[Surgery]  Surgical Planning 2 implants

I am planning to place 45,46 implants both 5x8.5.

My question is regarding grafting as in the plan both implants will require grafting.

Obviously would utilise sticky bone to cover threads.

Due to proximity of mental nerve to the 45 and the location can someone comment here on there thoughts as far as flap design and release. 

I would think placing cover screws and trying to achieve primary closure is my goal.


by Chad Denomme at Tue, May 7, 2019 9:09 AM

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Chad Denomme Replied at Wed, May 8, 2019 6:15 PM

Thank you

is it a bad plan to move implants a bit lingually to try to avoid grafting?

if I do graft and release vertically at 44 MB line angle

and dissect down to foramen to see nerve can you give me more detail how to protect it properly.

also if I only have the one short vertical how do I effectively release the flap.



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Ho-Young Chung Replied at Wed, May 8, 2019 9:18 AM

Hey Chad. Great planning here.  I would suggest 4.5 by 8.5 for molar and 4 by 7 for premolar. the premolar implant needs to be countersunk deeper than planned here on cbct.  the distal bone will shrink close to the level of 46 M of the implant.  flap management certainly is important as to not cause parasthesia as mental foramen is right above 45 site.  make flap ending coronal to mental foramen.  If you see the foramen, place collagtape around it to protect the area from bone graft material going around it.  you can make vertical releasing incision if need be 44MB line angle.  periosteal release without actually traumatizing the periosteum will be critical in achieving primary closure and graft success as blood supply is critical.  good luck and keep us updated.  Ho-Young Chung

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Chad Denomme Replied at Tue, May 7, 2019 9:11 AM

Sorry those are 4.0mm diameter not 5.