[Jedediah]

Clinical experience and research shows they have almost the same success rate as long implants. If you have the bone width, I do prefer to go wider when I go shorter if there’s enough bone and biology to allow that.

[Jedediah]

I would choose option #1. Typically if the RBH is 4mm or more I will do a Crestal sinus lift rather than a lateral sinus lift. Irregular anatomy may be easier to manipulate via the Crestal approach as well is this case.

[Jedediah]

It very well could be a mucus retained cyst (very common) which typically we don’t do anything for unless you need to do a sinus lift, and that can be physically removed doing a lateral window and if you don’t want to take that on you could have the ENT remove that so it is clear and will give you a better opportunity to do a proper Crestal sinus lift.

[Jedediah]

Hello William,

The design looks relatively good relative to how the implants were replaced. As you drew the lines, you could obviously make a better emergency profile from the head so there’s more of a convex rather than concave emergence profile. You could get a little tissue compression may be around a millimeter or so, but it just depends on the bone levels around those implants. Depending on the type of implant that was placed yes you could have some screw loosening if the patient has a strong bite that typically is less of an issue with newer implants and OEM parts, but can still happen so splitting them together would absolutely minimize that but then you have more of a hygienic issue potentially. There’s not just one way to correctly restore them but if the patient is a grinder and has a heavy occlusal load, you can spin them. If not, you can keep them separate and just have the lab make the profile transition smoothly from the head of the implant to the light tissue compression and you should be good. I have seen many restored like that that have worked out very well with no issues

[Jedediah]

#3- width 10.6, height 10.7, bone seems a bit spongy, but should be ok? It’s not quite as wide as you think your measurement is very far down in the bone and it’s much thinner towards the top. You should be able to get an implant in there, but it’s not quite as wide as you think.

#4- width 7.3, height 13.6, width can benefit from guided bone regeneration? Again very similar to tooth number three but your measurement is a little bit more accurate but when you try to measure the width, do it slightly below the rest of the bone so it’s more accurate of what you will actually see during surgery

#11- width 3.3, length 10.6, would benefit with GBR. Looks like a difficult case for a newbie? Severe resorption definitely not for the faint of heart. Absolutely needs a ridge augmentation and if you don’t do those or do them well I would definitely send it to someone that does typically a periodontist or oral surgeon but make sure that they do them often and well.

#13- width 7.8, height 11.6, should be ok? This is definitely your more straightforward case nice wide, bone and pretty parallel buccal and lingual walls.

#14- width 7.8, height 10.8, there seems to be a root tip embedded? I can go in extract, curettage, BG and wait? This one doesn’t look like the height measurement is correct there’s not as much height there I believe at least from what I can see from that single screenshot. This will most likely need a vertical sinus lift or what’s not as a Crystal sinus lift, and that doesn’t look like a root tip and that pic to me it looks like xenograft was placed sometime ago which is basically cow bone which shows up much more radioopaque. As the posterior teeth are infected as also, make sure he gets those out so it doesn’t complicate anything that’s done. Especially at being family I don’t know how often you do these procedures, but might be best to refer out for some of the more complicated areas and you can extract and graft whatever posterior infected teeth are whether patient likes it or not things will get worse if that doesn’t get taken care of. Best of luck.

[Jedediah]

Should be ok with thickness of other bone and thick palatal tissue

[Jedediah]

Welcome to the forum William. It just depends on the case. If the implant is sounding, you know that there’s plenty of bone around it. Sometimes all of our patients can’t heal perfectly if there’s a mild bit of bone loss but everything looks stable and the patient aesthetically is OK with it and you can go ahead and proceed. Depending on the case, just putting bone graft on there won’t mean that that’s gonna take to the bone. Another possibility is improving the thickness of their keratinized tissue that may mass that and help further stabilize it for the future.

[Jedediah]

Hello Safanah! I typically don’t stick to one general number they can range from 7 to 9 mm or even greater but much of it depends on the patients occlusion and their existing dentition. Yes, you could go old-school like some mentioned and do a model and wax up or you can just do that digitally very similar to what you did and get it pretty good idea on the spacing that’s needed and giving your specific patient. One thing I would mention is the implants that you digitally placed I would make sure that they are slightly more sub Crestal as commonly, they are not sufficient deep and if you leave them at the bone level or slightly above, they can be more prone to bone loss and not adequate tissue thickness. hope this helps.

[Jedediah]

I don’t believe they’re compatible either

[Jedediah]

If the implant had sufficient stability for a healing above men which is typically 20 Newton centimeters and above, and an IQ of 60 or above then, either the healing above it was not the correct platform, or sometimes doctors can put it in the wrong path of insertion, and it doesn’t seem to thread. Most likely just a simple common mistake of one of those.

[Jedediah]

It is always a bit tedious and a pain but typically using various X-rays and especially a pano can give you areas to try to access slowing until you find all the screws, slow and patience is keep to not over prep into the screws

[Jedediah]

That is a ton of great bone and a great case. Typically you can get away with a minimum of 5 to 7 mm with a screw routine crown and be fine. However, in the limited information that I saw on your case, there’s a couple things that you can do to help improve and give you more inter-occlusal space. One, as you can submerge your implant deeper in the bone like you did on your digital placement 2 to 3 mm below the crest of the bone or you can do some alveoplasty and reduce 2 to 3 mm of bone to give you more space and then also place the implant a millimeter or two sub Crestal. Several different ways to treat it so you have plenty of room for your restoration which also give you a better emergency profile.