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#19
Hi,
These are images of a recent scan.
This is 5 months after #19 implant was explanted (failed 2 weeks after placement) and simultaneous grafting was done.
I have currently planned for a Hiossen 4.5x7mm with buccal veneer grafting. This will be placed relatively deep due to ridge atrophy. What are your thoughts on this deep placement and somewhat undersize/shorter implant for long term prognosis?
Ideally I would like to do more vertical/horizontal grafting to be able to place an implant more coronally and a longer one (perhaps 5×8.5) but I’m not very confident in a good grafting outcome due to much difficulty every time I work on him. He has limited opening, gigantic tongue that automatically raises up and spills over into #19 and very short buccal vestibule.
My plan is to also make the occlusal table of the eventual crown #19 smaller due to the undersized implant. My other thought is to splint the #19 with #20; but that would require him to pay for an additional crown.
Also in one of the slices, it may appear to be a branch of IA coming off and it like it’s running into my planned implant. Is this something to be concerned with and can cause paresthesia?
Thank you for your advice.
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This discussion was modified 7 months, 1 week ago by
Dr..
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This discussion was modified 7 months, 1 week ago by Dr..
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This discussion was modified 7 months, 1 week ago by Dr..
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This discussion was modified 7 months, 1 week ago by Dr..
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This discussion was modified 7 months, 1 week ago by
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2 Replies
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Hey doc,
The shorter implant you selected should be fine. There’s actually great research that shows almost the same or very similar success rate with shorter implants compared with normal length or longer implants. However, if you have sufficient bone width it’s best to go wider if you’re going shorter to help compensate to minimize the stress of the implant. To do a large grafting procedure just to get a 1.5mm longer implant doesn’t seem good enough to put the patient through that.
so the implant is not extremely deep you could do some alveoplasty on the lingual Crestal portion of the bone so it is a little bit more even. I don’t believe the nerve is in the way, even though it is somewhat close It appears there sufficient room there where you should be fine, but in any case, if there is potential nerve pressure or damage that can always lead to paresthesia, whether short term or long term so you always wanna explain any potential with the patient briefly.
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Also, if you place the implant slightly more lingual and upright the implant slightly more lingual in terms of angulation from buccal to lingual, I don’t think you’ll need additional grafting in that area potentially
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