MINIMIZED DENTAL IMPLANT REPLACEMENT OF THE UPPER LEFT CANINE IMMEDIATELY AFTER EXTRACTION

This lady presented with a retained primary left canine due to a congenitally missing permanent canine. Since it was already mobile and inflamed, we extracted it and immediately placed in a mini dental implant. A composite BUD was moulded on with the MOSTDIMOLD and the resulting abutment was shaped. An impression was taken and sent for a PFM which was then cemented the following visit. In this particular case, there was some resorption of the adjacent premolar root due probably to the prolonged retention of the  chronically inflamed primary canine next to it. A flap was raised and all infamed tissue was curretted thoroughly before placement of the mini. Three years later, an xray revealed that the resorbed portion of the root has been filled with bone and the implant supported canine was still looking good and biting strong.

The bone had filled up the socket and climbed up the mini dental implant to the max, thus giving the mucosa good support, hence the wonderful aesthetics.

Put minis in the hands of the GPs and minimized dental implants will become the main workhorse of implant dentistry. The future of implant dentistry is mini dental implants in the trained and skilled hands of the GPs!

About two years later, the patient came back complaining of swelling and discharge for some time next to the implant. An xray revealed that the discharge was from the premolar whose root had been partly resorbed by the chronic infection before the implant was placed. The implant was not only healthy and firm, bone had climbed up....... I mean regenerated around it right up to the crown. The treatment was then merely to do an endo on the premolar..... nothing to do with the mini dental implant. Up! Up! The Mighty Mini!!!

The pic here you see is not one from the time of the cementation of the crown, but more than two years later. No loss of papillae and no black triangles.

MY BLOG BOOK: http://minimized-dentalimplants.blogspot.com/2010/05/minimized-dental-implants-coming.html

NARROW DIAMETER DENTAL IMPLANTS: POSTED IN OSSEONEWS

K. F. Chow BDS., FDSRCS says:

October 23, 2009 at 11:26 am

THE CASE FOR NARROW DIAMETERS/MINIS/REDUCED DIAMETERS/ MINIMIZED DENTAL IMPLANTS/MOSTDIS

Narrow diameter dental implants are being increasingly used not only to stabilize dentures but also for long term applications like crowns and bridges. I agree with Carl in that there is no such thing as an absolute contraindication in medicine. Even botox which will kill you if injected into your bloodstream is used ingeniously and judiciously to extend the youthful looks of people. The key word is “judiciously”. Know your medicine well and know what you want to do with it and then you can apply it safely and usefully.

It is significant that one of the doyens of implant dentistry has recognized that narrow diameters have their uses especially in narrow ridges and in suitable bone. I started out with conventionals and with the advent of minis, incorporated them into my treatment planning and in many complex cases have successfully integrated them both into my treatment planning taking into consideration the patient’s expectations and budget,the materials available and their limitations and my own experience, knowledge and skill.

However, with the greatest of respect, having read the classic Contemporary Implant Dentistry, I wish to highlight some misconceptions and give my opinion.

As pointed out earlier, many narrow diameters or minis used for fixed applications are 2.4mm to 2.9mm in diameter and are made of solid titanium alloy grade 5. They are certainly stronger than say a 4mm diameter fixture that has a hole in the middle to receive an abutment. Say the abutment is 2mm in diameter. That leaves the surrounding rim with a thickness of only 1mm! That is weaker definitely than a solid 2.5mm diameter mini. Furthermore, many of the conventional fixtures are made of titanium grade 3 or 4 which is 99.9% pure titanium and is softer and therefore weaker than the alloy.

One piece minis heal very well if they are placed in with a torque of at least 35 to 50ncm.Reason being that the healing challenge is much less than conventionals and also the transmucosal wound is very small, so that chances of infection in a normal patient is minimal.

As for the misconception that the surface area is insufficient, Paresh Patel has given an eloquent correction to that. Minis are usually placed longer than conventionals and in multiples. So as Patel has pointed out, two 2.5 by 10mm minis give a total surface area of 157sq mm. This has a greater surface area than a conventional of 4 by 10mm which gives only 125sq mm. 2.5 by 13mm gives 100sq mm. 2.5 by 16mm gives 125sq mm. All these are commonly used such that the argument of insufficient surface area for osseointegration holds no water.

The initial or primary stability of minis, I find often surpasses that of conventionals. In fact, I surmise that because of the minimal trauma and small entrance, the surrounding bone and soft tissue has overwhelming healing advantage when compared to conventionals that invokes a much greater healing challenge to the surrounding tissues. The overwhelming healing advantage in the context of minis may mean that the classical necrotic margin phase of osseointegration may be bypassed and osseointegration in the case of minis may be taking place almost immediately. Anyone wants to do a PhD on this?

Narrow diameter users must concede however that the charges of inadequate prosthodontic solutions to solve the problems of non-parallellism, insufficient prosthetic components, and poor emergence profile may have some credence. These problems I believe are being sorted out. As it is, narrow diameters or minis are here to stay and will be increasingly integrated into treatment plans to cater to all sorts of situations that it can solve much better than conventionals. I look forward to minis making great strides to make the benefits of implant dentistry affordable to everyone who needs them, and not just to the well-off only. I forsee that they will play an increasingly greater part in the development of implant dentistry and am preparing a book…”Minimized Dental Implants” and hope to outline and deliver elegant prosthodontic solutions to minis that will address the current shortcomings as pointed out.

ECTODERMAL DYSPLASIA SEEN SINCE AGE 8 NOW 13. FINISH WITH MINIS?

Mother had been searching all over the country for a dentist willing to treat her son. With some trepedition took it on. First visit refused even to open the mouth. Spoke with the patient and asked this 8year old to come  again. Gave him a small gift. Got these models only on the third visit.

At 10 years old bracketed the two centrals and approximated the two teeth. By now patient has gotten used to visiting us and being comfortable in the dental chair. Parents and child becoming more positive and encouraged as they see the two centrals attaining a more natural position.

Retained the centrals together with a flat wire and composite. What next ?!?!

We raised the bite to a more normal vertical dimension with over crowns on the posterior molars. Observe the edentulous ridges. They have never ever hosted teeth before and cannot then be called alveolar bone.
How are we going to restore this 13 year old's dentition?

A pair of removable acrylic partial dentures with stabilizing stainless steel clasps is not too bad a temporization. In fact the boy was very pleased and grinned from molar to molar. And the parents were almost ecstatic. Are minis/narrow diameters/small diameters the best bet for this boy? Or are we going to place conventionals with the accompanying bone grafts etc. Methinks I will place minis cos I can remove them and reposition them at will as the youngun matures and I have to modify his teeth upwards to match his growth until maturity. Not only that, I will use minis for the final "permanents" or more accurately and realistically speaking even for all our unchallenged patients, for long term use in supporting the necessary crowns and bridges. Minis the best...... simpler..... faster...... cheaper........ stronger .....more versatile!!!!!!
Especially for ectodermal dysplasia may well be the treatment of choice!!

REPLACING MANDIBULAR FREE END SADDLE WITH THE BUDDY SYSTEM

The most distal mini seems to be hitting the IDN. However, because of the small diameter of the mini, little damage is done and most of the time, it is asymptomatic. If symptoms occur, it is a simple matter to remove the mini and the nerve recovers rapidly. Severance or neurometsis of a nerve by a mini is almost impossible, and this is a hugh advantage over conventional sized implants. In this particular case, the xray probably shows an overlap rather than an impingement onto the nerve. There was no sign or symptoms in this case. Thus, a long mini can usually be used even if it seems to enter the nerve canal because it is often only apparent and even if it does so, the nerve is not injured because the nerve occupies only part of the canal and you have to be pretty "lucky" to strike it right in the centre.

Using the Buddy System as described in this blog, we placed mini implants and cemented on the buds. Immediately, we took an impression and sent it to the lab.

And two weeks later........... we cemented the bridge in and the patient went off.

More than a month later, the patient came back. No problems.... he was able to eat quite well on the right side. Can you now look at my left side.... the upper bridge is failing.... please do what you did like on the right side !!

The following pictures is another case of a free end saddle restored with minis.

This is the condition of the composite abutments around the mini-implants and its surrounding soft tissue 3 years later. The PFM bridge came off and had to be recemented. The soft tissue looks healthy and relatively inflammation free. This patient also happens to be a norcturnal bruxer.