Implant Surgical Planning In A Patient With Severely Atrophic Mandible  

Objective

Implant-retained mandibular overdenture is well recognized as a desirable treatment for edentulous patients . However, severely atrophic anterior mandible with extended lingual concavity is not uncommon and may cause severe surgical complications such as perforation of the lingual plate during osteotomy. Therefore, a delicate prosthetically-driven surgical plan is necessary before the surgery.

Patient Background 

A 69-year-old female patient presented with existing dentures. Her chief complaint was the poor retention of her mandibular denture. Different treatment options were presented to the patient, including maxillary complete denture and, mandibular implant-supported fixed complete denture or mandibular implant-retained overdenture. Mandibular implant-retained overdenture with 2 dental implants was accepted by the patient.

Treatment Sequenceand Methods

1)A pairs of wax dentures with new diagnostic teeth set-up was created in patient’s centric relation at desired vertical dimension .  

2)After clinical trial insertion, the dual scan protocol was adopted in the following procedures: 6 fiducial markers were attached onto the diagnostic tooth arrangement. Two DICOM datasets were acquired by CBCT imaging, one is extraoral imaging on diagnostic tooth arrangement only and the other is intraoral imaging with diagnostic tooth arrangement in situ. The two sets of DICOM files were imported, processed and registered into an implant planning software program (CodiagnostiX).