I have a patient who is pretty desperate for some added retention in her mandible. Therefore, I have recommended two implants between the inter-canine region. She does have a severely atrophic ridge with dense cortical bone. On the CBCT scan, there is hardly any cancellous bone and also it is pretty difficult to visualize the mental foramen as this is almost at the height of the crest. Medically she has COPD, but does not take any medications which may affect her dental treatment.
A few concerns I have raised:
1) Will implants still heal in dense cortical bone with little bleeding?
2) Any issues penetrating branches of the inferior dental nerve between the incisor region?
3) The inferior alveolar nerve appears on the alveolar crest. Which flap design should I use to avoid incising this?