[Diagnostic / Planning]  26 slanted ridge.

Dear Drs,

I have a male, healthy patient looking for a 26 implant.

The ridge is so slanted. If I was to place an implant either I have to countersink the mesial by 3mm or have 3 mm of threads exposed on the distal. Neither situation would be acceptable. 

Alternatively, I would have to GBR the heck out of the entire ridge in both vertical and horizontal dimention to build a level platform. How predictable is that?

What would you do, where does it sit in the level of difficulty, and do you have any cases to show me where this slanted ridge is present.

I appreciate your input greatly.



by Keyhan Alavian at Fri, Mar 23, 2018 5:23 PM

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Ho-Young Chung Replied at Sun, Mar 25, 2018 8:23 PM

9mm width is not wide enough for 6mm implant.  It's best to have minimum 2mm of bone buccal and palatal/lingual.  In maxilla you can expand a bit with the implant but a 6mm implant in my opinion is not necessary.  5mm wide implant is plenty here.  

vertical augmentation is predictable here with the right technique if carried out properly with the right materials.  Having said that, this will require meticulous ST and HT manipulation and possibly in 2-3 steps including a FGG to increase KT.  I can't comment without any photos but Dr. Albert Lui is probably correct in that there is a frenum pull here in this area (there usually is).  

Do what is predictably successful long-term here.  If you aren't sure what that is, then I would respectfully recommend that you refer to someone who does know.  Overcoming vertical bone deficiency is not an easy challenge for anyone of us.  

You could place the implants w/ only sinus augmentation.  However, something to consider is what would happen if your implants failed at this point.  Your vertical bone loss would be catastophic and I think you will have many sleepless nights.  

An informed consent here won't protect you here if something goes sideways and the patient is left in a worst condition than when you first started.  

I agree with Dr. Lui.  I would be doing a lateral approach and not a crestal approach for this case.  crestal approach should be reserved for single sites with minimum 5mm of crestal bone height.  Crestal approach for multiple sites will often lead to poor outcome in the long-run as the lift is not as predictable.  

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Keyhan Alavian Replied at Sat, Mar 24, 2018 11:46 AM

Thank you Albert for your detailed help. 

Fortunately there appears to be at least 9mm of horizontal bone for a 6mm implant. What are your thoughts on a crestal approach sinus lift since we have at least 4mm of bone?.