Posterior Implants Change Occlusion

A 73-year-old woman requests implant restoration at #18 and 19 (Fig.1).  The left posterior occlusion is Class II (Fig.1,2).  The right one is Class I because of small dimension of the restoration at #30 (Fig.3 (premolar)).  The normal size of the lower left molars will keep Class II occlusion (Fig.4), which may create cheek bite posteriorly.  To correct the occlusion to Class I, move osteotomies to the mesial aspect of waxed-up molars (Fig.6 white circles).  Finally a premolar crown and the 1st molar will be placed at #19 and 18, respectively.  The supraerupted opposing molars (Fig.5 arrowheads) will to be adjusted when the abutments are placed at the lower molars.

The lady has taken Fosamax for osteoporosis several years.  The medicine may cause osteonecrosis.  CBCT study does not show sign of osteonecrosis apparently (Fig.7-9).  Since the ridge at #19 is narrow (Fig.8), it is reasonable to have a premolar there after ridge trimming. 

A new setup of wax up is established immediately preop (Fig.10) to have atypical Class I occlusion between the upper 2nd molar and the lower 1st one (Fig.11 straight lines).  Take photos of the occlusion post cementation.

Return to Lower Molar Immediate Implant, IBS

Xin Wei, DDS, PhD, MS 1st edition 11/25/2016, last revision 05/31/2020