Lower Left Mandibular Reconstruction: suggestions for long term treatment?

There are several reasons why the treatment may have failed you would be the best person to form a hypothesis even though I have some ideas. However with two failed grafts which are high skill and risky techniques the blood supply to this area and regenerative capacity are probably compromised. I would do a bridge at this point. Now looking at the first periapical I would have used the molar root for one implant, and expanded the adjacent site with motorized spreaders and a small onlay graft. I would have seen what I got and perhaps just placed a single implant or two depending on how it healed. What I have found is that an area that has been edentulous for a long time resorbs to more cortical bone with less blood supply. I'm not sure why a hemi section was done without endodontic treatment. I think that molar is tooth#19. Why not remake the bridge originally it doesn't look that bad on the film just an open margin. I would be sure and document any rationale and discussions with the patient on the treatment plan.When these complicated grafts fail it can be ugly. Welcome to the world of Oral and Maxillofacial surgery, I feel your pain!

In this narrow alveolar ridge case I would've considered a single blade implant form with two abutments (Linkow's).

Im not well versed enough in implant surgery to comment on the treatment, but why couldn't root canal treatment be done on the abutment(s) and a new bridge by made before it got to this stage?

This is not a blade case. The two root forms free standing or a four unit bridge are the best options. Blades are not designed for free standing use in most cases. Plate forms can be used free standing.

Good tunnel graft case , simple low pain , graft to increase bone with through incision anteriorly . Place implants at 4 months take core sample for histology at the same time , use Osstell to check placement and loading ( in 10 weeks ) ISQs ... Regards Peter

The use of a blade requires abutting to natural teeth. Both adjacent teeth already have cast metal restorations. A fixed partial denture will serve this patient very well without all the invasive procedures and excessive financial cost. Yes this is a tunnel graft or expansion case, if implants were selected as the treatment of choice.

I agree with the bridge comments but it appears to me that the extracted tooth was a 2nd premolar not a hemi-sected tooth. The root morphology looks like a premolar and that would explain the lack of a root canal being done. It seems to me that redoing the bridge would have been the simplest solution.???

Bridges are a good solution , but in cases where they have failed before patients themselves are more reluctant to go down that road again ...... Will show a tunnel graft with Histology and Osstell readings as well as long term results this weekend in Porto Conference Peter