Knife edge mandibular ridge implant placement?
I have a 40 year old patient who I treatment planned for implant supported fixed dental prosthesis in the mandible. On the panoramic radiograph the mandible has about 14mm vertical bone height. Its buccolingual bone width is 2.5mm and it has a knife edge ridge. What would be the best way to proceed on this case?
8 Comments on Knife edge mandibular ridge implant placement?
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David Bernhard
11/8/2016
Any imaging?
Montana
11/8/2016
2 mm of bone thickness should surround the implant; therefore, CBCT the patient and determine the bone reduction necessary to achieve minimal thickness. At that point, measure to see if there is still room to place the implants.
dr Zoran Milankov
11/8/2016
Just take a look
http://www.bicon.com/cases/
peter smilovits
11/8/2016
graft for width, ramus graft would be ideal
Brian
11/8/2016
Densah burs
Dennis Flanagan DDS MSc
11/8/2016
Do a partial thickness flap, carefully cut through the crest with a #15 scalpel. Or reduce the crst by 1-2mm and cut the crest with a #330 burr. Separate the facial and lingual with expansion screws. Then do the apical drilling for 3.2X10mm diameter implants. fill gaps with particulate allograft and cover with a collagen barrier strip and secure with 4-0 BSS. Cover with Rx Amox or Clinda and CHX. Pain 2 Advil and 2 Tylenol q4h. 1 week SR.
Yaron Miller
11/9/2016
Firstly cbt to properly rx plan. Post some images and photos to get best advice. Assuming some attached tissue which is unlikely I would do a full thickness flap with crestal incision slightly to the lingual. Relieving incisions one tooth beyond the edentulous area mesially and small hockey stick distally. Reduce crest by 2mm with piezo/bur, keep bone. Split the ridge down the middle with a piezo or Ridge splitting saw. Use densah burs to expand and create osteotomies to desired length probably around 10mm. Graft buccally and between the implants with particulate allograft bone mixed with prf liquid. Make sure you achieve good buccal and lingual release of the flap. Cover graft with prf membranes and close using a horizontal mattress suture at the crest to achieve a tension free closure. Interrupted sutures for the rest and the usual meds and post ops. No rpd or any pressure on the area for at least 2 months. If inadequate attached tissue you may have to go back and do a connective graft or free gingival as a second stage. Good luck, these are challenging.
Surov
11/16/2016
1. check anatomy on CT and make a plan for implant and prosthetics. Plan anterior support - teeth or screw implants, depebding on clinical situation
2. use HM 34IL 317 012 burr or piezo for longitudinal vertical osteotomy in posterior area
3. place blade implant; probably you could find them at Park Dental corp. USA
4. wait 4-5 months
5. put a bridge on blade implant connected to some support in anterior area
