Anterior Implants: Perforate the Mandibular Incisive Canal?

We need to see the sagittal oblique images to determine if that is a loop or an extension. Severing a loop will cause a parasthesia. Severing the incisive canal is basically a non-event.

i would like to know this as well

Don’t do it. There is often an artery associated with this Canal and this could cause a major hemorrhagic event.

No problem at all. We do this every week. Allo-on -four or any other system will work for this. You have to extract remaining teeth. Do a bone reduction of approximately 6-7 mm in the anterior region where the teeth are extraxted , to reach bone thickness and have prosthetic space. You can then place 4 implants ABDF. You can angle the distal implants or put them vertical like we used to do before. If vertical, place the implants 5mm anterior to the mental foramen. That gives you room for a 3mm anterior loop. If angled, start right on top verticaly to the mental foramen and angle 30 degrees anteriorly. You wil be clear. These are not recipies. You need to review your scan, but it work well. I have not had sensory problems in the anterior area as long as you do not damage the mental nerve. Perforating the incisive canal is OK. You will get a little bleeding but it will stop rapidly and end when you place the implant. Major bleeding occur if you perforate the lingual plate and damage the lingual artery. This would be life treathening. Make a generous flap on the lingual side and probe the cortical plate to visualice where you are. If not used to do this, a surgical guide could help. This procedure is routine and probably one of the easiest and most rewarding as patients are allways satisfied. Maybe you could assist a few procedures, take some cadaver training so you will feel more comfortable. Why not a mini residency? Or an All-on-Four residency in Lisbon? This is a great service and a lot of needy patients in terminal dentition Good luck

I would like to thank all of you here in this forum for all the help and guidance that you have provided to me for this case. I was able to deliver two anterior mandibular implants for my patient today as part of the treatment which eventually would include all on four procedure. After surgery I took a small field CT Scan of the area to verify if there were any perforation of the lingual plate, everything looked great just like planned on surgical guide. I also followed up with patient for possible sublingual hematoma or mental nerve damage, patient is doing just fine. Thank you once more and your help is greatly appreciated and you guys are true scholars.