Implant placement for recently extracted site?

I have treatment planned a fully edentulous patient for 4 implants and a fixed hybrid prosthesis in the maxilla and 4 implants and a fixed hybrid prosthesis in the mandible.  The patient had the extractions done only one month ago.  My questions: When can I place the implants?  What do you think will be the best sites/positions for the implants?

10 thoughts on “Implant placement for recently extracted site?

  1. John T says:

    I assume you are referring to upper and lower full arch “all-on-four” bridgework. This requires a high degree of skill in order to achieve an accurate occlusion, vertical dimension and cosmesis, and a high degree of cooperation from your patient to maintain good oral hygiene.

    With respect, the questions you have asked are rather fundamental to any implant supported bridgework, let alone full mouth fixed prostheses. Are you sure you have the experience to undertake this work?

  2. Sb oms says:

    Is the patient wearing dentures? Is the patient happy with the tooth position? Is there adequate lip support?
    Is the vertical dimension stable and acceptable?
    Once you can answer yes, then get a scan a start looking for good implant sites. A-P spread should be maximized, and that’s where tilted implants and angled abutments come into place.
    You can’t just free hand the case.
    Sounds like your a beginner.
    You need guides and a plan.
    I would look into the Nsequence technique.
    You’ll need a scan.
    It will guide you through bone reduction, implant placement, and abutment selection.
    Either that, or do the case with someone who has experience.

    These cases are more than just drilling 4 holes.
    Plan, plan,plan.

    Steep and very rewarding learning curve.

    • Rk says:

      Thank you Sb for your comment. We have given a provisional denture for the patient, vd and support is fine. I have done a couple of full mouth rehab, still thought of getting experts opinion on it. We are fabricating a stent also…

    • b. spencer says:

      I could be wrong but from the pano it would appear that a sinus graft/floor lift might be in order. I would suggest before undertaking any serious thought of such a job, much more training would be in order if the questioner is considering doing this work. Also, all-on-4 might not be the optimal choice in this instance and perhaps a more experienced practitioner who has been thoroughly trained in implantology as part of his/her work could have further comments.

  3. mwjohnson dds. ms says:

    OK, if you’ve done “a couple of full mouth cases” what makes you think that makes you qualified to be an implant surgeon on the most difficult restorative case you can possibly dream up?
    1) you have way too much bone in the mandible. How much are you going to reduce? Why wait after tooth extractions? most “all on 4” treatment is done at time of tooth removal. If you’ve taken out the teeth then my surgeons usually wait 6 weeks for tissue healing before going back in. How much bone reduction on the maxilla? What materials are you going to use? You’re only asking basic questions; there are so many unanswered questionsas outlined above.
    2) may I kindly suggest you not tackle this case? You should refer to specialists and watch what they do. Are you ready to take on the liablility of a very expensive treatment? Would you want a beginner doing this treatment on you and asking the “experts” on the internet how to treat you?
    3) I hate to be an *** but, as a prosthodontist, I’ve had to redo these big treatments too many times and the poor patient is the one that suffers. So get trained before you leap.

  4. fred gustave says:

    I really think that dr johnson’s comments are not in the spirit of this website. We all have begun our implant journey at some point on the implant continuum either thru specialty training or thru self guided learning. My concept of this site is to have a forum where seekers can feel safe to post cases and ask questions. I have seen too many responses that are critical and not at all helpful to the posting DDS. I am a strong believer in continuous learning and strongly support any effort to help our dental colleagues improve their skills and understanding of implant dentistry.

    • Mwjohnson dds, ms says:

      I agree we all start somewhere in the implant spectrum. But a full mouth implant reconstruction is not the place to start. When someone puts a panoramic radiograph on a blog then asks how to treatment plan the patient then they are getting beyond simple blog questions. I would hope that part of the learning curve is knowing when you’re in over your head. I think telling someone that the best treatment is referring is all part of that curve. I didn’t mean to offend anyone. But we should not candy coat comments at the expense of good ethical patient care.

    • John T says:

      Fred G – I agree with you entirely. My earlier posting was (I hope) just a gentle nudge encouraging Rk to seek guidance from a local specialist. There is no place for vitriolic comments on this forum such as those posted by Dr Johnson

  5. mihai says:

    As there are so many extraction sites, you may wait 6 months, for the bone to level up on its own.
    After a ct scan, I would do more than 4 implants on each jaw, for a fixed prosthesis; it seams there is enough vertical space.
    Anyway, don t let other comments bring you down. Just prepare youself..

  6. Dr. Ifeanyi Celestine says:

    These are questions, not a comment. I hope it will be accommodated.

    1] In bone and soft tissue grafting protocol in immediate implant do we have to place a barrier membrane over the bone graft before the soft tissue graft, at the same time? Or is it advisable to place the bone graft and membrane first,then to do the soft tissue graft a little later?

    2] Can bone recession around an implant in a ridge that was augmented during or after implant placement be treated with bone augmentation instead of removing the implant?

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