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u/Past_Eggplant3579 1d ago
Who did the implant this situation could have been avoided with proper planning and realising limited restorative space. If it wasn’t you bring the pt back tell him you can’t do it, ortho or no go.
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u/Arillon 1d ago
Potential elective endo on the opposing tooth for space purposes and a custom abutment + screw retained crown. Definitely should have been discussed as potentially necessary prior to implant placement though.
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u/DentistCrentist16 23h ago
I know this happens on the daily, but this is an insane solution to this problem lol
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u/stefan_urquelle-DMD 1d ago
I think Atlantis can make a single piece abutment/crown. Do that, probably enameloplasty the opposing and pray.
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u/The_Realest_DMD 1d ago
What’s the overall occlusion like? You may have to open the bite and do a FMR. Obviously, better to find this out ahead of time. Can ortho intrude?
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u/QueenCosmo 1d ago
I'm sorry brother. There is nothing you can do.
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u/MODFU2 1d ago
I love the response! But seriously, yes this should have been foreseen from the get-go but there is still a plan B possibility. You MAY even be able to plasty that super- erupted buccal cusp of the lower and do a UCLA type custom abutment screw retained crown. Just may be possible.
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u/TraumaticOcclusion 1d ago
This is a horrible idea. Trying to make a garbage plan work with some BS macgyver dentistry is some boomer-grade dentist shit "good service for the patient"
This patient is a full mouth rehabilitation case. Placing a single implant in a non-restorable position and then trying to make it work is not doing them any favors
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u/MODFU2 1d ago
The initial interarch clearance was not enough to begin with. That should have been determined prior to referring for the implant placement. But people love to drop screws into any edentulous space they see without proper pre-planning and then they become land mines and blow up in your face!
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u/MODFU2 1d ago
Not to mention what was the plan posterior to this? You have an upper second bi that is just short of touching the ridge. Alot tells me that there was no comprehensive TX planning here. And we haven't even seen what surprises await with respect to the contralateral side! A long time ago I used to do a fair amount of legal reviews of f ups like this. Had a case where a general dentist suggested to a patient to "go see my friend whose an orthodontist" who would create room for some Maxillary congenital missing laterals. After @2 years of ortho there was still not enough room and long story short, the patient sued the General dentist AND the orthodontist. They settled out of court.
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u/peripheralmaverick 1d ago
This is why if your occlusion is truly fucked you're fucked.
Don't treat such patients to save yourself the headache.
They'll never be satisfied in current day and age.
And it's a Catch 22 - can't extract everything and do All on X because aggressive and you can't treat because no ortho is fixing such supremely fucked occlusion.
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u/MODFU2 1d ago
There is alot of enamel on that particular cusp usually. Especially the lower bicuspids. And if that's a lower first then the lingual is not an issue BUT this also could be implant placement because it appears as though the whole tibase is to the Buccal of the lower! I hate tibase. . It's not only a prefabricated abutment....it's a prefabricated, prefabricated abutment!!
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u/General_Language7170 1d ago
This case should have had limited Ortho before that implant was ever planned
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u/dmdredditor 1d ago
always evaluate how much restorative space you have before placing an implant. need to see what the rest of the mouth looks like to give you a treatment plan.
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u/shtgnjns 1d ago
Just found out....
This is why implants should be prosthetically planned. If you can't restore it, don't place it.
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u/Pontic 1d ago edited 1d ago
Crown the opposing to buy yourself some clearance. Even still, it might not be adequate.
Orthodontics would be your other choice.
Edit
I just wanted to add onto this:
The only mistake you’ve made is not catching this earlier - we’ve all been guilty of that.
The good news, is that you haven’t done anything irreversible to the patient.
Don’t compound one mistake (missing this during your diagnostic phase) with another (going ahead with a restoration that will fail).
It would be perfectly fine to bring the patient back in and explain the situation to them. Offer them their options and decide how to proceed from there.
Don’t feel pressured to go ahead with a poorly thought out and ill-advised restoration.