Maxillary 1st Premolar Buccal Concavity with Narrow Ridge: Treatment Options?

I would place the implant short of the sinus floor. No need for internal lift with 11mm bony height. The ridge appears wide enough for a 3.5mm diameter implant. Drill initial osteotomy with 2mm drill to depth then use bone spreading osteotomes to expand the alveolus. Exposure of the alveolus is the key in this situation to avoid perforating through the buccal plate. Design the incision with mesial and distal releases at the line angles of the adjacent teeth.

there is two way for this case; 1.bone split technique 2.bone spread technique: A.use of osteotom B.use of compression kit use of bone compression kit such as MIS kit is easier and no agressive and the reasult is good.try it specially for this case.

in this case, sinus lift is not necessary. you perfectly can install a 3.3 or even a 4.1, i suggest allograft in the buccal face of alveolar bone for improve the biotype, even if the threads are not exposed.... a better prognosis you will have. it looks a simple case.... but always must be careful good luck camilo

as long as there's a tooth distal to it, should be ok. May want to set the patient up for a GBR with buccal membrane. Flap, implant osteotomy, save the bone shavings from the drill, if no dehiscence, just install. If there is a dehescence, put the bone shavings first, then some mineross or biooss on top with membrane and close. Stitch it closed. The stitching being the most important. It's gotta be completely closed. Put tetracycline powder on the stitch, and put perio bandage on top. Rx antibiotic 10 days. As long as you are super anal about not getting infection, this should be a slam dunk. Good Luck!

Implants 101: Place when you have 2mm of bone circumferentially. Anything LESS is a compromise - PERIOD! Do compromises always fail? NOPE THANK GOD! But you know what really sucks? to loose an implant in an area that was compromised to begin with! Now you've got twice the grafting to do! HOORAH!!! Consider INFORMING the patient what will decrease or increase the chances of survival of the implant and move forward. Yes, some type of augmentation, or ridge split procedure should improve your boney mass. Yes, you can "fit" an implant in the given bone without doing anything and hopefully it'll all turn out nicely! Pick your battles wisely! BTW - Tanaka forgot a very important ingredient of any augmentation procedure - you'll need to perforate the buccal plate in several areas to allow blood to flow (hence angiogenesis). Your membrane is going to prevent influx from the tissue, and just by stripping the periosteum alone does not guarantee blood vessels will form thru the graft. Without angiogenesis, you'll loose your graft or have a very high rate of resorption. Please review the book "Tissue Engineering" by Lynch, Genco, and Marx page 92. Have fun!

Since patient refused graft, I would place a 3.3 and do it by compression/condensation (hartzell makes a wonderful kit), and i would place an 11.5 so to intrude lightly in the sinus for better initial stability and that will give you a good result. Is the patient aware of the probable lack of cosmetic result?

Thia case can be well managed with bone expansion and placing an implant of reasonable size. Try to maintain at least 2mm buccal bone thickness and give at least 6 to 8 months prior to restoration. There is no need to raise the sinus.

bone spreading using osteotomes should be ok for this case. Insert implant utilizing the full height avaliable.

IMHO- 1) use a 2.0 pilot drill 2) take a p.a. w/ guide pin or pilot 3) use a tapered 3.3 x 10mm. tapered screw implant to gently spread the type 2-3 bone w/ engine then hand wrench.

This case seems good for bone expansion. Tatum surgical makes kits to expand the bone. One can fairly predictably place a 4x14 Tatum S implant in this site. This is not so easy unless you know what to do and how to do it. You can learn these types of techniques at Dr. Jose Pedroza's hands on course in San Juan Puerto Rico. Dr. Tatum attends and instructs in most of the sessions. There is probably no better qualified person to learn this technique than from the master that has perfected this modality.

Dear Dr, your planning is the very good for the kind of patient you have, You can use 3.3 x 1o straight, or 3.6,3.7 tapered implant, drill a little parallel aiming to go bisecting the buccal concavity and the palatal wall keeping in mind an angled abutment for the prosthesis,

I would use a 3.0mm x 8.0 mm Bicon implant...hand instrument the last reamer...no need to graft or split ridge...but inform patient that if any type of perforation on buccal or lingual some synthetic bone graft will be needed with GTR membrane. Up to patient at that point.

Looks like you have minmum of 4mm bucco - lingual dimension there, in this case you can expand the ridge easily in maxilla with osteotome to place a 3.3 or 4 mm diameter implant comfortably. The ridge may also be split quite easily also. Wouldn't worry about the sinus too much. you can tent it for 2mm no problem without graft. Just take your time expanding the ridge and tenting the sinus floor.

You can do the case with bone expansion/ ridge expansion utilizing osteotomes or ridge expansion kits like one from MIS or Meissinger . Plan the expansion beforehand such that there is sufficient bone ( 2mm ) around the implant after expansion osteotomy and placement You will need a good flap release to achieve primary closure over the implant site . In case you notice any dehiscence any where over the implant body after insertion , you may need to graft the site with a suitable bone graft and place a membrane over the defect .

you have enough height , try to split the ridge and place a 4.3

Not a big fan of bicon. Biohorizon 3.0 laserlok would work. This is a rare case that I may even say (shudder at the thought) a mini, 2.5 or so.

Be careful! Your patient is practicing medecine/dentistry . Regardless, you have the measurements, place the implant. Bv

On a related note, prescribe Augmentin for the sinus, then followup.

Mike, are you treating the ct scan or the patient, when you make that suggestion? A thickened sinus membrane or an opacified sinus, even, does not an infection make. This mentality, is exactly why we are getting super- resistant bacterial strains. Unless the patient is experiencing rubor, tumor and calor, then there is no need to give empirical antibiotics. Bv

Bv is correct as usual. Why over medicate. I would use a 2.0 pilot drill than install megagen anyridge 3.5 x 11.5. No compression needed. You can use this specially designed implant to compress. Just remember after installing at crest reverse torque 1-2 thread the reinsert no more than 45ncm.

I would use bicon 3.5*8mm implant, first use pilot reamer (2mm) after this 2.5mm and then start to expand gently,you shoud have minimum thickness 1mm of eache wall of your osteotomy,no need of full thickness flap elevation on the buccal side(because it will compromise blood supply to walls) if you dont perforate the wall.And of course no need to elevate the sinus.In case if you have dehiscence you can use "sandwich technique"- place autobone(its available if you use Bicon technique),subsequently put SynthoGraft and cover with resorbable membrane( for realization this raise full thickness flap with implication of minimum nearest 2 teeth Good luck from Ukraine

Well said BV , I would be exicited to have this much bone compared to most cases that get referred in , just raise a full flap so you can see what you are doing ( Scans may not be the full picture ) and x-ray your pilot to check angulations . Simple Peter

HI You Need Atleast 53 Space Buccopallatally.You Must Do Surgery For Expansion With GBR and Membrane At Buccal Side and replace fixture at the region same time and after 4 months you can load imp....

Dr. Kazemi, the patient refuses the graft. The case will be a bit comprimised, but it can be done without splitting or expansion. I would engage the sinus, ever so slightly.

This case can be treated very nicely with bone expansion via one of Tatum's techniques. The ADI Skinny or a regular 3.75 mm. will work very nwell.

I do agree with Dr. Vinci. This case can be done without ridge expansion or grafting. It is not a difficult case. One Doctor from the Ukraine mentioned using a Bicon implant. This will work very well.

From prosthetic point of view the space 7-8mm (mesiodistal) is too wide for the future first premolar restoration, and my concern is a possible patient’s cosmetic complaint.

Dr. Zavyalov, you may want to go back and read your dental anatomy text. 7 to 8 mm. mesial-distally is ok.

Hi Rusian , I did my flapless thing a few years ago , it is always better to know visiually especially in this type of case that you have not perforated . I still never trust myself and angles even after over 20 years of placing. Peter

Thanks Peter.I understand you.

BV, you are most correct. You have to stick to the basics of flap design.

A pretty straightforward case. No grafting needed...pilot drill then 2mm drill....expand for a 3-3.5mm any approved system will do .I would certainly flap this ...otherwise an easy case can get messed up.

Place the implant after using tapered osteotomes in the osteotomy. Place an onlay graft. It the patient won 't have the graft then don't do the procedure as it is in their best interest for the long term success of the implant.