My patient is looking to replace all existing crown and bridge in the upper arch and I wanted to review my plan and get some feedback as to the best way to proceed. She had the original reconstruction done in the 90's and is currently unhappy with her smile. She doesn't like the fact that #9 and 10 are shorter incisally compared to #7 and 8. She would also like to show more tooth when she smiles. I dont have pictures from the original treatment so I'm not sure if the incisal edges of #8 & 9 were level at one point and have since become uneven.

Her current situation is as follows:

1) SIngle crown #2

2) Missing #3

3) 3-unit bridge #4-6

4) Single units #7 & 8

5) 4-unit bridge #9-12 with #9 being a natural tooth and #12 being an implant (Branemark 3.75 x 13 external hex)

6) 3-unit bridge #13-15

She refuses to get any more implants so I have to work with what's there. I have decided to lengthen #8 and 9 approx 1.5-2mm so she will show more tooth display at rest and address her chief concern of showing more tooth when she smiles. I will be opening the bite slightly to accomodate the new length without changing the occlusal relationship too much. My proposed treament plan is as follows:

1) 5-unit bridge #2-6

2) Single unit crowns #7 & 8

3) 4-unit bridge from #9-12 with stress breaker built in (female attachment on disto-lingual of #9 and male attachment on mesial of pontic #10). I will plan to cement #9 permanently to reduce chance of intrusion and temporarily cement implant crown #12 for retrievability in case of screw loosening. Should I consider not doing the bridge and cantilevering #10 off of #9 and cantilevering #11 off #12? If I should go with the bridge, is this the appropriate design and will path of draw be an issue if I run into problems with the screw associated with #12? Or, do I leave the design like the original considering there has been no complcations associated with it aside from chipped porcelain on facial of #12?

4) 3-unit bridge #13-15

Here are the photos:

[image:Screen_Shot_2014_03_14_at_11_19_46_AM.jpg][image:Screen_Shot_2014_03_14_at_11_20_29_AM.jpg][image:Screen_Shot_2014_03_14_at_11_41_58_AM.jpg][image:Screen_Shot_2014_03_14_at_11_42_53_AM.jpg][image:Screen_Shot_2014_03_14_at_11_43_25_AM.jpg][image:Screen_Shot_2014_03_14_at_11_44_23_AM.jpg]

Any input would be appreciated. Thanks

-Dave