Modified technique for fixed mandibular implant placement

Abstract

Advanced mandibular atrophy can frequently be treated satisfactorily by the placement of a fixed mandibular implant (Hall Surgical, Carpinteria, CA). This device replaced the original mandibular staple bone plate in 1987 and shares a 25-year history of a high degree of clinical success over a broad range of clinical applications.‘-4 A recent report evaluated the results of hydroxylapatite augmentation of the mandible followed by the placement of the mandibular staple and found excellent prosthetic stabilization and function, and a high degree of patient satisfaction.4 The success of the surgical procedure depends on parallel pin positioning and proper buccaMingua1 alignment, which is assured by a stable application of the drill guide clamping rack. The clamping rack is connected to the alveolar process by director rods when an acrylic stent is used or by anchoring jaws when a stent is not used. If the anchoring jaws are used, they are often difficult to position for proper emergence and can slip during drilling. If a stent is used on a flat ridge, it can also move during drilling and alter parallelism. With either technique, a prolonged time frequently needs to be spent in the oral cavity making adjustments, and this increases the exposure of the submental wound to contamination.