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Treatment Plan and Osteoporosis Concerns
Posted on 08.23.2012 08:04 AM
By Tommy McGee
In Full Arch & Dentures
This case is a 72 yof with osteoporosis and a history of oral bisphosphonates. She desires a full arch restoration with an implant overdenture. Her finances are limited and she can only afford a maximum of 4 implants and a locator retained IOD. It will oppose a rapidly declining natural dentition, which will probably be restored with a maxillary full denture in the near future. I have several questions:
1.Concerning treatment plan - Would the best option be 4 implants in the mandibular symphisis or 2 implants in the mandibular 1st molar positions and 2 implants near the canine position?
2. On the CT scan the osteoporosis is so severe in the deeper portions of the left mandible that the IA nerve cannot be traced (no matter how I alter the panoramic curve, except in the position of the mental foramen. Can I safely assume that it is in the same position on the left side as on the right? Does the nerve ever migrate in osteoporotic situations?
3. Will the density of the mandible increase in the areas where implants are placed in patients with osteoporosis?
Thank you for any input.
3 Comments
Band Ditto64 says on 08.23.2012 08:12 AM
4 Implants placed in Anterior mandible with 2 just 3mm in front of mental foramen and 2 in area of lateral incisors has worked well in literature. This is whether or not you tilt the distal implants as in the "ALL on Four" technique.
Bone does respond positively to micro trauma and loading so bone should become more dense after implants are placed.
Nerve should be traceable by walking the sections back frame br frame from mental formamen.
good luck
Band
Tommy McGee says on 08.23.2012 01:23 PM
Thank you for the suggestions. The nerve can be easily seen at the area of the mental foramen, however, it seems to disappear into black space just distal to the foramen. I have tried tracing it in two different programs.
bradford klassman says on 08.23.2012 01:55 PM
With limited finances as a concern i would plan on 4 implants between the mental foramina... Syncone abutments for sleeve coping type of prosthesis and immediated functional loading would be my first choice... finances may prevent all on 4 for a fixed solution. My concern would be duration of bisphosphonate use... if more than 3 years then be carefulll. Wouldnt do the case without a CTx blood test.. not a 100% predicter of problems but it is something to go by... see reasearch by Dr. Marx..