Anterior Loop Implant Case Part 2: Place Two Implants or Four Implants?

Dear Colleagues,

Many thanks to all those who posted on my previous thread regarding implant placement into the neurovascular bundle in the anterior mandible. A particular thank you to all those who provided helpful advice, rather than criticism.

Firstly, let me concur with many of you regarding the fact that the anterior progression of the neurovascular bundle in this case is most definitely the incisive branch of the inferior dental bundle and not the anterior loop as I initially suspected before tracing the panoramic image from the CBCT- see attached pic I below.

However, it seems that this discussion has now shifted onto: “The appropriateness of placing implants into the incisive canal.” It is apparent that many members have varying views regarding this point, which is what I found when I consulted some of the local surgeons regarding this case. There is no doubt that there are many practitioners out there who consider insertion of implants into the incisive canal of the edentulous patient to be quite acceptable as there are minimal long-term clinically significant neural disturbances and any bleeding is “plugged-up” by the implant at the time of surgery.

This is the reason that I posted the question about how critical it is to avoid the neurovascular bundle in the anterior mandible. I don’t believe that we will necessarily reach a consensus on this but let us at least discuss our opinions in a spirit of betterment rather than criticism.

My 2nd question is regarding the possibility of placing 2 implants anterior and 2 implants posterior to the mental foramina. In this case (Pic 2), the posterior alveolar ridge height is good but it is fairly narrow in width. I could potentially fit in 2x 6-8mm RP implants bilaterally in the lower 2nd molar sites. Would you prefer to do this (and thereby avoid the need to place implants into the incisive canals) or would you rather place 4 implants in the anterior mandible (to avoid adverse biomechanical complications associated with flexion of the mandible during function)?

Dr. S

Pic I: Panoramic view Anterior Loop (see this case for background)