Hi, I would like to get some insight from colleagues who can provide some advise with regards to placing an implant in the mandible in a patient with a enostosis.
What are your thoughts or how would one manage this case?
Thanks
It would be helpful, potentially, to see the contralateral side as benign lesions tend to appear bilateral or at the very least pathology could be ruled out if it were indeed bilateral. Assuming that it is just some form of benign opacity such as condensing osteitis I think it would be fine to proceed with implant placement and consider following a dense bone protocol which might even include using that the tapping tool in your implant kit… yes I am talking about that extra piece in the kit that nobody ever uses. Not sure what fixture you typically use but I would suggest avoiding any of the aggressively threaded fixtures that seem to dominate the market today and consider a more traditional fixture design such as a parallel walled Straumann inspired design or one with gradual taper and shallow threads. Hope this helps.
I would also suggest using new sharp drills at slow speed and good saline irrigation for cooling. Some implant systems like Astra Tech have dense bone drills as the final optional drill to open the osteotomy to a slightly larger size. Tapping the socket to full depth is also a good idea as mentioned above.
If you are concerned that it is more than condensing ostiis, send a CT to a Maxillofacial radiologist for evaluation and/or use a small trephine burr, as you create the osteotomy to biopsy the bone. Given there is boney proliferation under the buccal plate, I would do the former.