Placing an Implant with Thin Buccal Cortex?

This is a case that can do well with an implant. There is ample volume of bone available. However, there is no indication of the opposing occlusion, so it is difficult to determine the optimal orientation for the implant to be placed. The vertical line you have there for the implant would seem to be too labial, it would be easier if it was able to be angled more towards the crest of the ridge. You have to determine the diameter and the length of the implant that you desire to place. It may be possible to expand the ridge slightly in channel preparation with Densification. You should be able to avoid more involved procedures such as ridge splitting. Otherwise you should be prepared to augment the labial region with particulate bone and a membrane. If this is done, it is first critical to perforate the labial plate with small round bur holes. A case like this is best done with surgically guided implant placement. This will make it simpler, safer and easier. If there is a likelihood that you will need to augment the labial plate then you should plan to raise a labial flap, starting in attached gingiva, which will give good reflection and access to the region and allow for any augmentation that is necessary. So it will be a challenge, but if you plan it out well beforehand and have a step-by-step approach in your mind then you should do just fine. You will always remember your first one! Best wishes

Dr Hunt’s explanation is excellent. You should follow his comments. Most particularly I suggest you use a surgical guide. If you do, almost all the work is done before you start surgery. With the right guide you can be sure you know where the placement will be (depth, angulation). One suggestion I would make is to initially mill a small amount of bone on the crest which will flatten the profile and lower the implant height fractionally. If you do this (and as Dr Hunt suggests – angle the implant a little more) then you should have plenty of buccal bone. Perhaps also review using a graft material such as Ethoss, as an alternative to bone and membrane. There is plenty of online information for you to review. In the end it is a clinical decision in regards to this. This is an excellent case for you to start with, but do your homework first and make life easier for yourself and the patient by using a surgical guide.

I feel this is a good case . It is your first case and it is a great temptation to put off your first placement until you find the “ideal scenario” in terms of bone quantity, quality and so on , In my opinion , you could wait forever until you find the ideal case . I totally agree with the previous comments . I feel that using a membrane is particularly difficult for your first placement - so tricky to position without it sliding out of position , folding or displacement . I really like EthOsss. No membrane needed . Look on YouTube . Simple to apply to boney defects and to increase the width of thin buccal / labial plates . This also supports the buccal soft tissue . Good luck.

Is the "thin buccal cortex" a problem?

To me this is all about where the opposing teeth are. Looks like you have plenty of bone unless the ridge is very lingual to opposing teeth. No doubt guided is easiest. Very easy to make a simple guide to help, if not doing computer guided. Two impressions,relate, set denture tooth to desired position, suck splint, drill thru tooth to desired position. Take to mouth, score bone for pilot drill, verify . Your on your way.

The above comments are great and are true and tried protocols. However, in my opinion, this a perfect indication for the use of an Astra profile implant. It has a sloped platform. It will follow the contour of the posterior mandible perfectly. I use these routinely on my posterior cases and have had no need to put the patient through unnecessary bone grafting . Look into it and good luck on your first case!!! M.A. Ganni DMD

This is a great healed site however your hesitancy in assessment leads me to recommend you work with an experienced colleague. (thinking of your patient here). He or she can show you production of a template guide and a workup for your case and be there at placement. These days you don't have to go it alone, find a colleague nearby and let them share their experience and do a good structured course on implants - they are not teeth! You will be able to see or dismiss the need for grafting or biomaterials when you have planned your case in more detail. Good luck it will be a nice case to begin with (not in aesthetic zone) and like all medicine and dentistry case selection is a most important issue for success and satisfaction all round.

What's up colleagues, its enormous article about cultureand fully defined, keep it up all the time.