Parabolic bone format: What to do and which implant to use?

I have treatment planned a patient for an implant in 46 edentulous site [mandibular first molar].  The coronal surface of the alveolar ridge there has a parabolic morphology.  I was planning on flattening the lips of the curve to create a flat alveolar ridge for implant placement. I have adequate bone volume to do this.   In this case is there an alternative treatment?  Also, would you recommend a bone level or tissue level implant?

11 thoughts on “Parabolic bone format: What to do and which implant to use?

  1. Gary says:

    One possibility is to place an implant with a sloping shoulder such as Bicon or Quantum which would better approximate the parabolic morphology.

  2. David G Milder says:

    This looks like a relatively common case in my practice. I would recommend minimal crestal reduction to flatten the ridge somewhat. More reduction if needed to have adequate clearance with the opposing dentition. Consider countersinking about 1mm. This will also help the discrepancy. It also appears that the mandibular width and the opposing dentition would allow you to angulate the implant slightly buccally as well. This could idealize the occlusion as well. If there is still a small amount of buccal crestal dehiscence of the placed implant or even thin bone, consider a small GTR bone graft procedure. My preference here is a tissue level implant as long as the spacing is adequate. I consider this case to be routine in my practice and of almost 100% long term success. Good luck!

  3. Ismail says:

    Use bone level implant system.
    If the implant system which you are using is a platform switch system, you could place an implant on the level of buccal bone, so from lingual side it will be submerged.

  4. periodds says:

    Or an Astra EV Profile implant 4.8 x 11 or 13 mm. It is a newer generation Astra implant that the Tx and it has advantages over the Tx model. The collar shape of both is sloped on one side so is designed for this type ridge.

  5. CRS says:

    Don’t flatten the lingual plate just use it as a guide and place a small onlay graft on the buccal the bone will grow over it you can also use a resorbable membrane. Not a big problem never heard the term parabolic before interesting

  6. Montana says:

    Your patient is a poster child for the Astra EV Profile; 4.2 or 4.8. Really don’t see the need to add or subtract bone as long as interarch space is appropriate.

  7. Fran DuCoin says:

    Hi, guess I’m missing the problem here. Place whatever implant you are comfortable with, using the best width and lenght to minimize complications, it the best trajectory for the prosthesis, to the level of the lingual bone and graft the facial. Decorticate the bone to stimulate the graft and use a barrier. Should be okay. Have fun.

  8. Andris says:

    That is everyday case where no problems to put implants in simultaneously augment lateral aspect of ridge with xeno material.Good luck!

  9. John T says:

    I agree with Gary (although I have no personal experience of either Bicon or Quantum implants), periodds and Montana – when there is an implant specifically designed for the job why not use it? The approach described by Ismail is what we used to do before fixtures with sloping shoulders were introduced. It’s perfectly valid but, again, why not use an implant with the correct shoulder profile.

    I invariably use bone level implants for molar teeth as it allows one to use a custom made abutment e.g. Atlantis, which gives a better emergence profile.

    Why put in grafts and membranes? There’s no shortage of bone height and anything which involves foreign material increases the risk of infection and rejection, and adds to the cost.

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