[Therapy of the severely atrophied mandible]

The problems encountered in implant treatment of extensively resorbed mandibles concern poor residual height of the bone and the use of short implants in the least favorable prognosis, excessive corticalization of the bone making drilling difficult, poor vascularity of the implant site, and mechanical constraints sustained by implants bearing high prosthesis. This paper addresses these problems and suggests solutions, using author's own experience and the findings of other clinicians, published in professional literature. To solve poor vascularity of the implant site, the paper suggests preliminary stimulation of the bone prior to implant placement. New drilling steps are described, calling for disposable drills not only in the initial phase but in the subsequent drilling as well. Using a new drill for each surgical procedure provides the optimal sharpness, thereby decreasing the temperature generated at the site, which must not exceed the limit of 47 degrees C. To improve short implant performance, the use of wider diameter implants with tapping insertion is suggested for initial stabilization, along with avoidance of premature utilization of the implant. An unfavorable ratio between the prosthesis and the implant may cause fractures either in the implant or the prosthesis. To avoid these fractures, utilization of wider diameter implants, decrease of the cantilever size, and gradual utilization of the implants are suggested.