Implant in Narrow Crest

A 39-year-old man is pleased with implant placement at the lower right premolars (Fig.1: #28,29).  He wants to have the same treatment at the lower left (#20,21), although the neighboring teeth need more urgent treatment.  CBCT coronal sections at #21 (Fig.2) and 20 (Fig.4) show that the crest at the 1st premolar is particularly narrow and pointed.  Since the Mental Foramen is at the 2nd premolar (arrowhead in Fig.4, 6 (sagittal section)), it seems appropriate to resect the atrophic crest by 6-7 mm at #21 (Fig.3 black area) and place a narrow implant low.  It may invade the Incisive Nerve (Fig.7 brown cicle), which should be insignificant.  A long abutment is expected at #21.  A regular implant and abutment are expected at the 2nd premolar, similar to the right side.  Smaller implants may be more appropriate (3.8 mm) to reduce postop bone resorption.  In fact, the patient cracks the tooth #31.  It seems to be nonsalvageable.  In fact, what is to be done?

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Xin Wei, DDS, PhD, MS 1st edition 12/06/2015, last revision 01/04/2016