Proximity to Nerve: Length of Implant?

Length seems fine, but I would go a bit narrower, like maybe 4mm

Personally, I'd place the implant in the software and decide then. I would use a guide to duplicate the final plan. Without a guide, I think you are taking a chance. I don't take chances.

4.6 x 7 or 8 ...... width; at 9mm of ridge leaves 1.5 b/l if you’re dead on-but I like 2 mm around in addition a premolar doesn’t require such a large diameter. Lengthwise you may have 10mm but you want to keep 2mm from the IAC as some of those burs are 1+ mm longer than designated and another 1 or 2mm as a safety margin... it’s not worth risking. Getting a phone call or at the follow appointment to hear “ everything’s ok doc but I can’t feel my lip” is infinitely worse than an implant failing ...... gl

Why not do 4.3 or 5.0 diameter implant? And definitely shorter. You need to have at least 2mm clearance from the IAN canal. I usually stay at least 3 mm away to avoid any headaches. If you want longer, do some vertical block graft. IAN is about 10mm from the crest with error margin of the CBCT, length should be at most 7-8mm. Good luck

Hi I agree with width, but about length, personally I prefer to drill .5 to 1 mm longer than actual length of my fixture to have a little bit of freedom to insert implant deeper ,in case bone height is not equal all around. Plus pointed part of drills areusually .5 to 1 mm longer than length mentioned on them. So I won't go 9 mm, 8 sounds better for me

4.2x8. Angle slightly to lingual and you should be fine. Plenty of space with room for error. I would polish the mesial contact of tooth 19 to have better contact and less chance of food impaction during phase 2. Try using blue sky bio software for treatment planning. Helps visualize nerve and ideal implant placement. You can also fabricate a guide using the same software for flapless surgery. Nice case. Thanks for posting.

Your plan is fine. A 5.8 x 9 Biohorizon is what I too would use here. Do the ostotomy with 7.5 depth drill, take a PA and see exactly how much deeper you can safely go. These broad sites seldon have a flat crestal so after your crestal bone drill counter sink flush edge, you are going to be at least 2mm deeper than the top of the crest on your X-ray. I usually start off with a plan to use a BH 4.6 because the crest is too pointed and if can manage a 5.8 I would prefer the wider. Forget any advice to use anything narrower than 4 mm in these sites. Keep in mind the pointed end of the drill is deeper than where the implant ends up and do NOT push your luck. If you are closer than 2mm to the IAN you can injure the nerve by crushing the apical cortical bone onto the top of the nerve sheath so squeezing the implant in another 1mm (as we do in the anterior) is wrong. How much experience do you have with lower molar implants?

Digital guides will be the minimum standard of practice. You already have the CT. Just make a model (alginate impression is good enough), send the model and CT to a certified technician to make a digital guide.

On a stone model make a simple surgical guide ,then go Ankylos 3,5/9,5 or similar, flapless, 1-2 mm subcrestal , 3mm healing cap atop and should be fine :ok_hand:

I think length and the diameter of implant you are going to use is perfect . good luck