This complex interdisciplinary restoration case was led by Dr. Xie Yu, an implant specialist at Chengdu Anyu Dental Implant Hospital, who holds a Master's degree from the West China School of Stomatology, Sichuan University.

The patient, a 45-year-old systemically healthy adult male, presented with a long-term absence of a mandibular first molar. Due to prolonged disuse, the opposing maxillary molar supra-erupted into the edentulous space, resulting in severe interocclusal space restriction. Pre-operative 3D Cone Beam Computed Tomography (CBCT) analysis revealed an interocclusal space—measured vertically from the cusp tip of the opposing maxillary tooth to the mandibular alveolar ridge crest—of only 3.49 mm.

According to International Team for Implantology (ITI) Consensus Guidelines (2023), standard implant-supported prostheses require a minimum interocclusal space of 6.0 mm to ensure structural integrity and crown retention. Consequently, immediate conventional implant placement was impossible without first surgically creating adequate interocclusal space. To resolve this limitation in a single surgical entry, Dr. Xie’s clinical team designed a combined protocol involving segmental alveolar ostectomy and simultaneous dental implant placement.

When severe interocclusal space collapse prevents standard abutment seating, modifying the local bone architecture provides a conservative alternative to substantial enamel reduction or extraction of opposing healthy teeth.

• Segmental Alveolar Ostectomy: Under local anesthesia, a controlled resection of the edentulous mandibular alveolar ridge was performed. This pre-operatively planned bone reduction safely lowered the local ridge crest to target dimensions without compromising the structural integrity of the mandible.
• Simultaneous Implant Placement & Healing Protocol: Following osteotomy, a bone-level implant post (Straumann Bone Level Tapered, 4.1 mm × 10 mm) was surgically anchored into the prepared implant bed during the same session, achieving a high primary stability torque of >35 N·cm. This single-stage approach avoided secondary surgical site trauma and reduced cumulative treatment time. A healing abutment was placed to facilitate a non-submerged transmucosal healing protocol.
• Objective Space Expansion: Immediate post-operative CBCT imaging confirmed that the vertical interocclusal space—measured consistently from the opposing maxillary cusp tip to the newly resected mandibular ridge crest—expanded from 3.49 mm to 6.40 mm, successfully satisfying the clinical clearance required for a durable final restoration.

Following an uneventful 3-month osseointegration period, a final custom titanium abutment and screw-retained zirconia crown were delivered. Simultaneous segmental alveolar ostectomy and implant placement effectively established functional interocclusal dimensions while restoring masticatory efficiency. At the 12-month post-restoration follow-up, CBCT evaluation demonstrated stable peri-implant marginal bone levels and satisfactory masticatory function without mechanical complications.

Because this combined technique requires precise anatomical execution, pre-operative CBCT mapping is essential to assess available bone height and maintain a safe margin from vital neurovascular structures, specifically the mandibular canal housing the inferior alveolar nerve (IAN). When strict clinical indications are met, this approach offers a highly predictable, time-efficient solution for complex vertical restoration deficits. Diagnostic CBCT imaging data are available from the corresponding author upon reasonable request.

1. International Team for Implantology (ITI). ITI Consensus Guidelines on Implant Prosthetic Rehabilitation and Vertical Interocclusal Space Requirements. ITI Consensus Conference, Lisbon, 2023.