implants - the journal of oral implantology UK Edition

34 I I clinical _ implant retained crowns implants1_2012 Fig3_CrestalIncision/RidgeR.No buccaladvancement.Note extractionsite Fig4_UL45Placement.Noteheadof implantUL4ismesialtoextractedsite Figsd+e_Periapicalswithosteotome inplacetocheckpositionand tenting.Firstat10mms,thenat 16mminternallyliftedby2mms.Note changeofangulationofUR4toavoid sinus, andinanareaofgreaterbone quantity. Figf+g_Implantsingoodposition. Bonelevelsnoted. plant length can be considered. I felt that the lining could be successfully lifted internally, therefore placement of 16mms implant with a internal lifting length of 2mm for the UL4 and 10mm implant for the UL5. This would provide a greater surface area for integration. This would have also allowed a greater than 4.5mm space between the two implants and 1.5mms between implant and tooth structure. A pros- thetic stent manufactured by the laboratory would guide the final position of the implant head for the UL4, and the implant can be thus angulated mesially. The UR4 also had a mesial defect, and long term this will require attention but due to fi- nancial constraints, the patient did not wish to have any treatment to this tooth at this time. I advised her that if her periodontal health de- teriorates, further bone will be lost, and the placement of an implant may require augmen- tation procedures however, following this dis- cussion, the patient was content to continue to monitor this tooth for the time being. _Proposed treatment I outlined and discussed with the patient various treatment options that included: • no treatment • dentures (both cobolt chrome and acylic) • conventional bridges • implant retained crowns Following this discussion and taking into account the patient’s verbal and written deci- sion to have no treatment of the UR4, the fol- lowing treatment plan was proposed: 1) Removal of upper left bridge and maintain- ing the UL6 as a crown. It was important that the patient had already been made aware that a new crown would be required if the UL6 crown was not intact after the bridge had been divided. 2) Replacement of the UL4 with a dental im- plant, which would be angled mesially to 16 mm length, 3.5mm width, internally lifting the sinus membrane by 2mm. If there was an acute infection at time of surgery, the treat- ment would be abandoned and healing time of six weeks to three months allowed. If there seemed less bone available than anticipated, or the socket was not intact at the crestal level and 5mms from the crest (as the implant was not being placed in the socket) then the wound would be closed off and reassessed at a later date. Replacement of the UL5 (as long as there was no acute infection present with UL4) with a 10mm long, 3.5mm wide implant supported crown. Should the implants be in position and adequate soft tissue was not present then a palatal flap would be considered. 3) Temporisation with a small denture avoiding the soft tissues. This would prevent movement Fig. 3 Fig. 4 Fig. d Fig. e Fig. f Fig. g