Mandible implant rehabilitation: opinions?

Our colleague has asked for opinions, why the smart ass comment?? obviously, you can care less about helping other colleagues with this kind of an answer, people like you make me sick to my stomach that our profession is full of dentists who love to make fellow dentists look or feel like crap!! I am not a big shot implantologist , but I don`t see anything wrong with the treatment plan, he stayed away from the lesion on LR4, and maybe it`s enough to have a shorter arch from LR6 -LL6, but that does not mean this colleague is a hustler!!

Dear Dr. Very well planed case, there are no excessive implants in your Treatment Plan. I would treat the pathology before implant placement. Personally I would place an extra implant in the area of 4.4 once the pathology has been taken care grafted and healed. Keep posting and asking questions, we all learn from an honest exchange of ideas.

Why to extract those teeth? It doesn't seem to have any pathology that indicates extraction. Particulate grafting won't work?

It was simply a question VladS. I neither advocate or disagree with the decision. One could support the decision to extract if one felt that the restoration would not need further intervention if the natural teeth eventually failed and needed extraction. I personally would prefer to retain the natural teeth to provide proprioception.

I didn't mean to be offensive. It was just q question. The reason of the post is to discuss from our knowledge and experience different options in treatment plans. I am not familiar with bone expansion and that's why I asked about praticulate grafting.

No offense taken VladS. Using particulate grafting materials to augment the volume of a ridge is not predictable. If one can achieve the development of a wider ridge using simple bone expanders the results are much more predictable. In more extreme cases a ridge split technique can also be done with better results than attempting to augment with particulate grafts. Many companies offer ridge expanders. They are basically round ended screws that are placed in sequence to expand the ridge after an initial osteotomy is made with a 2.2 mm twist drill to the planned depth. In this case I would want a printed 3D surgical template to make the initial osteotomies. This is not an easy case. .

I do not know the brand of the cbct..it's a local center and they are very carefull taking x rays and ct scans and I fell in love with this software..maybe I can send you via e-mail a whole scan to play with if you want. A very rich implant library and a lot of parameters you can check.