Mandible implant rehabilitation: opinions?

I would like to get some input regarding a case that I have to treat with implant supported restorations.  You can see on the CT scans my primary treatment plan implant positions. I avoided 4.4 site because of the periapical lesion. There is also a granuloma in 4.2, but that I cannot avoid.
I am thinking also to graft in 3 and 4 with Cerabone and Jason membrane.
What do you think about this treatment plan?  What are your recommendations?  Thanks!



14 thoughts on “Mandible implant rehabilitation: opinions?

    • Raul R Mena says:

      Dear Dr.
      Very well planed case, there are no excessive implants in your Treatment Plan. I would treat the pathology before implant placement. Personally I would place an extra implant in the area of 4.4 once the pathology has been taken care grafted and healed.
      Keep posting and asking questions, we all learn from an honest exchange of ideas.

      (1)
    • Assem says:

      Our colleague has asked for opinions, why the smart ass comment??
      obviously, you can care less about helping other colleagues with this kind of an answer, people like you make me sick to my stomach that our profession is full of dentists who love to make fellow dentists look or feel like crap!!
      I am not a big shot implantologist , but I don`t see anything wrong with the treatment plan, he stayed away from the lesion on LR4, and maybe it`s enough to have a shorter arch from LR6 -LL6, but that does not mean this colleague is a hustler!!

      (1)
  1. Ed Dergosits DDS says:

    Seems like a very reasonable treatment plan. I would use bone expanders because even though you have chosen narrow diameter implants the available bone bucco lingually is minimal. Are you planning to extract the remaining anterior teeth after the implants integrate?

    (0)
    • VladS says:

      Why to extract those teeth? It doesn’t seem to have any pathology that indicates extraction. Particulate grafting won’t work?

      (0)
      • Ed Dergosits DDS says:

        It was simply a question VladS. I neither advocate or disagree with the decision. One could support the decision to extract if one felt that the restoration would not need further intervention if the natural teeth eventually failed and needed extraction. I personally would prefer to retain the natural teeth to provide proprioception.

        (0)
        • VladS says:

          I didn’t mean to be offensive. It was just q question. The reason of the post is to discuss from our knowledge and experience different options in treatment plans. I am not familiar with bone expansion and that’s why I asked about praticulate grafting.

          (1)
          • Ed Dergosits DDS says:

            No offense taken VladS. Using particulate grafting materials to augment the volume of a ridge is not predictable. If one can achieve the development of a wider ridge using simple bone expanders the results are much more predictable. In more extreme cases a ridge split technique can also be done with better results than attempting to augment with particulate grafts. Many companies offer ridge expanders. They are basically round ended screws that are placed in sequence to expand the ridge after an initial osteotomy is made with a 2.2 mm twist drill to the planned depth. In this case I would want a printed 3D surgical template to make the initial osteotomies. This is not an easy case. .

            (0)
  2. Jeffrey Hoos DMD says:

    I would like to know more about this software……….
    I would like to know the machine this was done on
    Extremely well planed and very very very thoughtful
    do you need to save this tooth for transition into the final prosthetics
    if not…..remove the tooth, degranulate, grafting not necessary if not near the site. Will be fixed I am assuming.
    More dentists should be as thoughtful and well planned, nice job

    (1)
    • VladS says:

      I do not know the brand of the cbct..it’s a local center and they are very carefull taking x rays and ct scans and I fell in love with this software..maybe I can send you via e-mail a whole scan to play with if you want. A very rich implant library and a lot of parameters you can check.

      (0)
  3. Haydar Alkhatib says:

    You don’t need more than 3 implants for this case , the more unnecessary implants you put the more possible future complications , give patient antibiotic course starting 3 days befire the surgery and do good local debridement and disinfection in the granuloma site.

    (0)
  4. Bülent Zeytinoğlu says:

    Dear DR. If I were you I would extract no 43 enucleate the granuloma and extract no 42 curettage the bone at first.After the healing of the soft tissue install three implants at 43 45 and 47 if you want to use the localisation of 46 use a shorter implant .The implant in OPG is too near to the foramen mentale. Good Luck

    (0)

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