Prosthetic options for resorbed anterior mandible?

No cbvt makes it hard...but, Wants do not equal haves. There is no way she can have implant therapy without significant ridge augmentation. Don't attempt it. Just give her a RPD. This is a complex, 3D reconstruction.

The patient's poor oral hygiene will compromise the long term result of any care that you provide. That said, it is possible to plan a restoration that replaces the missing teeth and supporting tissue. The biggest variable is the location of the patient's transition line, and whether it will be visible and whether the patient will accept this limitation. Good luck!

I agree a CBCT is required. However based on the existing information, the patients expectations will make treatment difficult. Implants in this region without significant alveolar augmentation is not possible, and even then will be difficult. Oftentimes patients need to digest the information, do their own research and often they come back ready to proceed with your intended treatment plan. Let this person digest your treatment plan. At this time I feel an RPD is best.

This is not a difficult implant reconstruction. Everyone thinks we need to augment to bring the alveolus to the non resorbed level. Get a cone beam survey and I'll bet the ridge width is adequate for implants. Place three implants evenly spaced, then make a screw retained segmental hybrid restoration, just like a fully edentulous prosthesis only just replacing 6 teeth. The pink acrylic fills in the defect. No need for difficult vertical ridge augmentation. However, her hygiene needs to improve! and please evaluate the radioopacity apical to #28 (4-4)

CBCT may reveal that there is enough bone to place 2, 3 or 4 implants. Prosthetic plan is either hybrid screw retained denture or cement retained porcelain bridge with pink porcelain to restore gingival tissue. If CBCT reveal no bone to place implants then patient must accept that bone augmentation is a must for implant restorations.

If the patient doesn't want to reconstruct the ridge that's fine. Not everything needs to be ideal. A rpd is far from ideal. After a proper clean up and oral hygiene motivation place 3 implants is positions 42, 31 and 33. If you can guarantee 2 or 3 mm of buccal keratinized tissue fine otherwise apically reposition the flap after osseointegration (not getting into details about that). 2 single distal cantilevers, which means avoiding the oblique ridge. Plenty of bone in that anterior region for 3 15mm implants. Mandatory to do a cbct with a surgical stent in place. Place multi units and tell the patient you must see her every month for the first 3 months and if the o.h. Is proper 3 in 3 months otherwise once a month recall. She will most likely understand the message. Send a medium sized intrrdental brush to your lab and prescribe a 7unit metalceramic bridge (with brown/pink porcelain) with proper space for tight cleaning with the interdental brush.

My preference is to avoid augmentation as any gain will still require a tall restoration and artificial gingiva, Therefore, as Dr. Johnson suggested, I would evaluate width for implant placement and fill the site with a prosthesis. If fixed, I advocate zirconia as it will acquire less plaque than resin, reducing the caries risk to the adjacent teeth. It also prevents compensatory eruption of the maxillary anterior teeth as it will not wear. An alternative design is an implant supported removable design (bar in bar) so the patient has better facial support without compromising hygiene.

Dr. Johnson hit the nail on the head with all counts. I would perform a classic workup: diagnostic casts; CBCT; PAs; Medical Laboratory Test; prophy and SRP; complete Head and neck exam and intraoral exam. Monitor her hygiene and parafunctional habits. If there is sufficient width for standard root forms wich can be determined with a CBCT or at the time of surgical exposure. When performing the osteotomies, make sure they bleed.

Versah oseocondensing burs. You are the doctor!!! You know whats best for the patient not the patient!!!! You went to dental school right? Be careful of patients telling you how to be a doctor. If you don't trust yourself doing this case refer it out to someone who is more confident and alveolar reconstruction. I say this with love. Next, you should -you tube versah burs. They are about 1200 bucks, they work in reverse, I use them in every surgery. They expand bone horizontally and give you a little vertical condensed bone as well. Worth the bone to make sure that you get like 50Ncm torque. Trust versah brother not the patient. I did a case where I expanded a 1mm ridge to 5mm no bone graft needed with them lately.

Thank you for sharing the info about Versah Burs!

First, the panorex needs to be properly evaluated and full mouth radiographs taken and evaluated. CT is always a good adjunct. There is an endodontically involved lower first bicuspid with a large decay and a radiopaque mass at the apex. It is imperativet to take care of that condition before implant placement. I agree that a hybrid will be one of the choices. Personally, I don't like screw in hybrids due to the difficulty keeping it clean and maintaining healthy gingiva. My treatment of choice will be TruFit Snap-On-4 Hybrid. It functions like a fixed bridge with the advantages of a hybrid. It is very easy for the patient to remove, clean, and Snap to the abutments. There is no need for screws or cumbersome prosthetic and laboratory procedures.

This case would be best treated with 4 mini implants 2.5X13 or 15 mm. Fixed partial denture. Use a telescope technique stock abutments impressed for a telescoped fixed denture. Dennis Flanagan DDS MSc

From the photos provided, there seems to be adequate bone to do a very nice implant supported prosthesis......with pink artificial gingival tissue....... if natural anatomy is required, then obviously bone regeneration therapy in necessary.