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Table of Contents
CASE REPORT
Year : 2011  |  Volume : 1  |  Issue : 2  |  Page : 129-132

Mini dental implants: A flapless implant surgery for atrophic mandibular ridges


1 Department of Prosthodontics, Faculty of Dental Sciences, C.S.M. Medical University (Upgraded K.G.M.C), Lucknow, Uttar Pradesh, India
2 Padm. Dr. D.Y. Patil Dental College and Hospital, Navi Mumbai, India

Date of Web Publication17-Sep-2011

Correspondence Address:
Raghuwar D Singh
Department of Prosthodontics, Faculty of Dental Sciences, C.S.M. Medical University (Upgraded K.G.M.C), Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5194.85038

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   Abstract 

Mini dental implants (MDI) are ultra-small diameter (l.8 mm width), biocompatible titanium alloy implant screws, conceived and designed over 20 years ago by a board-certified Manhattan dentist, Victor I. Sendax, DDS. Dr. R.A. Bulard added a single one piece 'O-ball' design to Dr. Sandax`s concept. These implants can be used in atrophic ridges, flabby ridges or in other cases where there is denture instability or lack of retention due to poor availability of residual bone. In this article, we discuss a case report of a 59-year-old female patient with a severely atrophic mandibular ridge that was managed by the MDI system with an overdenture.

Keywords: Atrophic ridges, immediate loading implants, mini dental implants, overdenture


How to cite this article:
Singh RD, Ram SM, Ramashanker, Mishra NK, Tripathi S. Mini dental implants: A flapless implant surgery for atrophic mandibular ridges. J Interdiscip Dentistry 2011;1:129-32

How to cite this URL:
Singh RD, Ram SM, Ramashanker, Mishra NK, Tripathi S. Mini dental implants: A flapless implant surgery for atrophic mandibular ridges. J Interdiscip Dentistry [serial online] 2011 [cited 2019 Aug 17];1:129-32. Available from: http://www.jidonline.com/text.asp?2011/1/2/129/85038


   Introduction Top


Every dentist has experienced the problem of dealing with patients with atrophic ridges. The patients always return with complaints of instability of dentures. This problem is more pronounced in the mandibular arch. Traditional dental implants require a period of healing and tissue integration in a nonleaded capacity for optimum predictability. [1] The mini dental implant system (MDIs) can be immediately loaded and provides ongoing stabilization. [2] The advantage in use of MDIs is the minimally invasive, single stage placement procedure, which consists of turning the implant into the bone through a starting opening, but not a prepared bone site. [1],[2] Hence, there is no bone damage or bone wound during implantation. Bleeding and postoperative discomfort are reduced, and most importantly, healing time is shortened. [3]

MDIs are ultra-small diameter (l.8 mm width), biocompatible titanium alloy implant screws, conceived and designed over 20 years ago by a board-certified Manhattan dentist, Victor I. Sendax, DDS. Dr. R.A. Bulard added a single one piece 'O-ball' design to Dr. Sendax`s concept. This article discusses a case report of a 59-year-old female patient with severely resorbed mandibular ridge by placement of two MDI with overdenture.


   Case Report Top


A 59-year-old female patient reported to our clinical department with the complaint of a loose mandibular denture. The patient was unable to chew or speak properly as the denture kept coming out.

The patient gave a history of loosing her teeth 14 years back due to periodontal disease. She has been using her current set of dentures for the past two months. Clinical examination revealed that the patient has completely edentulous upper and lower arches. No bony spicules or root pieces were seen, but there was a knife-edge severely resorbed mandibular ridge. However, the maxillary ridge was favorable for denture construction.

Radiographic examination of the patient showed that the patient had dense compact bone in the mandibular anterior region without any pathology [Figure 1]. The blood reports of the patient also did not show any pathology to rule out surgery. She had been informed about the possibilities of implant therapy and fixed prosthodontic construction, but she could not afford it. Hence, it was decided to place two mini dental implants on the mandibular arch and place an overdenture over it.
Figure 1: Orthopantomograph of the residual ridge

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Procedure

A new set of complete denture was fabricated for the patient. The anatomy of the jaw was evaluated to determine the angulation for the implant. Here, the mandibular denture was used as a surgical template. It was punctured on selected spots by grinding bur and placed into the patient's mouth. The implant sites were marked through the holes in the surgical template with surgical marker and transgingival implantation was performed [Figure 2]. The gingiva was punctured on the marked spots, and the bone was initially drilled with the locator drill (IMTEC) according to the marks made with surgical marker [Figure 3]. The speed of the drill should not exceed 1600 RPM's with adequate torque and irrigation. The purpose of the drill was to establish access angulation and pilot starting point for placement of the implant. The drilling technique typically involves no surgical incision, or flaps. The drilling entry procedure was completed with a few pumping motions resulting in light penetration past the dense cortex into softer, more trabeculated medullary bone. Sterile irrigation was utilized throughout the drilling procedure. The desired site depth should not exceed one third to one-half the threaded length of the mini dental implant itself. A gentle up and down pumping motion prevents the drill tip from overheating, and/or becoming bound and embedded into the patient's bone.
Figure 2: Mandibular denture used as a surgical template

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Figure 3: Flapless surgery for mini dental implant

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A small thumb carrier-wrench or finger driver was used to retrieve, convey and introduce the mini dental implant into the target site after the initial pilot drilling process has been completed. The implant was carefully screwed clockwise into the site using rotation of the thumb and index finger on the knurled handle of the wrench until it became difficult to turn. The thumb wrench was then removed from the implant abutment head.

The thumb wrench was replaced with a winged thumb wrench for more mechanical advantage and leverage. The implant was again turned gradually into the patient's bone until once again it binds to a point where it became difficult to turn. Then the winged wrench was removed from the implant abutment head. A ratchet wrench was then used to slowly insert the implant into its final position. The neck of the mini dental implant was fully inserted into soft tissue (attached gingiva) so that only the abutment head protruded into the oral cavity.

The tissue side of the patient's mandibular denture was relieved so that it could be seated passively over the top of the seated implants. A soft block-out MDI shim was then placed on each inserted mini implant's square base portion of abutment head, leaving the O-Ball top half exposed for attachment placement. Keeper caps with IMTEC MDI O-Rings were then snapped onto the O-Ball heads [Figure 4].
Figure 4: Keeper cap fitted on each mini implant

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The patient's prosthesis was carefully examined to ensure passive fit. A standard chair side self cure acrylic mix was then prepared and placed into the denture, then seated with a functional bite into the patient's mouth over the top of the mini-implants with the keeper caps attached. After an appropriate hardening time, the prosthesis was removed from the patient's mouth, the block out shims discarded and excess acrylic material trimmed. Finished prosthesis containing the keeper caps, as shown in [Figure 5], was then replaced into the patient's mouth for occlusal equilibration and border adjustment [Figure 6].
Figure 5: Denture fitted with keeper caps

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Figure 6: Insertion of the denture into the patient's mouth

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   Discussion Top


The MDIs do not pretend to be substitute for conventional implants. They can be used in situations with lack of adequate bone tissue for conventional implant placement, or single tooth replacement with restricted space (lower incisors), but the most effective use of MDIs is for the retention and stabilization of complete dentures, especially lower dentures. [4],[5] In this way, the problems such as lack of retention and stability, decrease in function, difficulties in speech and soft tissue sensitivity, are solved. Griffitts et al, while evaluating the patients' satisfaction with overdentures supported with MDI (comfort, retention, chewing ability and speaking ability), found that patients' satisfaction was excellent. [3] Taking into consideration all advantages of MDI (success rates, surgical technique, financial advantages, possibilities of immediate loading), it can be concluded that MDI are highly successful implant option for edentulous mandible. This fact should be taken into consideration during prosthetic treatment planning, especially in narrow alveolar ridges and patients who are not able to withstand the costs of more expensive conventional implants of larger diameter.


   Summary Top


Mini implants have been in use since about 1970, but were not considered as "permanent" implanted devices until April 1999 when they were cleared by the Food and Drug Administration (FDA). Since the FDA approved the MDI mini implant as a long-term method of denture stabilization, mini implants have become increasingly popular among dentists. A vast majority of clinicians believe that implants not requiring surgical preparation have higher failure rates. When the failure rates of mini-implants are under evaluation, two main factors have to be considered - the biomechanical loading of peri-implant bone as well as the time schedule of loading, which can be assumed to determine the clinical fate of mini-implants. [6] A decrease in diameter is associated with a decrease in the cumulative survival rate, whereas the length of implants has no statistical significant effect on implant failure. [5] It has been shown that immediate loading can be performed successfully when peak loads do not exceed an upper limit of stress at the implant neck. [2] A biometric analysis of 1,029 MDI mini-implants, 5 months to 8 years in vivo, representing 5 clinics, facilitated the study of the MDI as a fixture for long-term prosthesis stabilization. [7] MDI failure rates for stabilization on average were 8.83%. These analyses establish that the MDI mini-implant system can be implemented for long-term prosthesis stabilization and deliver a consistent level of implant success.

 
   References Top

1.Balkin BE, Steflik DE, Naval F. Mini-dental implant insertion with the auto-advance technique for ongoing applications. J Oral Implantol 2001;27:32-7.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Gibney JW. Minimally invasive implant surgery. J Oral Implantol 2001;27:73-6.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Griffitts TM, Collins CP, Collins PC. Mini dental implants: An adjunct for retention, stability, and comfort for the edentulous patient. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:e81-4.   Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Dilek OC, Tezulas E. Treatment of a narrow, single tooth edentulous area with mini-dental implants: A clinical report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103:e22-5.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Shatkin TE, Shatkin S, Oppenheimer BD, Oppenheimer AJ. Mini dental implants for long-term fixed and removable prosthetics: A retrospective analysis of 2514 implants placed over a five-year period. Compend Contin Educ Dent 2007;28:92-9.   Back to cited text no. 5
[PUBMED]    
6.Campelo LD, Camara JR. Flapless implant surgery: A 10-year clinical retrospective analysis. Int J Oral Maxillofac Implants 2002;17:271-6.  Back to cited text no. 6
[PUBMED]    
7.Bulard RA, Vance JB. Multi-clinic evaluation using mini-dental implants for long-term denture stabilization: A preliminary biometric evaluation. Compend Contin Educ Dent 2005;26:892-7.  Back to cited text no. 7
[PUBMED]    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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