Atrophic Posterior Mandible
As,discussed earlier, the posterior mandible poses unique appealing. vidence suggests that implants can be sueproblems.
Presence of the inferior alveolar nerve 1imits ‘ cessfully placed into growing atients. In the fully edenimplant length. This, coupled’ with increased. ocdusal . . tulous ‘patient, an implant-supported prosthesis can be
load, is one reason for the higher implant. failure rate in . fabricated as soon as the patient is old enough to cooperthis region. Overengineering with placementof- more ate with-hygiene requirements. This is usually defined as plants can improve the prognosis. When less than 8 ‘age 7: Inpatients who have lost a portion of the jaw from mm of vertical height overlying the interior alveolar tumor resection or ‘tra ma, an implant-supported prosnerve is found, implant success will be severely cornpro- “. thesis can likewise be used as early as age 7. However, mised, Bone may be grafted to increase height as previ-· when .the edentulous area in question is ssociated with ously described. unerupted natural teeth, no implants should be placed However, if supereruption of the posterior maxillary until eruption of the’ natural dentition and alveolar dentition exists, a graft of, adequate thickness to . ‘growth -are complete (i.e., at approximately 16 years of
improve implant stability may result in inadequate” -age). Implants placed before this will behave in a similar interarch space for the prosthesis, In this case the infe-‘ .fashion to an ankylosed tooth, with progressive submerrior
alveolar nerve may be repositioned to ‘allowuse of sion’ of the implant as a resu\.t of eruption of adjacent the entire height of the mandibular body (Fig: 14-66). tee~~ and alveolar bone growth., . IThis procedure carries the risk of p.ermanel1t anesthesiaor painful dysesthesia. The magnitude of this ‘compltcation requires that a surgeon experienced withnerve surgery
and postoperative assessment of- neurosensory .function perform this operation, The advantage is thatwith repositioning of the nerve a longer Implant ca ‘be placed, with stabilization in both the superior and inferior
cortical bone. .