#27 Implant Severely Sloped Lingual Knife Edge Mandible: Ideas?

Last Updated: Mar 21, 2017

I have treatment planned #27 for extraction and replacement with an implant. It has a root fracture with 10mm pocket and is hopeless and needs to be extracted. The tooth has been symptomatic, but I have been able to control the symptoms with antibiotics. The alveolar ridge there is knife edged and inclined to the lingual. The periodontal status of the adjacent teeth is chronic Type I periodontal disease with 4-5mm pockets. How do I manage the knife edge ridge so I can place an implant and maintain the existing normal gingival architecture? The bony architecture is normal. Will this require bone augmentation? I maybe wrong about this, but I thought that you can only modify mandibular alveolar crest architecture temporarily and that it will revert to its pre-surgical state over time. Is that accurate? The adjacent teeth would be very poor abutments for a bridge to replace the canine. Should the implant be placed immediately at sufficient depth to allow for complete encapsulation in bone? Will the gingival architecture remain in place or recede? Any other ideas on the best way to manage this case?

4 Comments on #27 Implant Severely Sloped Lingual Knife Edge Mandible: Ideas?

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03/26/2017

Do another round of SRP. Ext, flap and debride the socket, GBR ideally with screw fixation, frenectomy. wait 3 months and take another CT. Can do an apically positioned flap at tiem of surgery to correct perio on adjacent teeth.

Peter Hunt

03/28/2017

The region needs to have good periodontal debridement before implant therapy. It should then be possible to remove the tooth, to groove the lingual plate slightly and to extend an implant channel down into the bone beneath the apex of the socket, about 4-5mm. Then a membrane can be placed out to the labial and a good amount of non-resorbing bone graft such as Bio-Oss Collagen can be placed to cover the exposed labial threads. Some people would do this via a flap approach, others would prefer to use a tunneling approach. An "Enhanced Protocol " using BMP or PDGF would also be appropriate for a situation such as this. Consideration should be given to extending this augmentation to the adjacent teeth. Good Luck

James C Cope, DDS

04/02/2017

Consider the 'Profile' implant from Dentsply Astra EV (i have no financial connection with this company). The sloped platform can be positioned to more closely match the slope of the bone.

DCTDMD

07/17/2017

I don't think an implant is the right choice here. The patient may have to resign themselves to a removable partial denture.

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