Thoughts on Implant Placement In Atrophic Mandibular Ridge?

Last Updated: Dec 30, 2019

Otherwise healthy 70 year old female patient, non-smoker, presented with severe case of peri-implantitis in area of #27. The implant was removed and the area was gently curretted and sutured. Four weeks after the removal of the unhealthy implant, patient underwent CT study for further evaluation of implant placement in area #26 or 25. Patient is now scheduled for implant placement after 10 weeks of healing in area of #25 with fully guided surgical stent. Could you please comment if it would be safe for my patient to undergo implant placement in the area next to a large radiolucency as seen on CT. Please note that after removal of the implant, area #27 has healed nicely and patient has not complained of any pain in that site. Your help as well as thoughts in this matter are greatly appreciated.

6 Comments on Thoughts on Implant Placement In Atrophic Mandibular Ridge?

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oralsurgeryjj

12/30/2019

You gotta consider pathologic fracture of mandible. Too early masticatory loading with adjacent implant could make your worst nightmare. Normally explanted site takes a long time to be healed, it sometimes takes almost a year to be healed by itself. Massive currettage for better vascularization and bone grafting accelerates the process. Vit D and Ca supplements also helps. Unless systemic condition contraindicates(such as kidney problems), make sure the patient to take those supplement until you build a good attachment of the implant. Also, I think it is better to place additional implant on explanted site later on. Asymmetric support of overdenture can cause myriads of problems afterwards.

sergio

12/30/2019

Why not consider mini implants? Age of the patient, the condition of the mandible,.. in my hand this is really for a case for mini implants.

Dr Dale Gerke, BDS, BScDe

12/30/2019

My advice would be to do one thing at a time. So sort out the pathology and allow healing. I suggest it would be a case of too much, too soon, if you implanted immediately. There does not seem to be any need for urgency so I suggest it would be more prudent to hold off on placing the implant until later.

Dennis Flanagan DDS MSc

12/31/2019

Yes, I agree with Sergio, consider mini implants but they have to be long, 2.5mm X 13, 16mm

Practical Caveman

01/02/2020

I'd graft the site and replace the implant in ideal B and D positions. Sometimes the patients expectations, maybe based on what they've heard from another provider, can make one feel pressured to do things quickly. I explain that the huge infection didn't happen quickly and that it is going to take time to rebuild the bone. I'm fond of the expression, "One miracle at a time".

Lynda novak

01/07/2020

I have lost aporix. 37 upper jaw implants..the last 15 yrs. I had 35 txs of radiation 18 yrs ago no face shield..and after ...started to lose all my newly placed implants. Ive had bone grafting..Bil sinus lifts..4 cancers..breast 2 lung cancers with surgery and thyroid. All after radiation. Im a non smoker..and work as an Occupational Therapist at Beaumont hospital. Now cant wven keep a regular denture in jaw..need bone graft from my hip zygomatic. Maybe 2. Noonexwill help me fund this i cant eat food and debture will not stay i want to keep working but need teeth. Any suggestions..trying to get help from U of M oral surgery. Lynda Novak 313 819 0400

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