Implant positioning: create less trauma for patients without complications?

I have been placing implants for 13 years and when appropriate I place full arch implants with immediate loading. The company I use for my surgical guides accidentally sent me a virtual plan that an oral surgeon had prepared. The plan was to place and load immediately. I noticed in his planning he was careful to always leave good buccal bone, but toward the palate the implants were often not in bone for 2-3 mm. I have a colleague who does alot of All-On-Four, and he had recently been to a lecture given by a prominent surgeon. He showed many cases, and there were several implants placed as I described above, sometimes the cases were done flapless. Now when I do these cases I open a flap and adjust the alveolar bone so I have bone 360. I do often leave thin palatal bone adjacent the restorative platform, but it gets pretty thick within a couple of millimeters. I would like to create less trauma for my patients, but I don’t want to introduce potential complications. Does the thick gingiva and great blood supply negate possible complications? I included a slice of a ct scan showing the positioning I am describing.

Slice with implant positioning I described.

Slice with implant positioning I described.

1 Comments on Implant positioning: create less trauma for patients without complications?

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CRS
7/12/2013
Just because someone else does a procedure differently doesn't make it right. I agree with you that an implant needs to be surrounded by as much bone as possible. I don 't see any type of barium guide with this CT. Who knows what was planned the only way you could be sure is to talk to this mystery surgeon. Just because someone is an OMS or perio or GP doesn't automatically make them an expert it is the actual work produced that counts! I don't like flapless unless it is totally CT guided but in this case it makes me very nervous not to have bone on the palate for future perio issues. Also I don't see a barium guide so there is guesswork involved on the final prosthesis. Very good post! If we all ran our treatment plans past a colleague, the second pair of eyes would be helpful that's why I like this forum!

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