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Jonathan posted an update
I have a patient who looks like a good implant candidate for a mandibular overdenture.
I’ve never done one before but the ridge width is adequate and the patient appears to have enough interocclusal space. Immediate were made about 5 months ago.
My question is, when deciding where to place the implants, do you guys routinely make a large flap to locate the exit of the mental foramen and then plan your implant positions anterior to it?
Do you guys have advice for flap design and how to do this to avoid damage to the nerve? I have implant placement experience in single and multiple tooth sites but just not with exposing the nerve.
Thank you!
Jonathan, Jedediah and Cayleen1 Comment-
Lots of different ways to go about it. However, I do prefer to do a full thickness flap to visualize the bone very well. If the patient has decent bone width distal to the mental foramen then I would take your incision distal to where the second molar would be so you have a great working space and I prefer to place four implants if the patient is able to at first molar and canine areas. If there is not sufficient Bone in the posterior area, then you’ll just work mental to mental place 2 to 4 implants again the more I do these I do more implants less better long-term outcome.
Even though you don’t need bone reduction, I typically like to reduce one to 2 mm of bone to make a nice flat working area, which helps for a better design of the future prosthesis and you Can reflect the full thickness flap with the blunt end of your perioossteal towards the mental foramen and gently identify, and then you can place your implants mesial and/or distal to that depending on the patient bone and anatomy
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