Two Stages of Implant Placement for Lower Arch

The patient wants to change unstable complete dentures to fixed ones.  Because the problem of pain is associated with the lower left (Fig.1 the left Inferior Alveolar Nerve is more superficial), the lower arch will be reconstructed first.  Totally 6 implants will be placed for bridges/crowns.  Due to time constraint, four implants are placed at the 1st stage (#21, 22, 27 and 28 (Fig.4,5,8,9)); the lower denture will be retained immediately by ball abutments and soft relined.  Two to three months later, two more implants will be placed (at #31 and 20, Fig.2,10).  Note severe atrophy of the crest at #18 and 19 (Fig.11 and 12).  If primary stability is achieved, a fixed immediate provisional will be fabricated.

In contrast to the upper arch, the bone density in the lower arch is high.  The challenge is bone height.  Short implants will be used (6 mm for #31 (Fig.2) and 8 mm for the majority of the others (at premolar and canine sites).  If needed, extra implants will be placed at incisor sites (Fig.6,7 (implant can be longer)) and at #29 (Fig.3) .  If a site is too small for a 3.8 mm 2-piece implant, a 1-piece one may be placed.

Use a 1.2 mm drill (from 1 piece implant kit) to start osteotomy through a surgical stent, followed by incision.

Take photos with and without dentures to see sudden facial collapse (profile, lateral view).  Also show the lower denture is in cross bite.  Before surgery, apply adhesive to the upper denture if necessary and use a sharp acrylic bur to remove acrylic from the tissue surface of the lower one so that it may be pushed posterior.  The patient has hypertension.  Ask her whether she has taken a medication in the morning.  Take blood pressure and write a note in Dentrix.  Which Xylocaine is preferable, 1:100,000 or 50,000?

Return to Lower Arch Immediate Implant

Xin Wei, DDS, PhD, MS 1st edition 06/05/2016, last revision 07/03/2016