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When a 4.5x14 mm implant is placed (>60 Ncm), IAC is hardly identifiable (Fig.5). Careful examination reveals that the tip of the mental loop overlap the apex of the implant (Fig.6 (the same image as Fig.5 except labeling) blue dashed line). Worry increases upon recalling Inferior Alveolar Nerve Block is administered before fully placing the implant to the depth. Red dashed line: Inferior Alveolar Canal (IAC).
Bone density of this patient is so high that some structures are not so distinct. CBCT should have been taken for this case. Ideally this implant should have been placed a little deeper. The overlapping looks intiminating. A shorter implant (4.5x12 mm) may also achieve desirable torque value.
Xin Wei, DDS, PhD, MS 1st edition 03/20/2015, last revision 03/21/2015