I am planning placement of four Straumann bone level implants in LL5 LL6 LR6 and LR7 site. I would be very grateful if you share your thoughts on the size of the implants I have selected. I also wonder if tapered effect Straumann implants would have any advantages in that case. I am considering of splinting the crowns especially on the left side. Thank you in advance.
Richard Winter comments:It appears that your bone width is B-W. The implants you have virtually placed are not angled properly and you have not placed full sized virtual crowns so we can’t evaluate where the screw access holes will be in relation to the occlusal table. Also the 3D rendering of the mandible shows the implants are out of the bone (I would check this.) So you may need ridge expansion, augmentation or osteoplasty to properly place these or you may need to place them and graft the exposed threads at the time of placement. Hope this helps. Rick
Dr. Who comments:Please find uploaded the new photos with virtual crowns. Thank you in advance
Richard Winter comments:The virtual crowns do not appear here. Having only a buccal shell doesn't help in the overall planning. Again, you have orientation that is incorrect, placement that is incorrect and splinting won't help if the force factors are off and implant placement is lingual. You may wish to replan the case with a mentor.
Mark Cohen comments:All the implants need to be sunk 1+ mm deeper which means different lengths and smaller diameters. Thinner implants preserve buccal bone better!!
Dr. Who comments:Thank you for your comment- I just wonder if thinner implants 4.1mm in diameter would be strong enough for posterior region. What about splinting them?
Tim Carter comments:I would be very interested in knowing how your plan to place #19 goes since you have it upside down in the plan. May I suggest a simple referral to someone with adequate experience. I understand the desire to learn and asking questions is good but you clearly lack the basic knowledge required to properly treat this patient
Dr. Who comments:Thank you for your constructive feedback, I just wanted to find out about implants size selection in cases like this even if its just in theory.
Anonymous Anonymous comments:It appears the implant at the premolars to be so close to the nerve loop. I will go one step back and re- draw the nerve.
Dr. Who comments:Thank you for your advise- I re-drew the nerve.
AJ comments:Be very careful of perforation of the lingual plate during your drilling sequence and keep your forefinger on the lingual gingiva overlaying the laying plate and feel the bone as you are drilling your osteotomy