All on 6 and All on 4: Unguided and Guided Surgery?

BTW I know with the Malo technique you probe within the sinus cavity and even the mental foramen (!) but what other techniques are there?

OK, no replies so far, maybe I should be more specific. Anyone here placing 30° angled implants in the mental foramen area who doesn't expose and probe the mental foramen? If so, what method are you using? Thanks.

Mike, Your questions require a lot of discussion in order to answer them properly. I would venture to say that any experienced implant surgeon would indeed explore the mental nerve before drilling if he did not have any other landmarks to use as a reference. The nerve is not that fragile but if you are reluctant to make a long incision in order to explore, then a bone stabilized surgical guide would be just the ticket. In the maxilla, again experience and information about the anatomy from the cone beam will determine if you explore the anterior extent of the sinus or not. Let me caution you about the limitations of a tissue borne surgical guide in the maxilla. They are helpful but not the panacea you would be led to think they are. Good luck with this case. Can you post some images?

I have been placing implants for the past 20 years free hand and rely on my panoramic films with no incident. I started to use mobile CBCT and lab fabricated surgical guides flapless approach. This method you will blindly rely on your lab. Came to learn that you can not rely on your lab only. One of my cases the implants were placed unfavorably into lingual plate due to a bad surgical guide. My suggestion is ,if you use surgical guide, be careful and make a flap. Good luck and thanks for sharing.

Mike, As the other first responders alluded to, the answer you seek is not a short one. As a free handed implant surgeon for many years the comfort level of placing angled implants comes from a defined skill set: the ability to assimilate the data from the CBCT, apply that info to the surgical site, add the compensation factor due to the patient's orientation in the chair results in the proper implant placement avoiding viral structures. Simply put, after many years of placing implants the ability to use the maxillary landmark of the mesial wall of the 2nd bicuspid and knowing where that buccal corridor/volumne of bone exsists in 3D becomes innate. Likewise for placing an angled premolar mandible implant, locating, visualizing and measuring the location of the mental foramen as well as the often obscured lingual undercut becomes central to avoiding complications. Mike, for me, the mental aspects of treatment planing, drawing up the game plan and the successful execution of it is one of the rewarding parts of what we do. Not sure if this response helps but trust your knowledge and training OR find a mentor to get you to that next level.