Knife Edged Ridge Case: Recommendations?

Plenty of width. Reduce height so you can place widest implants possible. This is standard implant dentistry.

Dr. L Your patient is not a dentist and his decision is important to you as long as keep you to the right job, otherwise, you are as a dentist and should make a final decision not your patients. However,at least ridge split is recomended for this patient. As part of your job,you would explained to patients what is right for him/or her. Good louck to you, Dr. Vaziri from Iran

With a two stage ridge split ( not the traumatic single stage procedure ) you can have an ideal result, increasing the width of ridge and attached tissue simultaneously. These are not difficult, risky operations and have minimal post-op symptoms with little or no graft needed, no membrane needed. Beware of letting the patient dictate over sound advice and your own judgement. Those are the first ones to turn on you in untoward events.

Without any scale it is difficult to know exactly how far down you need to go to get adequate width. Would anyone out there consider mini implants? I've done cases both ways with success. Bruce Burgess

This is easy, small alveolectomy and place a 3.5, 4.0 or 4.3mm implant in the 23 and 26 sites using locators to retain the overdenture. Ridge splitting makes no sense in the anterior mandible since you have tons of height available even after a slight alveolectomy.

Hi guys, unfortunately the editors changed some of my initial presentation, but the bulk of content is there. I understand its difficult for you guys to comment without a scale but I would need to reduce the ridge by 8/9mm to get an adequate platform for a 3.3/3.75 diameter implant. Ive reduced ridges before but not to this extent. I was concerned with the prosthetic and surgical issues caused by ridge reduction to this amount

Not a challengimg case, dont overtreat it, reduce the ridge as much as you need to place 4 or 5 standard diameter implants and provide your patient with a fixed toronto bridge.

No question this is a mini implant case. Cheaper, simpler surgery same result with the overdenture. Too few people recognise the value of the mini implant in these atrophic mandibular cases.

This can be treated with standard implants, with, a bit of alveolar reduction. Show us the coronal and sagital images, or even the nerve and implant edit. Unless this patient is unwilling to spend a bit more, she is going to get an inferior product. Please don't split this ridge. If you are asking the question , then with all respect, you are not ready to do this "technique sensetive" procedure. There is nothing wrong with placing a 3.5 mm fixture, but try to at least engage the inferior cortex. I'll say it again( in a positive tone ), I have yet to see a mandible that couldn't be tx with traditional root forms implants. Bv

Ramp down the ridge and place root forms, not minis.

mini implants and u r good to go :)

Reducing the ridge till the width is wide enough for a conventional/traditional implant is one way. But minis is the better way. You can maintain the ridge height, complete the job at one sitting of at most 2 hours, minimally invasive and at a fraction of the cost of traditionals. As a dentist, and if this condition is my mouth, I will put minis in.... get my best dentist friend to put minis in. Go to "The resorbed mandible, best treatment plan", in this website. All the salient arguments are there.

The above mentioned ridge is not that atrophic. Standard 3.75 mm root forms are a OK. I agree with Dr. Vinci, do not expand the ridge and do not use minis. One needs more metal to bone contact!

Truth be told, there is way to much bone present, to ever co sited using minis. Why give a patient an inferior service, when one can easily place standard root form implants? Again, you need as much metal contacting bone as possible (cortical and trabecular)!

The minis I would consider, are those from Inta Lock.

You have plenty of bone . Defnitely no need for splitting the ridge ! Your initial plan is perfect . Forget what the patient tells you . simply remove the spiny ridge with rongers or a bur until you get wide enough bone and go for standard implants followed by Zest locaters.. Good luck !

Dr. Shalash, are you under the impression that the mini is as good of an option, as the standard, root form fixture? When you make the suggestion of placing the mini , in this situation, it makes me wonder , if you place traditional implants as well. I am going to encourage you to consider it, if not. Bv

In cases like this, a spiny ridge will not give you much to work with. I am wondering if you are considering just expanding the bone with bone expanders on the two implant sites? rather than removing more bone through ridge splitting. Unless you plan to use 4-5 implants on the lower anterior ridge which will make sense, but if you are only placing two implants, that will suffice. Bone expanders as you know just simply "expands" the osteotomy site to accommodate your desired implant size. Its also less invasive and easier on the patient. Less trauma and pain after the procedure. Besides, we dont want bone to resorb in that area? Do we? Unless you graft the area after ridge splitting which your patient doesn't want. Correct?