Mental Loop

Initial osteotomy with 1.6 mm drill for 11 mm seems to be distal (Fig.1).  The trajectory should be changed as shown by the black line in Fig.2; the drawback would be close to the Mental Loop (red line).  Fortunately the trajectory is changed, but not so much as to be close the Loop when a 4x11 mm dummy implant is placed (Fig.3).   When a 4x13 mm IBS is placed with 46 Ncm, there is clearance from the Loop (Fig.4-6).  In fact there is no postop paresthesia.  The main point is no block anesthesia.  Infiltration anesthesia is administered with 34 mg Xylocaine with 17 mcg Epinephrine.  The patient experiences dull pain when the implant is placed (Fig.4-6).  After further anesthesia with 68 mg Septocaine, 17 mcg Epinephrine, the implant is torqued for a few turns (still with some discomfort).  Finally autogenous bone with Osteogen is placed around the implant following placement of a 4.5x4(2) mm abutment.  To reduce anxiety, a shorter implant should have been used. The patient complains of cold sensitivity in the lower left quadrant 4 months postop (Fig.7): the implant apparently close to the Mental Loop.  Without an immediate provisional, the gingiva around the abutment is healthy.

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Xin Wei, DDS, PhD, MS 1st edition 04/14/2017, last revision 08/27/2017