Prosthodontic Management of Unfavourably Positioned Implants

Abstract

The success rate of implant therapy has improved up to 90-95 %. This can be attributed to a numerous factors namely proper case selection, improved diagnostic and radiographic techniques, good softwares for treatment planning, improved surgical equipments, good surgical techniques and sophisticated implant design. The cost of advanced diagnostic techniques and treatment planning software can sometime limit them from being used routinely. In such unfortunate situations, older technique of exposing the ridge and placing implants wherever possible without regard for favorable implant position or angulation is still being followed. This case report describes prosthetic rehabilitation of a partially edentulous patient who was abandoned by a general practitioner after implant placement. Five implants had been placed in the maxilla in prosthetically unfavorable positions and angulations. Castable abutments were then used and a single bar was cast. This bar was then incorporated in a FP3 type of a fixed maxillary prosthesis opposing existing fixed partial denture in the lower jaw. 1 year follow up shows stable implants, healthy peri-implant tissue, minimal probing depth and no radiographic evidence of pathology.

Fig. 1

Preoperative

Fig. 2

Castable abutments secured to the implant analogues show the unfavorable position and angulation

Fig. 3

Wax-up ready for investing

Fig. 4

Fit of abutment bar after ‘Cast joining’

Fig. 5

Occlusal view of prosthesis

Fig. 6

Intaglio surface of prosthesis

Fig. 7

Occlusion of prosthesis