Mini-Implants. vs. Standard Implants

7 mini implants in upper jaw

The underside of the denture

Mini-implant supported teeth

The above patient came to me for a consultation after he had received 8 mini-implants (one had failed and been removed) from a local dentist to stabilize an upper denture. The patient was told his new teeth would not be removable and he wouldn??t have a denture anymore. He was told it was all “permanent.” He was not aware that this type of implant was most commonly used for temporary stabilization of dentures since it is not FDA approved for permanent use.

The patient was tired of his loose denture teeth even though he had “implants.” He was worried about losing more mini-implants. He hated his denture teeth and couldn’t eat what he thought he would be able to. He didn??t like having to change out those “O-rings” every couple of months. Although he thought he would save money by having this mini-implant solution, the huge cost to his quality of life was expensive given all the mini-implant failures.

After 3D imaging it was determined the patient would be a good candidate for the “All-on-4” solution from Nobel Biocare. Being able to place 4 standard root form implants without any grafting of bone made the solution simple for the patient. Using Nobel Biocare’s zygomatic implants in the back of the jaw allowed for more stability of his teeth and greater predictability of long term success. His new teeth were screwed in the very day the implants were placed and can only be removed by a dentist with the proper instrumentation. He is very happy that he can finally eat, speak, and live with confidence.

At Shelbourne & Associates, we do place mini-implants for temporary stabilization of a denture. Although temporary implants are typically a less expensive option than permanent implants, they may not last as long as you expect them to. A compromise in choice can be catastrophic to your quality of life. If patients want permanent support for a denture or teeth that are not removable, then we use Nobel dental implants. These are “root form” implants that mimic natural teeth much better than a mini-implant. This allows for better stabilization and more permanent teeth.

At Shelbourne & Associates we are able to provide you with all your dental implant options and a clear understanding of what to expect from each one. When it comes to choices that affect your quality of life, we will never recommend you compromise.

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8/30/2016

Mini-Implants – Useful for stabilization of dentures when unable to load an “All-on-Four” immediately

One of many advantages of an “All-on-4” procedure is being able to leave our office with new teeth that are secured by 4 dental implants. Patients seem to appreciate the convenience of having their implants and new teeth all done as one procedure. This requires technical skill from the surgeon and an excellent lab technician. Implants placed must reach a certain level of stability when placed in order to support the teeth. This stability is measured by insertional torque values and dictated by industry standards.

allon4What if the torque is not high enough? Catastrophic failure can occur by connecting the teeth to the implants prematurely. Rather than allowing this to happen, it is more prudent to allow the implants time to integrate with the patient’s bone and then connect the teeth at a later date once the implants are more stable.

What kind of teeth do I get if they can’t be secured on the 4 implants? Traditionally the patient would get a denture to wear for 4-6 months. Dentures are loose teeth and do not allow for normal function.

Is there a way to help secure the loose denture so it’s easier to eat, talk, smile, etc without it coming out? Mini-implants placed strategically can be used during the transitional time to secure the denture. These can be placed at the same time of the “All-on-4” procedure or at a later date if necessary. The pictures included here show the placement of 3 mini-implants and the retro-fitted denture after an “All-on-4” procedure where insertional torque values were too low to load the implants immediately.

How do mini-implants differ from the traditional “root form” implants? Mini-implants are one piece implants that have been used for years as an efficient method to temporarily stabilize a denture. Traditionally 4 are placed in the lower or upper jaw for maximum benefit.

Are these mini-implants removed once the permanent implants are integrated? Yes. The surgeon simply removes these implants with a counter-clockwise twist of the implant. The new teeth are screwed to the “root form” implants and are now more stable than ever before. They can not be removed unless unscrewed by the dentist.

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4/7/2016

Case Study: Dental Implants

Since starting my private practice in Charleston in 2002, I’ve always used the best surgical
principles and implant materials available. By doing this, I’ve been able to achieve the most
predictable, permanent, and aesthetically pleasing results. Below is an example of one of the
first immediately placed and immediately restored implants in Charleston that I placed in 2002.
The picture below taken in 2016, although revealing some aged teeth, also reveals excellent
maintenance of soft tissue architecture framing the implant supported tooth #8 for more than
14 years! There is absolutely no recession of soft tissue. This is predominantly because of the
maintenance of hard tissue underneath it. Maintenance of these two biological areas is directly
due to position and placement of the implant as well as proper shape of the
restoration…principles that remain true today.

2002 #8 tooth with vertical fracture prior to removal and implant 2002

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2002 #8 tooth with immediately placed implant, zirconium abutment, and porcelain crown

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2016 14 years later the soft tissue height and thickness is perfectly maintained thanks to the use of good surgical and restorative principles.

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2/4/2016

Follow-up on Previous Blog Socket Shield & Partial Extraction Therapy (PET) for Dental Implants

These photos reveal the successful outcome of using the PET technique for anterior implants. Success being defined by the preservation of hard tissue (bone), soft tissue (gingiva), and overall aesthetics.

If you are needing anterior teeth replaced, the PET technique might be beneficial for you. At Shelbourne & Associates we continue to strive to be the best in the south-east at achieving the most aesthetic outcomes for our dental implant patients. Using new techniques like the PET is just one of the ways we do this.

 

BEFORE

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DURING

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TEMP

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FINAL

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7/8/2015

Socket Shield & Partial Extraction Therapy (PET) for Dental Implants

The concept of submergence of roots for conservation of alveolar bone as described by O’Neal and
colleagues in 1978 is not a new concept. With this technique vertical and horizontal hard tissue is
preserved, thus, maintaining soft tissue architecture. In the aesthetic zone this approach is often used in
order to maximize the cosmetic/restorative outcome.
A modification of this technique is being used when placing implants immediately following the extraction
of a tooth in the anterior region of a patient’s mouth. Originally discussed in 2010 by Hurzeler et al as the
Socket Shield Technique, Gluckman and Salama have recently suggested further modification and called
it Partial Extraction Therapy. This new approach calls for leaving a small sliver of the labial portion of the
tooth being removed in order to preserve the labial hard and soft tissue. The piece of tooth can not be
mobile and the implant should avoid contact with it.
There are 3 major benefits of the Partial Extraction Therapy. First, it minimizes resorption of labial bone
and soft tissue. Second, it requires less grafting of bone and/or soft tissue at time of implant. Third, it
minimizes trauma in difficult extraction cases.
There are some disadvantages of this new approach. It is technically more challenging then simple
atraumatic removal of a tooth for immediate implant placement. There is no osseointegration of the
implant to the fragment of tooth left behind. There is risk of infection or loss of the tooth fragment causing
loss of alveolar bone.
The technique is outline above in the images taken during a recent procedure.
Image 1. Pre-operative photo of tooth #9 with internal resorption and failing prognosis, short/wide papilla
and thick biotype of tissue.

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Image 2. Incisal view showing excellent labial bone convexity in anterior area.

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Image 3/4. Surgical management to remove tooth and leave labial sliver of tooth for Partial Extraction
Therapy.

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Image 5. Sliver of tooth is reduced 3mm from crest of soft tissue margin.

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Image 6/7. Implant is placed while maintaining excellent soft tissue architecture.

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Image 8. Sliver is tooth is noted on labial with lack of implant contact to tooth.

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Image 9. Incisal view showing maintenance of hard/soft tissue architecture on labial aspect.

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The implant had greater than 70NcM insertional torque and thus was temporized in a non-loaded
manner the same day by the patient’s restorative dentist.

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1/29/2015

Failed Mini-Implant Restoration

Courtney W. Shelbourne, DMD

Board Certified Oral & Maxillofacial Surgeon

Mini dental implants, implants less than 3mm in diameter, are useful for temporary support of a

removable prosthesis or denture. They can also be helpful in very small spaces for temporary

support of a fixed restoration such as an anterior incisor. It is not a commonly accepted practice

to use more than one mini-implant to support a fixed, single-crown restoration as was performed

below.

Below is a case where the restoration on the mini-dental implants failed and was lost by the

patient. The restoration had been re-cemented multiple times before it was finally lost. The

mini-implants were removed so a standard implant could be placed the same day. Because the

mini-implants do not integrate with bone, they are easy to remove with the implant torque

wrench.

A standard permanent implant engineered for posterior teeth is placed. Note the abundance of

soft tissue on the new implant relative to that seen in the mini-implants. Being able to place an

anatomical healing cuff on the standard implant while creating more soft tissue will provide a

much better restorative outcome. The restoration will be more aesthetic, more hygienic, and

more permanent than the previous implants. From this example, many differences between

mini-implants and standard implants are seen.

Nobel

Nobel Biocare 5.5mm Active Implant with 7x8mm Anatomical Healing Cuff.

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1/15/2015

Anatomic Healing Cuffs

Courtney W. Shelbourne, DMD

 

Dr. Shelbourne is proud to be the first surgeon in SC to use Nobel Biocares Anatomic Healing Cuffs.

Nobel Biocare has just developed a simple, yet novel approach to improving the restorative management of an implant. Their new anatomic healing cuffs mimic the future restoration and emergency profile much much better than the standard stock abutments we are accustomed to. The cuff, made of PEEK material, is simple to adjust if necessary prior to positioning. Currently, the abutment only comes in sizes/shapes appropriate for the posterior dentition. This cost-effective solution is sure to set the standard for soft tissue development prior to restoration. Whenever possible, Dr. Shelbourne will certainly use this approach to allow for the best possible restorative outcome.

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#30 site post extraction & graft for site preservation. Note the small buccal atrophy of hard tissue support for the soft tissue.

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Nobel Biocares 7mm x 8mm PEEK Anatomic Healing Cuff for 5.5mm diameter conical connection Active implants.

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Anatomic Healing Cuff in place. all soft tissue was preserved and tucked under the buccal flap for augmentation of hard tissue defect.

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