Thin mandible for implant overdenture: thoughts?
I have treatment planned a patient for a mandibular implant retained overdenture using 2 implants and we received the CBCT scan for this patient. I was hoping that we could place 2x3mm wide implants, but as you can see, the width in the anterior area is a bit thin, approximately 3mm across at the crest. I can flatten the ridge quite a bit to gain more width, but it is only approx. 5- 5.5mm wide. And obviously as I flatten more, we lose bone height and issues with attachments come into play. 3mm wide implants are pushing the dimensions a bit. What are your thoughts? I haven’t used mini implants previously, but could this work well here? Please forget about the remaining 2 teeth in quadrant 2- they’ve been extracted. Thanks in advance
12 Comments on Thin mandible for implant overdenture: thoughts?
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Dr.ieng
10/15/2015
Bone expansion prior to place implants.
Nailesh Gandhi
10/16/2015
I have used 4 narrow diameter implants in such situation.They work fine.
CRS
10/16/2015
Agree with the expansion, I would do this computer guided with a stent to avoid ending up in the floor of the mouth, three or four implants with locators. A bit of grafting on the buccal with sonic weld and prgf, 3.3mm roxolid Straumann or 3.0 diameter.
Richard Hughes, DDS, FAAI
10/17/2015
This is a sub or ramus frame case, if one knows how! Yes, one can ramp down and place four root forms and rehabilitate with a bar overdenture. You may want to use a guide and narrow body implants may be required. A vestibuloplasty may be required after the ramp down.
Anand Patel
10/20/2015
1- raise a flap , premolar to premolar ,
2-locate the mental foramen ..... carefully and know where they are .
3-make a crestal ridge split , gaining deep upto 15 mm using a piezotome making sure you stay in between the buccal and lingual cortical plates
4-use bone / ridge expanders , spread out the plates
5-place implants ..... you should be able to place 4
6- graft the split if you want to or leave alone to fill yp with blood and that will turn into bone.
7-Periosteal releasing incision to mobilise flap and close over., for submerged healing if you use root form implants.
Hope this helps.
Good luck
drBoomer
10/20/2015
Just to clarify in case it isn't obvious, use extreme care when expanding the ridge. Anyone who has ever extracted a tooth knows the bone will expand, but remember you are doing this now -without- teeth on atrophic bone. If the plate fractures slightly (and it probably will) its not catastrophic failure, but use care and try to expand "atraumatically". Go slow. Be patient.
What is the patient's age? Male or female? Any chance of osteoporosis? Remember, a 60 year old isn't going to stretch like a teenager.
Dr L
10/20/2015
Thanks for your input Anand. Just a question- when you say locate the mental foramen- do you mean simply knowing where it is or expose it so you can see it?
Gary OMS
10/21/2015
I did this in a two- stage technique last week. Four weeks earlier I made two box osteotomies with the piëzotome and closure.I figured this would be easier to mobilize than a large visor- type of osteotomy. Last week I re- opened from the buccal, inciding 3 mm below the MGG junction and then supraperiostally to the crest. I noticed te osteotomies were completely healed! I outfractured the buccal plates with a chisel without stripping of the flap and inserted 4 implants 2 mm longer than the osseous flap, for primary stability. The remaining space was filled with a substitute and covered with A- PRF; the flap was easily closed with a bit of undermining apically. I believe in the original technique the incision is made on top of the crest an the lingual periosteum is incised but I think my technique is easier and safer.
Ernest Scheerer
10/20/2015
I believe all of the suggested treatment options will be successful; however, as usual, none of suggestions make any mention of the patient's desires, fears, medical status, age, financial restraints, etc. Does it really improve the quality of life of this patient if the dentist has unlimited talent and recommends what he considers the best treatment only to see the patient evaporate. Having restored over 250 conventional implant cases and completed 17 mini (1.8 mm dia) cases before retirement I can attest to the fact that there is a place for both modalities in the general practice. The decision has to be based on the presenting anatomy and a comprehensive consultation with the patient. Guideline: every implant must be surrounded by 1 mm of bone.
Bottom line: This is an ideal situation to use the narrowest small diameter implant; however, the other options will also be successful after additional surgical procedures.
Thanks for asking.
sergio
10/21/2015
Often I hear from surgeons and perio guys that mini implants shouldn't be used in as many occasions as they are. Well.. This is one of the occasions minis were designed for. Give all the options to the patient and see what he/she says. It's a disservice to the pt. not to give ALL the options.
Dr Shyam Mahajan
10/23/2015
What will be upper prosthesis ?
With four implants . Two angulated to increase AP spread . Its possible to go for All on Four fixed implant supported prosthesis . .
DR.M
11/1/2015
Four mini with ball attachment works well, alternatively 3 , 3mm implants with locators holds better.
