Thoughts on radiolucency above anatomical structure next to IAN?

Unfortunately I can't get past the large radiolucency on #19-D. To answer your question I think you are fine to place a 4.3x10 in that area.

I also would use a 10. Safely stay away from mental foramen, anterior loop and the lingual plate.

Looks like a void in the graft site along with amalgam with a old filling. I’d regraft it. Better bone, better implant .

I was wondering if this is accessory nerve canal that originates from major branch of ian and needs to be respected as seen on the lingual of implant on ct or just vascular bundle. Besides the bleeding are there any sensory changes that can occur to the surrounding tissues that can occur due to damaged accessory nerve of IAN in type 3 or 4 type ian structures.

I think this is a great question and being very cautious with the patient. Send the CBCT to radiologist: may be a medical legal requirement? I can see the IA accessory on the OPG. I would do a literature search on accessory IA and surgical complications of entering the area. On another note: why only one implant in the quadrant? And what about full arch implants and prosthetic restoration. Piecemeal treatment is ok per patient, but we are then putting our work in an infected mouth. I wont do it. We set ourselves up for failure regardless of disclaimers and consents. Sincerely Leonard

Thank you all for contributing towards this discussion. I was able to verify this treatment plan with two professors at BU perio department, who advised me that there is nothing there on CT that could compromise my patient health. I performed nobel guided surgery and placed implants in areas #29 and #30. Today, only after 3 days following rendered treatment, I checked with the patient who reported no swelling, no presence of pain as well as no altered sensations to his lower arch. Thank you all and your help in this matter was greatly appreciated.