Care must be taken to avoid the inferior alveolar nerve and the mental foramina in the premolar region, since the mandibular nerve is often inclined coronal
in this area.
Care must be taken to avoid the penetration of the submandibular fossa which is located below the mylohyoid line, and particularly the sublingual space in the anterior mandible where the sublingual artery is located. Inadvertent penetration of these lingual plates may be avoided by appropriately directing the pilot bur and reamer burs toward the buccal and monitoring the area with digital contact while drilling.
The location of the maxillary sinus and nasal floor must be positively identified to avoid their inadvertent penetration with a reamer or an implant.
In general, 2.0mm of bone should separate the apex of the implant osteotomy and the mandibular canal.
Examine patient with mouth closed to ascertain if there is enough inter-occlusal space for the intended prosthesis.
A frenectomy may be advisable, to improve the soft tissue environment around the intended prosthesis.
Computer Aided Tomography (CAT scan), although usually not necessary, can be of value in determining the best implant placement sites where there is minimal bone or concern as to the exact location of anatomical structures.
