Can this site be made suitable for an implant?

Thank you.

It just doesn't make sense to blindly cut into the mandibular cortex blindly with a non specific lesion which really won't affect the outcome but so be it. You have the available CT scan to do a guide. I don't understand why patient's don't have a barium lined surgiguide in place when the CT scan is in place so that the lesion can at least be located or avoided radiographically. It is just good surgical planning. Also the density of the area in hershfield units could help aid in the diagnosis. It is a more conservative approach. Also a literature search to see if there are any cases that have implants placed in sclerotic less vascular bone and if osteointegration is affected. The above posts indicate biopsy, why not do it in a skilled,planned manner. These lesions are difficult to visualize,benign and hard to remove that's why they are left in situ. This is difficult to biopsy without a radiographic guide and the bottom line is where the implant will be placed. You started the technology with the CT so learn how to work with a guide otherwise I feel the patient is being exposed to a lot if radiation and a blind biopsy near either the canal or thru the healthy bone, lateral plate, that you need. Just how many of these have you done? Get some help with this to avoid trouble . Thanks for reading ,

I like it

Not sure what the above comment is implying about experience, just because another doctor has a different opinion from yours, does not mean it is invalid. You are still suggesting a blind technique when there is the availability of a CT scan for the guide. This is just basic treatment planning and biopsing for the implant position. Pretty straightforward. I find that the trephines get burned up pretty quickly especially in this type of dense bone. I think that the patient deserves a well thought out approach. Also being your own pathologist is probably not wise either. A patient should not be a learning experience for a relatively new implantologist, it is not about about pearls but about diagnosis and judgment not about how good a trephine is. You need to have a diagnosis for safe implant placement, and know where the implant is planned in relation to the lesion. I actually have done many, many biopsies in the mandible over the years and feel very comfortable sending the specimens out to be decalcified and the cells examined for neoplasia. I don't think your Global microscope with 20x would have the same benefit. So let's keep an open mind "guy" and have respect for one's limitations and a healthy respect for other poster's imput. I had forgotten about the enostosis possibility and appreciate the other posters techniques and imput. Again thank you for taking the time to read, and try not to make it personal. Hopefully as you gain more maturity, humility and experience these posts will have more impact. Thanks

Dr. Jain a trephine does not cut bone efficiently and generates considerable heat. If you use a trephine to remove hard bone you will have a few millimeters of dead bone both surrounding the outside of the trephine and in the core sample you are taking for analysis. The area of dead bone presents as osteocytes without nuclei because they have been cooked. Whenever I use a trephine for a core sample I always seek to use the smallest trephine possible so I will then be able to remove the cooked bone with my finishing implant drills. Trephines can also mangle the core sample and produce inaccurate information so I now prefer using a long bur in a high speed handpience to get as accurate sample as possible. Greg Steiner Steiner Laboratories.

Dr Steiner I know there will be all that cooking of bone and for that you will use chilled saline, brand new trephine. The bigger goal here is to place an implant and not a biopsy (everybody agrees it just a benign hard piece of bone and nothing more than that) and using trephine would prevent you from getting veered off by hard bone and as a side benefit you will get a core for analysis although not perfect. If it was some cancer to be biopsied, then we cooking of bone will have to be considered. The surgical approach/instruments might be different. There is only one place where the implants needs to be placed ie prosthetic center and the thickness of the trephine acts as a guide to keep you in there. You drill to 11mm and take a small molt, hollanback, endo explorer, thin perotome and try to work around the core and you would loosen it out. Then take piezo to grind the bottom further as core could break at 8mm or so. Implant dentistry is awesome. Enjoy

That is the first thing I am going to do.

dro, there is no prior history available. The pt is an orphan who was brought here as a teen from eastern europe. I am treating her gratis. I am not even sure if there was an extraction or #30 never developed. Sent scan out to radiologist, waiting for his report.

I would be curious how the core would be removed since the inferior portion would be in very dense bone not marrow, and if you go too deep or move the inferior portion you may cause a paresthesia. And you are working blind.

Because under most circumstances a single crown on an implant will last 2-5 times as long as a 3 unit fixed bridge, with no risk of breakdown of the adjacent teeth, no risk of needing endo on the adjacent teeth, better ability to maintain the health of her teeth and gums. She is only 26 y/o, and in all likelihood she will have to replace a 3-unit FPD at least 2-3 times over her lifespan. Thus, an implant supported crown is the most economical and the least invasive treatment option, if it can be done.

not your decision gentleman, its the patients