Narrow ridge Straumann implant placement: thoughts?

Why not try straumann tapered 2.9 and graft. I love versah. Use it regularly, but not the biggest fan of ridge split. Like is better in maxilla than mandible.

I would need to see more of the radiographic views before being definite but with what you have shown me I think the ridge would be better suited for some of Peter Fairbairn’s methods using CP and CS grafts on the buccal aspect. If there is not enough initial bone to get primary stability (looks like there is) then perhaps do a tunnel technic followed by implant and buccal overlay about 3-4 months later. You can check out the publications here: https://ethoss.dental/publications/

I agree with grafting first to get more buccal and alveolar bone. With the diameter implants you are planning, they are still too close to the buccal plate and you will lose bone along with the gingiva. You will also most likely lose the interproximal bone between the implants. If you are still planning the Straumann implants after grafting, they have a 2.8mm that might work.

wow, that's a big defect. What is your restorative plan? Hopefully the patient has a long lip to hide the gingival and alveolar loss. You may very well need pink porcelain to fill the defect. The implant placement is the easy part, the restorative part is much more difficult. Hopefully you are working with a really good restorative dentist or a prosthodontist to help. I'm not a surgeon but, if this is going to be a cosmetic issue I would love to see more vertical and horizontal bone volume before the implants go in. Another outlier in terms of treatment planning is to place an implant at UL-2 since it seems to have the most width, then connect with natural toothUR-1. The surgeon can beef up the residual ridge with a soft tissue graft which would be more dependable than a large block graft and give you reasonable esthetics without pink porcelain.

Ridge expansion may work but may not be long term .I would do remote palatal flap, place two similar diameter implants you have mentioned and do a GBR with Bio-Oss and membrane secured with tacks and bury the implants. Re enter the site for second stage and transitional crowns placement in 6 months. You can either do a chair side transitional crown or take fixture level impression at the first stage.

The panoramic xray of this area does not show the adjacent natural teeth...…… it would be good if you took another xray and post it...….that being said, the gingival tissue is firmly attached and looks very healthy......I would make a crestal incision and slightly open the soft tissue just to see the crest of the ridge......then with a Piezo Cutter with a thin sharp blade, try to go as high as the sinus, and with fine chisels, split the ridge and fill in the space with Osseo Grafting Material that will resorb; by not opening a full thickness flap you will not have interfered with the blood supply...…..in 5-6 month you will go back to the area and place wider diameter implants using your Versah Burs, and you will have a decent thickness of buccal bone over the implants....but the message here is that you need to spit the ridge and graft.

With ridge spliting the smaller the segment the less vascular the plate of bone. That technique will have more bone loss as the crestal bone is narrower, and the rotated flap will put the crest bone margin even higher, creating soft tissue issues. I would favor GBR with TiMesh and PDGF/L-PRF, allograft combo to grow more ridge, and later a CTG which would resolve the deficiencies rather than risk creating a bigger one.