Dear Spear Community,

I would really appreciate your input on one of the cases Im stuck in the middle of.

Pt presented with #7 implant placed and scheduled for #10 implant (pictures attached) and CC: "I dont like the flipper". To address the CC I did temporary bridge 6-11 while implants are healing as pt was going to redo the upper anteriors anyway. As you can see on the pictures: he is a grinder, lost some VDO, no canine guidance, has in the bottom front only #22-27. He doesnt have any posterior support and the bite is held by the front and the bridge. Over a few months the bridge cracked few times mostly in the canine region. I made lower flipper for him to give at least some support on the back, however i doubt he is wearing it. He is ready for final impression now, however I am worried about his bite and at this point thinking about my next course of actions:

1. should i open the bite first with lower flipper, than build up the lower anteriors and only after that do the final impression and restore the top?

2. should i complete the top and than open the bite and finish the bottom?

3. should i do PFM with metal occlusion on the top vs brixzir taking into account that we are going to restore the bottom?

4. would it be better to do the bridge in the top as a final restoration? if so how to proceed as he has #7, #10 implants?

Thank you very much for your feedback.

Sincerely,

Yuliya

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