DR Murugavel's dental implant course: INFRA CANAL BASAL IMPLANT (BOI) PLACEMENT ( Below Inferior Alveolar Nerve )

Placement of CRESTAL Implants in the atropied distal mandible is difficult.
Few procedures for enlarging the bone volume increase the risks of the overall treatment and they reduce therby the predictability and the acceptance.. Cases of severe atropy in distal mandible cannot be solved by using crestal Implants with a reasonable chances of success.
So, treating the atropied mandible through use of BASAL IMPLANTS are available.They require special techniques which are briefly discussed here with clinical photos which was done by us.

When the vertical bone height is 3-4mm above the mandibular nerve canal, there is indication for placement of INFRA CANAL BASAL IMPLANT (BOI) PLACEMENT.
It is the done by placing the Base Plates below the Mandibular Nerve.

INDICATIONS:

Severe atropy, when the mandible has a vertically reduced bone height of 3 - 4 mm above the Inferior alveolar nerve where crestal implants are not applicable.

Patient not willing for removable conventional dentures and wanting for fixed teeth replacement.

TECHNIQUE:

The full thickness flap is prepared on centre of the alveolar crest.
The most distal implant must be placed in the area of 2nd molar.
First osteotomy with a hard metal cutter( horizontal cutter) at sufficient speed is made. This cut should reach the bundle of nerve and vessels.
The more distal the implant position is chosen, the more likelly the nerve located favourably.
The second osteotomy is done vertically from the vestibular side. The vertical cutter 1.6mm diameter or 1.9mmd is used
This cut almost reaches the area of mandibular nerve: the safety distance can only be 1mm or less.
Typical Implant for this procedure are basal implants with a base plate diameter of 9mm or 10 mm or Implants with two base plates of 7-10 mm each.
It is necessary to choose implants with a long vertical part, as vertical bone growth along the implant must be expected.

The slots created for osteotomy will heal quickly and in some cases new woven bone generation inside the mandible will occur.

ADVANTAGES:

Patient acceptance to go in for fixed teeth replacement rather than the conventional prosthesis.
Can be immediately loaded with prosthesis.
Safe and effective.
Design is simple, single piece Implant.
Maintainence is simple.
Due to thin and polished nature of the vertical implant parts, no peri implant infections can possibly develop.
No need for bone transplant or augmentation procedures.
Bone remains in its original shape and height.
No need to localize or dislocate the nerve.