Is the bone quality good enough for an implant?

There's a great variability in hard tissue formation (remodelling from woven to lamellar bone) within extraction sockets between different individuals (especially on a molar), so don't sweat it. Standard wait time is 12-24 weeks. So, I would go ahead and place that implant.

Hi Sorry but i think a PA would be a better view of this area to comment. Also it would be good to know what type of a graft was used..was it a resorbable graft or a xenograft. However either way 5 months is a very good time to place an implant...

Youbare most likely ready to proceed.

5 months is good enough, Panoramic x-ray is not enough to evaluate bone quality, CBCT would be better, and sometimes it's totally different story when you start doing your osteotomy, If this is my own mouth i'll agree placing the implant right away Good Luck

DrS a xenograft most likely will not resorb. Check out Buser's book.

The powerful antagonists dictate “D” or “Q” type of Ankylos insertion (at least 8mm long) to withstand loading, but there is no image of the inferior nerve canal location on the X ray.

The type of bone graft was an allograft. DBX putty. What is "D" or "Q" type of insertion? Does anyone know if its best to use an 8mm and place 1-2 mm subcrestal or a 9.5mm and place at crest of bone if bone height is limited (ankylos)

“C” not “Q” means a 5.5mm-diameter implant: “D” means 7mm

You are better off placing an Akylos implant subcrestal than crestal. Subcrestal placement means the surrounding bone will carry the stresses, but crestal placement will cause the implant itself to carry more of the lateral forces. A "B" 9.5mm subcrestal should be sufficient, if you are looking at 8mm length, then I would go wider as mentioned already to a "C". I have personally never placed a "D".

The most important thing is the amount of buccal plate at extraction, this needs to be evaluated at extraction,via a flap with releasing excision. If it is thin or a defect is there place a membrane, teflon or resorbable. I have not liked the results with the bone puttys, not as dense, I use bottled human cortical-cancellous demineralized it packs better and blood fills the spaces. Primary closure. place implants at crest you will get dieback to the first thread if you go subcrestal due to biologic width. Hang in there, always check the bucccal plate you won't get collapse. Nice case I'd place a 4.1x11.5 tapered self tapper!

If you are not confident with the result of the graft.....then open a flap, check out the density, make sure there is no granulation tissue, and add more graft material and wait another 4 months....better to be sure than be sorry later.

i agree with CRS

I would certainly get a ct scan done. It will provide all the information you need on bone shape and density as well as whether there are voids or buccal clefts in bone. The nerve location is always important when deciding implant length or how far subcrestal you can afford to go with a given implant length.

If you get a CBCT and an implant software, you can determine in hounsfield units the bone quality in the area where you are going to place the implant. Softwares have a library where you can pick the implant brand and decide its width and lenght.

CBCT are always very nice, but you can't operate on what you can't see at extraction and implant placement, not a good idea to work blind. Also how can you tell at what bone level the implant is placed? It's just good surgical technique. I do love cone beam but a ct generated surgiguide it the only way to accurately transfer to info.

Pl take my advise Take a CT scan. CT scan are your eyes in the px' s jaw Bone. It gives you confidence when are drilling and piece of mind. Bone looks ok, place a 5.0x10 fixture tissue level like Screw plus from implant direct for $150 bucks which includes abut also. Why do u have to use the most expensive implant. Implant brand does not matter, it is the surgeons knowledge that matters. And for CRA: pl don't teach these newbies 10 yr old implant dentistry concepts. Sam Jain, DMD Center for Implant Dentistry Fremont, CA

Dear all, I agree. Pls take CT scan ALWAYS when is possibile, we humans are 3D not 2D like ORTHO or something like photo. One dimension always miss, because of that fact CBCT is golden standard. I personaly use Morita Acc. CBCT and Ankylos implants. Mercedes or somethihg else, they both are cars. Would you in your mouth want something alse then superior product, or you think that knowledge is only important or surgeon ? I agree knowlwdge is the power. Make your life easier... CBCT ! Then the answer comes ! The panoramic radiograph is history ! P.s. As for the implant, I used 8 different systems, why think about sealing or closure, the superstructure, bone loss, the risk should be reduced still. But not all think alike, which is perhaps good ? We work with people and their confidence that they pay. Esthetics Dental Center Opatija Croatia Europe

the paradox of good and bad quality of bone is wrong, it was based only on primary stability of machined type implant. now with advance technology and better understanding on molecular bone biology, we know that there is different bone type with different way to handle and primary stability is just to sit the stage of secondary stability which well increase in trabecular bone and decrease in cortical bone. a critical stability with no micro movement 50- 150 um which is the stability needed for bone healing. we need to update our knowledge about bone and forget the wrong believes.