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Mandibular 3 units posterior space with limited bone dimension
Good morning everyone, I would like to get your opinion on the following treatment options for this case. This patient has missing 47, 46 and a retained root at 45. Interocclusal space is about 5mm ( so i cannot perform vertical bone augmentation), bone height is limited, about 10mm ( close proximity to ID canal) and bone width is not satisfactory as well . I have not used any short implants with high engaging threads ( BLX implant) in my practice so I would like to get everyone’s input on this. Thank you.
Treatment plan 1 : 3 units straumann BLX implants ( 45 : 3.75mm x 6mm, 46 : 3.75mmx6mm, 47: 4.5mmx6mm) + GBR with autogenous and straumann xenograft + 3 units splinted final prosthesis
– Rationale – to place implant more subcrestally and have more bone buccally, splinted prosthesis at higher risk of peri implantitis
Treatment plan 3 units straumann BLT implant (45 : 4.1mm x 8mm, 46 : 4.1mmx8mm, 47: 4.8mmx8mm) + GBR with autogenous and straumann xenograft + 2 units splinted 46,47 and single unit 45 final prosthesis
– Concern – Longer implants but near to ID canal, about 1-2mm away if place implants at the same level at bone crest and limited/abscence of buccal bone
Thank you for your time and feel free to leave any comments. Have a nice day !
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2 Replies
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More lingual placement on 47 and site 45 looks very narrow so may have the most predictable outcome performing GBR in area prior to placement and I would go with shorter implants to allow more subcrestal placement which will also allow more restorative space. I also typically prefer individual implants but in this case an implant bridge may make more sense for the pt. And/or minimize treatment for patient as the middle site has the least bone width.
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Thanks for the post William! I think in this case, you should plan a GBR like @restoredsmiles suggested. Also, the shorter implants are the way to go here so you still have 2mm safety zone before the nerve canal!
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