Place Implants at Mandibular Interforaminal region in this case?

Please provide a sagittal view of the radiuolucentcy. This case cmay be immediately loaded with 4-6 mini 2.5X16 implants . These would provide adequate retention and a very low percutaneous exposure and a long service life with a lingualized or zero degree occlusal scheme.

Dennis is right on.... we can see that there is plenty of bone in the height......but seeing the sagittal view is the key......so please supply this.

Kindly check here in attached pictures. I could provide any other information if further needed. Thanks

Place any implant size acording to the limitation of the bony structure. The incisive canal is not a factor. Why use minis when you can place regular size diameter implants?

Suggest you read Dr. Cameron Lee's article in a 2012 or 2013 issue Implant Dentistry (ICOI) in which he describes a bleeding event arising from an osteotomy into the incisive canal. Bleeding was finally controlled in the ED with potent hemostatic agent. Take away was no 15mm implants in the anterior mandible....13mm was suggested for maximum length, depending on the patient's anatomy. Valuable article.

Nice case for 4 régular implants. Dont go with minis or Narrow 3mm implants. Go 3.5 or 4 ma implants. Absolutely no problem with incisive canal. Just plan it Well.you must not have a lot of experience if you Ask that question, so good planning is that much more important. Good luck

Use a great implant planning software, a surgical guide and a lab. There are article on significant "bleeds" from placing implants in the incisive foramen region...do not "freehand"

Frank is correct. This case looks like there should be no problems using small diameter regular implants. I would not be that concerned with the incisive branch of the mental nerve. I might consider a small flattening of the crest of the ridge to make everything level and possibly add a little width.

Avoiding a bleed in the mand anterior involves checking the CT for the lingual artery. I am not aware of any other case report other than noted above. If you are going to place implants ANY WHERE near vascular structures you should have the different level of hemostatic agents as well as be comfortable in handling a bleed. Mini implants bend and break. In my own mouth I would want a 3-3.5mm implant at each site as feasible. Certainly the bone reduction is a consideration for adequate material thickness of the prosthetic.

The sublingual artery emanates from the lingual artery to supply the anterior mandible. The lingual artery gives of the sublingual and deep lingual. Anatomical knowledge is key. CBCT will not demonstrate arteries unless they are surrounded by bone. Mini implants are a good answer only when place appropriately. Control of occlusal loads is key in any implant treatment. Minis are a good choice in dense bone due to low percutaneous exposure, immediate loading capability and cost effectiveness. Dennis Flanagan DDS MSc DABOI/ID, DICOI, FAO, DABGD

dear dr.Flanagan, what does it mean "low percutaneous exposure" using minis? thanks. dr.Zahorec

Mini implants (2.5mm diameter) have much less of a circumference as they pass through the gingiva (percutaneous) so there is less opportunity for peri-implantitis. It has been my experience that minis do not get peri-implantitis when they are placed correctly with control of occlusal loading