Important Takeaways from Video:

• 8mm bone height recommended everywhere
• EXCEPT 10mm for posterior mandible

TRANSCRIPT:

Alright, so the first thing we're going to look at is bone height. So, the way I measure bone height is I measure the crest of the ridge where the tooth is going to emerge from. The sight of the implant for the crest of the ridge is where the bone level is, right. That's my first distance, and the second distance is going to be the anatomical limitation of that. With the posterior maxilla, I'm going to start my measurement at the crest of the Ridge and measure all the way up to the floor of the sinus. Then in the anterior maxilla, I'm going to measure at the crest of the ridge all the way up to the nasal floor. So that's going to be how much height.

Now, in the mandible, in the posterior, we're going to start at the crest of the ridge. We're always starting at the crest of the ridge. And we're going to measure all the way down to where the superior border of the inferior alveolar nerve canal is. And now in the anterior mandible, there's not like a traditional limitation, there's not something that's always regularly there that you have to look out for but sometimes it could be a little bit dangerous even though you have a lot of height there and you don't have a traditional limitation, you do want to evaluate that site radiographically to make sure you're not going to drill into anything that's going to get you into trouble and cause you an uncontrolled bleed.

How much vertical height of bone do you actually need though? So I have a general rule of thumb that I use for treatment planning all of my cases, and that rule of thumb is 8 millimeters. I want to place my implant into 8 millimeters of bone, and so that means that in anywhere in the mouth, everywhere I'm looking for 8 millimeters of bone height. Except the posterior mandible. So the posterior mandible, you're measuring from the crest of the ridge, all the way to where the superior border of the IA nerve is, but you want to avoid nerve compression.

To avoid nerve compression, you can preserve 2 millimeters of safety zone. So, to preserve 2 millimeters of safety zone and still put your implant into 8 millimeters of bone, you're looking for 10 millimeters of height, total. That's above the superior border. So everywhere in the mouth I'm looking for 8 millimeters, but in the posterior mandible, I'm looking for 10 millimeters above the superior border of the IA. So that's my rule of thumb. I look for 8 millimeters and 10 millimeters, 8 and 10, and if you don't have that much height, there's a couple of things you could do.

First, if you're in the posterior maxilla, you can do a sinus lift. A sinus lift is pretty predictable, it's traditional, it works. So what if you're not in the posterior maxilla, so another option is to do vertical augmentation. Vertical augmentation is a lot more technique-sensitive. You'll probably be referring out to an oral surgeon or a periodontist to do vertical augmentation for you. The last traditional option, if you don't have enough height is to discuss implant alternatives. So maybe in this case, maybe if you only have like 4 millimeters of height or something, maybe implants are not the best therapy for the patient. They might benefit from a bridge or something removable instead.

Lesson Summary

The first thing to consider when determining the suitability for dental implants is the bone height. This is measured from the crest of the ridge to the anatomical limitation of the area.

• In the posterior maxilla, the measurement is taken from the crest of the ridge to the floor of the sinus.
• In the anterior maxilla, the measurement is taken from the crest of the ridge to the nasal floor.
• In the posterior mandible, the measurement is taken from the crest of the ridge to the superior border of the inferior alveolar (IA) nerve canal.
• In the anterior mandible, there is no specific limitation, but caution should be taken to avoid drilling into any potentially dangerous areas.

The general rule of thumb for bone height is 8 millimeters, which is recommended for most cases. However, in the posterior mandible, it is necessary to have 10 millimeters of bone height above the superior border of the IA nerve to avoid nerve compression.

• If there is not enough bone height in the posterior maxilla, a sinus lift can be performed.
• If vertical augmentation is required, it is recommended to refer the patient to an oral surgeon or periodontist.
• If there is insufficient bone height, alternative options like bridges or removable dentures should be considered instead of implants.