Input for Mandibular Implants Treatment Planning?

I was wondering if someone could evaluate this treatment plan for implant placement for the areas #20 and 19 using Nobel Replace Guided surgical technique and Anatomage Guide. I plan to place two tapered 4.3x10mm implants in the areas #20 and 19. Since I do not possess great knowledge or experience in implant placement in the mandibular arch, your valuable input as well as criticism in this matter is greatly appreciated. I intend to utilize the flapless technique. Thank you

8 thoughts on: Input for Mandibular Implants Treatment Planning?

  1. Doc says:

    Simply based on the images your provide: I would remove that last tooth and place the two implants in a more parallel fashion directed along the long axis of occlusal forces.

  2. Dr F says:

    Why the medial tilt on both the implants?
    If your not that experienced. Raise a flap and visualise the bone rather than going flap less

  3. Anon

    Thank you for the information. in order to avoid the mandibular canal/mental foramen i had the implant 20 planned more posterior. I have made some adjustments after receiving comments here and was wondering if someone could review the cross section images and tell me if it makes sense to use implant of 4.3×8 implant as shown or go up in size to 4.3×10. Please note this would be guided implant surgery from start to finish.

  4. Carlo says:

    Isn’t it not rather risky and inappropriate placing implants in the presence of periodontal disease involving the second molar?

  5. Carter says:

    maybe it would be better to extract the second molar and evaluate for a bridge on two implants in position 20-18?

  6. Dale Gerke - BDS, BScDent(Hons), PhD, MDS, FRACDS, MRACDS (Pros) says:

    Your second set of CAD/CAM data (implants) look much better orientated. However I stress there is not enough information provided for a complete opinion, but initial review looks OK.
    However your comment that you intend to extract the posterior tooth on the day of placing implants is probably not your best option.
    I would recommend extracting the perio affected tooth well before implant placement and allow healing. Firstly you will have enough to do on the day of surgery without have to worry about the extra extraction. There will be more than enough tooth support remaining for the surgical guide to be made (I think you said you were going to use one). Secondly and more importantly, you need to give your patient the best chance of success. As such, removing the perio contamination from the adjacent area is surgical common sense. You lose nothing but increase your prognosis of success.

  7. Anon

    Hi, I was wondering if someone could look at these cross sections for the area #20. I have a guided surgery scheduled for this patient this Friday, yet I am not sure if I should use smaller implant like 4.3×8 instead of shown 4.3×10. Your help in this matter greatly appreciated.

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