Case Presentation: Computer guided implant placement on severely atrophic mandibles

Last Updated: Feb 17, 2014

Case Sponsored by Live Implant Training. Live implant training courses were created to bridge the clinical gap between theory and reality by elevating the clinicians surgical skills and their clinical confidence. Learn More and Register for a Course

Patients that have worn mandibular dentures for several decades suffer from loose prosthesis and constant pain in the posterior region due to extreme resorption to the point that the mental foramina are at the same height as the alveolar crestal ridge.

The following clinical case will show the advantages that guided surgeries offer:

Avoid laying flaps since mid-crestal incisions might result in nerve damage.
Reduce surgical time considering that we are working with elderly patients with compromised health conditions.
Accurate and safe surgical proven techniques.

![]Patient with extreme atrophic ridge](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2014/02/photo-51-revised.jpg)Patient with extreme atrophic ridge
![]Cad/cam surgical guide, Cad guide in place](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2014/02/photo-41.jpg)Cad/cam surgical guide, Cad guide in place
![]Bite registration record, Anchor pins stabilizing the surgical guide](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2014/02/photo-31.jpg)Bite registration record, Anchor pins stabilizing the surgical guide
![]Case planned for overdenture, Implants placed through the guide](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2014/02/photo-21.jpg)Case planned for overdenture, Implants placed through the guide
![]Surgically accurate, reduces post-op pain Complicated case becomes simple surgery](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2014/02/photo-11.jpg)Surgically accurate, reduces post-op pain Complicated case becomes simple surgery

7 Comments on Case Presentation: Computer guided implant placement on severely atrophic mandibles

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myonphu yip

02/16/2014

How you gonna manage the soft tissue? What if the absence of keratinized gingiva?

Dr Virgilio mongalo

02/18/2014

Doc, This is a a 75 year old patient whose chief complaint was not being able to have a retentive lower denture due to severe atrophy. She was presented with hard and soft tissue grafting procedures prior to implant placement but she refused due to health problems and advanced age. Our only options was to perform as simple non-invasive surgery and clearly computer guided was the only available solution to this complex case. The reason for presenting this clinical case was to demonstrate how a difficult clinical condition can be solved in a simple manner. This is just another example of how 3D imaging, virtual planning and 3D printing can enhance our treatments and provide our patients with high level solutions. sincerely Dr Virgilio Mongalo Clinical Director of Computer Guided Courses taught at Georgia Regents University Department of Oral and Maxillofacial Surgery Clinical Director of Live Implant Training

mwjohnson dds, ms

02/18/2014

the surgery is nicely done but I don't believe that guided surgery was the "only available solution". These mandibles are easily treated with conventional surgery to locate the mental nerve then place 4-5 implants in a traditional manner without the expense of a computer guided stent. Sometimes technology is looking for a problem to solve. We've been implanting and restoring the severely resorbed mandible since Branemark described the technique and mostly without computers. Nobody in their right mind would even consider grafting this mandible. There is plenty of bone height between the mental foramina. The deciding factor, I have found, in these atrophic mandibles is ridge width not height. There needs to be at least 1-2mm of bone buccally and lingually around each implant to decrease the risk of spontaneous mandibular fracture.

Charles Friedman DDS

02/18/2014

Non-invasive surgery: I think not.

Gary OMFS

02/19/2014

For Your info: I know of several fractures after placement of 4 implants in the atrophic mandible. Horror scenario I can tell you: reconstructive surgery with fibular flap may be needed, this is more than any patients would want for a fixed denture. I think it still may be more prudent to start off with an onlay block graft (a distractor is absolutely a no-no) and later implants. It will elevate the crest also, making the prosthesis less bulky so two implants can suffice for retention against tongue/lip forces. Second: absence of keratinized tissue and difficulty in cleaning indeed will cause rapid peri- implantitis, subsequent procedures and implant removal. I know this is common practice but lots of problems should be mentioned.

mwjohnson dds, ms

02/19/2014

I looked at my post from yesterday and noticed that osseonews deleted the last line of my blog. I stated this case study "looks like an ad for Live Implant Training" and I agree with CRS. If this is an ad, say so. Put it under the advertising banner.

OsseoNews

02/19/2014

Sponsored cases are clearly marked as such, and there is no confusion whatsoever who posted this case. There is no need to belabor this point. Furthermore, this is a case, and not an ad. The post is marked as Sponsored, simply because it is coming from a company that offers courses, rather than an individual dentist, and we want our readers to understand that. OsseoNews received absolutely no advertising fees for this case. Ultimately, it does not matter who posts a case, it is still a case and as always you are free to post comments on the case whether positive or negative. If you don't like the case, please say why from a clinical perspective, so everyone can learn from the case. If you have comments about the site in general, that are not clinically oriented to the case in question, please feel free to contact us directly. Thanks for your feedback and continued support. Now lets get back to the case.

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