Anterior mandible post extraction: what would prolong implant longevity?

I am planning on extracting the mandibular right central and lateral incisors and the mandibular left lateral incisor and installing BioHorizon 3.4x9mm implants.  Most of the mandibular anterior, teeth from canine to canine, have advanced periodontal disease.  I am planning on extracting the ones that are most affected by periodontal disease and have Grade 3 mobility.  I suggested extracting all the mandibular anterior teeth and placing 2 implant in the canine sites but this was not accepted by the patient.  The buccolingual bone width at the implant sites is 4.4mm.  I believe I will need to do bone grafts at the sites.  Which would be the better treatment to prolong the longevity of the implants, bone blocks or particulate xenografts?  I am especially concerned if a fenestration of the buccal plate occurs during the drilling of the osteotomy.   What do you recommend?

11 thoughts on “Anterior mandible post extraction: what would prolong implant longevity?

  1. Timothy C Carter says:

    That is plenty of width especially with the taper of the fixtures you are planning and if you install them at the proper angle. You will probably be lacking soft tissue rather than bone.

  2. Adibo says:

    It would have been helpful to have more information about the case including a panoramic x-ray.
    Active periodontitis is a contraindication for implant treatment . It is difficult to imagine a patient with grade 3 mobility incisors and canines, not having severe chronic generalised periodontitis.

    • akram says:

      actually most of the anterior teeth from canine to canine are involved in to to periodontitis but the mobility is less except for the two central and the left lateral incisots which has a greater mobility, I suggested extracting all anterior teeth but the patient isn’t okay with this

  3. scott berdelle says:

    Do the posterior teeth have
    periodontal disease
    If they do then I would
    consider an all on 4 treatment or
    implant overdenture or depending
    on bone volume a trefoil case
    from nobel

  4. Perioperry says:

    Not enough info presented here to make a good decision. Need to see pano, or periapical radiographs of the mandibular teeth. What is the periodontal status of the lower canine teeth and the lower posterior teeth? Why leave one central incisor? If the canine teeth can be retained by means of periodontal therapy, extract all of the incisors, place implants into both lateral incisor positions to later support a four unit fixed bridge. The alveolar process appears to be thin thin, so you can expect loss of ridge height after extraction, but there appears to be adequate bone apically to support implants without having to do extensive bone grafting. The soft tissue will be low and the prosthesis will have long teeth, but this is not likely to be an esthetic problem in the mandibular anterior area.

  5. Frank Avason says:

    Be careful with letting the patient dictate treatment…. Either do the right thing or don’t do any treatment… Common sense.

  6. Dr KS says:

    After any extraction, you get bone loss which is part of healing process.
    This will be even more in periodontal diseases.
    So need good diagnosis, then planning & preparation and good execution which would need surgeon’s technique & experience.
    Agree to above comment : ( do the right treatment & do not allow to be dictated by the patient)

  7. Asja says:

    Why don’t you try with mini dental implants (MDIs) 2,5 mm wide and 14 mm long or longer (much longer than the extraction site). You can splint them temporarily with composite resin mimicking crowns in a subocclusal position for 3 month and then go further with ceramics. You have Dentium MDI-fixed type of 2.5 mm wide. You can place 3 or 2 MDIs depending on available mesiodistal width. Maybe it is a bit risky, but my opinion is that MDIs in this region act very well. Or extract the frontal teeth (incisors), make a flipper for 3 month (or fiber reinforced composite bridge from 3-3 and then go with implants.

  8. Kurt Whitlow says:

    Remove all 4 incisors and place standard implants in areas 23 and 26 for a 4 unit bridge. Trying to do individual implants with that much loss of bone height will be a restorative nightmare (think cat teeth)! I speak from personal experience.

  9. akram says:

    thank you all for valuable inputs , it’s really helpful to see this much information and will definitely help a lot in the planning,
    I am thinking of extracting the whole four incisors and placing to implant 3.4 x 10,5 in the lateral incsiors area for a 4 unit bridge if and when fenestratioon of the buccal plate occurs grafting the plate will be carried out , I will keep you posted .

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