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Molar restoration

From: Dr. Kwan To: Sent: Wednesday, May 12, 2010 9:47 AM Subject: Molar restoration Upper and lower molars are multi-root teeth, it make sense to support a large mandiblular molar restoration with 2 or 3 implants for a large maxillary molar - Kwan

Dr Kwan, with all do respect. that thought went out the window in the early 90's. Dr O. Bahat in Beverly Hills i think has the world record (tongue in cheek) for most implants in a case, was routinely placing 2 for a mand molar and 3 for a max molar. this is no longer done. the maintenance isssues and loss of inter-implant bone due to proximity issues being the formost concerns a savvy surgeon will have - Dwayne Dr. Karateew, Yes, you are correct, 2 implants supporting a molar is no longer done, as a matter of fact, it was rarely done. I think the main reasons was 2 regular size implants are too big for average molar space and the restorative nightmare for the abutments being so close together and they are usually at the back of the mouth, so we really did not have enough cases to look into the "maintenance issue" or data to suggest there are loss of inter-implant bone due to the splinting of crowns between implants. I do not remember Dr. O Bahat to have the most implants in one case nor his 2 implants molar concept, he certainly was known to me as the creator of the "anatomical Abutments" in the 90's for Sterio-oss then the whole industry caught on like 3i , NBC etc., immediately all the implant catalogs increased by at least half a kg, just imagine, 28 teeth, different sizes at $250 each, and they hired many opinion leaders to speak on the importance of emergence profile, esthetics and all the likes....that was probably the fore-father of the concept of Custom abutments manufacturer like Atlantis, but now it is $450 a pop. I mentioned this because over the years I have seen different products and treatment fashions promoted by many different leaders in implant dentistry supported by the big implant companies, and then become "Passť" like in the Fashion industry. If our treatment decisions are dependent on what is in fashion then our patients will suffer, because the implant companies have to forever differentiate their products in order to sell. I am sure all molar restorations supported by wide diameter implants, single implants or even mini-implants are doing fine and have no problems, no bone loss, no fractures, no screw loosening etc. etc. but the fact remains when we look at the 2 implant supported molar crown, it make a lot of common sense for long term support,.and the last time I look at a pericapical x-ray of a natural mandibular molar it has mesial and distal roots. - Norman ah, i agree the trifecta on a max molar is passe and not a good biologic idea, but i would disagree that the use of two mandibular implants is no longer done. in fact, on some molars that are very wide m/d, it may be preferred to one single centrally placed fixture with long arms extended mesially and distally. for sure it is not done as nearly as often as we once did, but i for one still give it at least passing consideration in my differential treatment planning - Gary

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