Should I remove these implants?

Should you decide on removing the implants, you can use the reverse torque technique with reverse threaded drills. See the Implant Removal Kit for more details.

By placing regular diameter implants in narrow bone you eliminated the blood supply to the thin cortical bone and caused it to disappear. This patient would have been better served by placing 4 mini implants in the same area. This was one of the best indications for mini implants in my opinion.

I think the critical photo is missing here. You should have posted a clinical photo of the implants that would show the soft tissue as well as the photo of the intaglio of the over-denture. the PA you have posted as you can tell does not have any diagnostic value. If you think there was not enough bone to place the implant due to inadequate alveolar bone width, then why did you do it, i'd like to ask. also, the Pre-Surgical CT does not say anything about the location or the parallelism of the dental implants. It is hard to make any recommendations without adequate clinical information. Grafting for the purpose of a ridge augmentation while patient is wearing a complete denture on a 74 yo does not sound like a good plan. You need to make sure the OD itself fits well, specially if there is no KG around or over the implants. If there is pressure on the mucosa over the implants, it certainly needs to be adjusted. Has the OD been relined with a soft reline or it is a regular acrylic base? you may be able to deal with 1-2 threads exposed, but the quality & quantity of Keratinzed gingiva is also important. I think you should re-evaluate the patient and look at both Periodontal aspect as well as the Prosthetic aspects of the case. ( make a check list before you see the patient).

Hi, The issue is most likely that the Patient DOES NOT have a Vestibule. If Pt is deficient in soft tissue, the denture will rock anterio-posteriorly and will impinge on the soft tissue causing discomfort. 2 implants OD must also get it's stability by being perfectly balanced on implants and posterior flange on soft tissue. Any little movement will cause a rock. Also if the implants are too anteriorly placed (as it looks from the x-ray), i.e. not enough anterior-posterior spread, the Anterio-posterior rock will be exaggerated. Like PerioProsth said, we need to see the picture however we can extrapolate based on Pt's missing bone that soft tissue is the issue. Most likely the implants will work if a Vestibuloplasty is done. My $0.02

Since clearly you have a referral practice you want both a predictable result and the dentist to be happy. To remove the implants they will likely torque out, even tho integrated. Graft the sockets, wait, re-eval soft tissue and vestibular depth as recommended above . I've yet to see a patients mandible that didn't have room for 4 implants if the dentist, you and the patient want implant supported occlusion. The anterior implants may need to be more toward central incisor sites which improves AP spread, Good luck.

We absolutely need photos...… when we can see how much of the implant bodied have protruded beyond the gingival tissues, then only the cover screw for each implant can be placed, ….place soft molding wax into the lower denture in the area of the symphysis to pick up an imprint where the implants are, and then reduce the denture base, so that the denture fits over the implants...then place a small quantity of a soft denture reline material over the holes you have reamed out.....cut away the excess reline material...and low and behold, the implants are now securing the denture without any need for attachments.......change the material as often as necessary...problem is solved, with no expense to the patient, no lab fee for the dentist... and no surgery for the patient.

It would be wise to ask the patient what he wants. Obviously there are quite a few options (and I agree there is more clinical information required before a proper decision can be made). However even if the implants are not ideal, with too little bone around the crest, it may be that the patient would be willing to accept a result using what is there? If the implants are integrated, and if the patient maintains them, they should last for years. Whether they are functional , due to their position (as explained above), needs to be evaluated. I suspect the retention aspect will be fine but whether the rotation is tolerable will depend on the patient’s response. Since the denture will be tissue borne, there is a very good chance tissue impingement will not occur. The reality is that once a good denture has been constructed, it is not terribly hard to remove and replace implants and use new locator or ball inserts into the denture (if the existing implants fail). So while an immediate ideal outcome would be the best to achieve, there is logic to asking the patient if he would rather leave things as they are and try a new denture and review the results – on the understanding that if unsatisfactory then things can be changed but with pain and suffering involved (which will happen anyway if the existing implants are removed and replaced with new).

Contrary to Dr. Moe, AP spread is not a concept in a two Implant locator overdenture. How can you have an AP spread with only two implants? You can't. The way to eliminate rocking around locators is to place then as far forward as possible. I recommend the 23 and 26 positions. The implants need to be under the incisors if you want to minimize the rocking. The farther posterior you go, the more the incisors are anterior to the fulcrum line set up between the two locators and rocking occurs when using the incisors. Secondly, the incisors appear to have been recently extracted. Ideally the thin, spiny crestal bone should have been reduced until there was an adequate width for Implant placement. This also helps create adequate interarch space for the denture and housings without overbulking.

Mini implants would probably be very successful in this case. they can be placed in the intact bone distal to the existing implants and immediately loaded. I would recommend four-five 2.5X15mm. The occlusal scheme should be checked for off axial loading

It would be important to post clinical photos first. Next, you need x-rays that show threads that are not angled so we can see what level of bone loss has occurred. I agree this is a case where perhaps mini-implants would have been a better option and 6 likely could have been placed. Alternatively, ridge spreading and smaller implants would be an option and as other doctors have alluded to, this is not a 2 implant OD case. If you wished to splint them with a bar or added more implants it would decrease forces that may lead to additional bone loss. I can't comment on what to do with the information presented. Also a CBCT with implants placed would be helpful. Best R

please explain why this is not a two implant overdenture case? It seems pretty straight forward to me. There are many ways to treatment plan this individual, from minis to two conventional implants to 4 implants and a fixed restoration. In my mind there's no contraindication to any of the treatments discussed. And, to answer the original question, no, the denture won't impinge on the tissue since it will be somewhat supported anteriorly by the locators. It's the rocking that could be a problem with tissue impingement but your implant locations are ideal to minimize rocking. It may be wise, in the long term, to remove the implants flatten the ridge crest to get more width, then replace them. Ridge splitting makes no sense, simply flatten the knife edge! However, most likely the bone loss will stabilize once the thin bone has necrosed/resorbed to a more stable width, but no guarantees :(

I've not seen any research that indicates sites B and D (basically 23 and 26) are not the best sites for a 2 implant OD.