Thoughts on Challenge due to Significant Concavity in Implant Site?
This patient desires implants in #3,4,5 sites. #5 was recently extracted with graft placed at #5 site. My concern is the amount and location of quality bone. From the axial view you can see the #5 site has a significant concavity. From a restorative perspective, the crown would be placed outside of the normal arch form. Vertically there is minimal space, perhaps 6 to 10 mm for placing implants. I have done several cases similar to this, but there was slightly more bone and it worked out fantastically. What would you recommend? Horizontal ridge expansion? Sinus lift? Patient would rather not have additional bone grafting, but she says she will do whatever I recommend.
5 Comments on Thoughts on Challenge due to Significant Concavity in Implant Site?
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Dennis Flanagan DDS MSc
11/16/2017
Split the ridges with a scalpel, D channel former then Densah burrs. Do not try this unless you are trained. The AAID Maxi Course is a good start. Multiple short implants would work well here 3.2X8.
Nehal Sheth
11/18/2017
You can expand it in cocavity site
Dennis Flanagan DDS MSc
11/18/2017
Yes but the osseous cut needs to be parallel to the palatal bone contour. If the cut does not follow the palatal bone contour the facial segment will be too thin or there will be formation of a detached facial segment.
Michael Walker, DDS
11/18/2017
Yes.....that is true. Thing is, expanding bone will still place the body of the implant well medial to the arch form. I would have to angle the implant then place an angled abutment. Makes me nervous to put lateral forces on an implant at that location. Another challenge is that there is minimal keratinized tissue lateral to the B -L midline. Since I think I can work with sites 3 and 4, I was thinking to do a particulate graft at site 5, perhaps using xenograft with non-resorbable PTFE or titanium mesh membrane.
Nilo Faria, DDS
11/21/2017
I would expand the bone less than the implant width and place it.
