 5/7, if he/she preps small rest seats on opposing surfaces, RBBs would be ideal intermediate solution for a couple of years provided bone loss is not excessive.

patem2ar

how unrestorable are the 6s? hemi section and cantilever crown (obviously with careful occlusal management and mticulous periodontal assessment) could buy you a few more years. Not easy to do but in the right hands and with the right case selection could work well.

SM35

davo10 wrote: »

Have to disagree with you there, no treatment after loss of three of four sixes means significant reduction in chewing capacity, drifting/tilting/over eruption of multiple teeth, significant difficulty in later pros treatment and probable cosmetic implications. If the patient can't afford implants now but might in the future, space/axial maintenance is important. Even intermediate marylands/ partial denture with a thin lingual bar connector should be considered before doing nothing at all.

Missed the last sentence of fishorsealants post about not doing RBB off 5/7, if he/she preps small rest seats on opposing surfaces, RBBs would be ideal intermediate solution for a couple of years provided bone loss is not excessive.

I was recently at an ITI talk where the visiting prosthodontist presented long term rates of survival of teeth either side of a gap, and the odds ratio of survival of teeth adjacent to an implant was almost 100 times that of teeth adjacent to a partial denture over ten years.. I agree a hygienic partial or maryland bridge will help preserve occlusion, but if the patient was considering implants within a few years, I would be inclined to do nothing for a while..

digzy

Fishorsealant wrote: »

Looking for some opinions on this case.
Patient in 30s.
26,36,46 xla, unrestorable.
All other teeth good.
7s and 5s unrestored.
Can't afford implants.
Wants teeth replaced after I extract them.

Is there any ideal option in this case?
No chance of conventional with virgin abutments.
Not going to RBB a 6 off a 7 or 5.

I’d say I see this case about 4 times a day!
Gross caries. Tx options are rct or xla. The molar is extracted because the px can’t /won’t afford
Rct. Yet they think that they will have an implant in a few months/years/ ....etc

You px may need 3 implants. It’ll cost him between 5-10 k depending upon where he goes.
He’ll get no implants if he can’t afford bridgework now! won’t wear partial dentures and you’re asking for hassle putting a rbb there.

I’ll bet ya a few beers in the gingerman he’ll have no tx to restore those molars so do yourself a favor and don’t waste your time!

Fishorsealant

Where can I find the new criteria for using amalgam?