Prosthodontics & Occlusion · patient case question
What must be addressed BEFORE the implants are placed?
Patient case: Asthma on two inhalers, with posterior teeth planned for implants
Patient: Male, 48 years old
Chief Complaint: “I want implants to replace the two teeth I lost.”
Background: Asthma, well controlled. Uses ALBUTEROL as a rescue inhaler and SALMETEROL twice daily with an inhaled corticosteroid. Last attack over a year ago. No other medical history.
Vital Signs: BP 126/78 mmHg · HR 74 bpm · RR 16 · SpO₂ 98%
Findings: Teeth #5 and #30 missing for several years. Clinical photographs show a POSTERIOR OPEN BITE, with the unopposed teeth in the opposing arches SUPRA-ERUPTED into the edentulous spaces. Radiographs show good bone height and volume at both sites. Periodontium healthy.
Show answer and explanation
Correct answer: D. Correction of the occlusal plane, by intruding or reducing the supra-erupted opposing teeth
- A. The radiographs are explicitly described as showing good bone height and volume. Grafting solves a problem this patient does not have.
- B. There is no infection and no indication for antibiotics. Prophylaxis at placement is a separate question and does not substitute for restorative planning.
- C. An interim denture may be worn for aesthetics, but it does not correct the supra-eruption and does not resolve the space deficiency.
- D. CORRECT. Years of unopposed function have allowed the opposing teeth to SUPRA-ERUPT into the edentulous spaces, collapsing the occlusal plane and consuming the INTEROCCLUSAL RESTORATIVE SPACE. Place implants under that and there is no room for an abutment and a crown of adequate thickness, the emergence profile is wrong, and the restoration is loaded off-axis. The occlusal plane is corrected first — by orthodontic intrusion, by enameloplasty and crowning of the supra-erupted teeth, or in severe cases by segmental surgery — and the implant position is planned from the RESTORATIVE end result backwards.
Note: What this item adds is the sequencing decision that follows from it. The governing principle in implant dentistry is that treatment is RESTORATIVELY DRIVEN: decide where the tooth must be, then place the fixture to serve it — never the reverse.
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