Severely resorbed lower mandible: implant locator overdenture?

you have done a good work up. i am not sure of your qualifications or expertise but i would suggest referring this one off.

You are likely to fracture this mandible if you attempt implants. Don’t do it.

Thank you for your nice images! In my residency we looked at spontaneous mandibular fractures after implant placement. We had 10 fractures that we evaluated. (none involved a pool cue to the jaw). The height of the mandible is not the critical factor it's the width. We routinely went through the inferior border of the mandible with the old 7mm long Branemark fixtures. To avoid a fracture, there needs to be at least 2mm of bone surrounding the implant. Also, all fractures occurred within the first 3 months of implant placement and none after loading. So... with that being said, it appears you have enough bone for implants without grafting. In the severely resorbed mandible I try to get 4 implants in to retain a fixed hybrid. These patients have such an atrophied residual ridge that wearing a tissue borne denture even retained by locators, is frustrating so if you can get the pressure of the tissues it's a huge help. I talked with my surgeon and he routinely goes through the incisive branch of the IAN since it's only function is innervating teeth, so don't worry about the branch, just watch for the mental foramina and try to get 4 implants in if you can. Best of luck!

site 23 & 26 implant locator

I love the "where is the mental foramen" who-done-it . :)) Hello? On a mandible this resorbed it has "migrated" to the edentulous crest! Palpate the edentulous crest carefully and you will find it. As for the rest: impinging on the IAN in the intercanine region in a fully edentulous mandible is not a problem. Causing a possible mandbular fracture is. That said, the best solution for this case, by far, is mini-implants with locators in the inter-canine region, and a denture with a soft tissue base. The mini-implant locators are only retaining (but not supporting, therefore not rigid) allowing the denture to "float" slightly when necessary, and the soft tissue-side of the denture will prevent IAN trauma and pain.

unless you have lots of experience you should refer out.