Placement of total removable denture: suggestions?

Since you have Grafted the buccal, i would advise you modify the denture to not place any pressure over the graft sites and over the implants. Personally, i would hollow the area significantly and do a soft reline and consider shortening the buccal area. Make sure, Make sure no pressure is placed over the graft sites. BTW, the xray looks great and great job with your placement. a final thought, if you had good primary stabilility, a better option would have been to convert the denture and connect all implants. This way, you dont need to worry about pressure over the graft sites. Good luck and keep us posted!

in this situation rather than grafting ,cut the ridge down until its level and wide enough for your Implants. look at all the bone you still have apical to the anterior implants . use that bone by using a longer implant . Then splint the implants and immediately load them . I have been doing that for 30 years with tremendous success. A one piece implant like a Zive TG is perfect for this situation . the patient can chew on it the same day !

what kind of overdenture are you doing? I suspect, judging by the size of the mandible, that you will not have vertical space for a bar and clips and a well contoured mandibular denture. You also overbulked the facial of the ridge with your grafting so the flanges will be very bulky. To do a mandibular overdenture or fixed prosthesis you need at least 15mm of interarch space. Therefore, like the poster before, you should have removed the spiny superior aspect of the ridge at least one centimeter to get to the width where an implant could be placed. this would have given you space for your restoration and made your surgery so much simpler, less complex and less expensive. I wish you all the best with the restoration but, I promise you, you won't have room without overopening the patients vertical dimension and/or way overbulking the denture. Always start with the final restoration in mind. And if you're not sure, enlist the help of a prosthodontist or someone with more experience in restoring implants.

I agree, ridge reduction first and then longer implants would have been the appropriate treatment

You can remove most of the acrylic on the impression surface so there is no contact with the lower ridge. Then add temporary soft lining so you get a reasonable fit. Many would say (especially oral surgeons) that the patient should not wear a denture until 3-4 months. However as a prosthodontist, I generally cannot get away with telling my patients that. So I use temporary relining material. However I always tell the patient to leave the denture out as often as possible at home and at night. I also warn them that they cannot eat hard food (soup and mornay diet) until I tell them otherwise (usually 3 months). It also depends on the particular case (eg has the soft tissue healed well). The timing is usually wait for reasonable soft tissue healing (about 2-4 days) then do the reline. I do not let them wear a denture until I do the soft reline. Of course what I describe is not a brilliant solution but it is quick, easy and cheap. And the patient usually fumbles their way through the situation. So far (quite a few years) such a method has not caused any issues.

Place 3 mini implants in the anterior mandible with retainers immediate load and place the old soft lined denture. The minis will support the occlusal load and keep pressure to a minimum.