Clinical case of total reconstruction in the upper jaw with guided surgery protocol and immediate loading

Dr. Fabio Lo Meo

Introduction
Nowadays modern surgical techniques are more and more moving towards simplified and minimally invasive protocols, aimed at offering patients more effective and highly predictable solutions with shorter treatment times. In addition, this approach makes treatments better tolerated, faster, with more comfortable postoperative courses and reduced costs.
Implant surgery also aligns with this general trend, and one of the brightest and most impressive examples is the Computer Assisted Surgery, more simply and perhaps improperly called Guided Surgery.

Magazine PIP • Practical implantology and implant prosthetics • 08 June 2022

Dentist Michael Weiland: excellent care is important to me!

In times of skilled labor bottlenecks and a fundamental lack of staff, the first thing that many lose is the services that were once seen as so essential. But the more a piece of hardware is interchangeable and discount battles want to be avoided, the more a company stands out from the customer with the many free little help.
Interview with dentist Michael Weiland and his team

pip: How did your first contact with the implant manufacturer C-Tech and Mr. Lütfü Agic come about?
Michael Weiland: I’ve known Mr. Agic for a very long time, for more than ten years, from my time in practice. Four years ago I set up my own practice, but at first I had too much to do with getting the practice up and running. At the same time, a lot was happening within our family – as it is at our age, that often happens alltogether. That’s why I didn’t deal with implantology myself at first and only provided prosthetics at first. Nevertheless, contact with Mr. Agic was never lost, especially since my basic interest continued to exist. Mr. Agic then drew my attention to the further training here at the municipal clinic with Prof. Anton Dunsche.

pip: What is particularly important to you at a training event?
Michael Weiland: Everyone is always talking about ‘take home messages’, and that’s actually what it’s all about. I would like to learn something that I can use in my practice in the relatively short term. In addition to the theory, which you can read up on or acquire through an online event, it is important to me to have the opportunity to try out and practice techniques yourself, preferably with someone at your side who can immediately give you one or two good ones can show tricks and tips. It’s about getting more security for me in my practice. The first course with Prof. Dunsche was just super organized, we learned theory, but also a lot of practice with exercises on the pig’s jaw and later the opportunity to assist Prof. Dunsche himself with surgeries.

pip: So it didn’t stop at this event?
Michael Weiland: No, after that I was given the opportunity to attend a four-day course in Palermo, Italy. They do things slightly differently there, with personal warmth and beautiful surroundings. Everything was very well organized, we even got two translators at our side, so there were no problems here either. For two days we were introduced to the C-Tech system and various surgical techniques, and we were able to use the third and fourth day very intensively for practical exercises and treatments directly on the patient. The two very experienced speakers also supervised this part and took over more complex situations myself, which I might never want to do myself in my practice, but which were exciting to watch. But I also learned an enormous number of new techniques for my areas of application and was able to practice them in such a way that I now feel safe with them. After all, I want to offer my patients the ‘state of the art’ of today’s implantology.

pip: How important is the support provided by Mr. Agic to you?
Michael Weiland: We work directly with and on people, and I personally prefer it if I too am seen as a person. Mr. Agic has never promised too much, is always available and implements my requests incredibly quickly, even if I reach him on the way. I receive all important information promptly and in Mr. Agic I have a good partner for the exchange of ideas, at the same time I never feel pressured. I sometimes think that my time is more important to Mr. Agic than his own, and I can feel that through this great service.

Magazine PIP • Practical Implantology and Implant Prosthetics • August 2022 | Issue 4′

Rehabilitation of the jaw by means of immediate implantation and immediate restoration Digital workflow

Catarina G. Rodrigues, DDS, MSc – Manuel D. Marques, DDS – Raquel Bandeira, CDT

The success of any complex dental treatment depends on proper diagnostics and treatment planning. Digital treatment planning, prosthetic backward planning and guided implant surgery can help improve success rates and predictability of complex rehabilitations. The 3D information about the bone anatomy obtained by means of digital volume tomography (DVT) of the patient form the basis for successful treatment planning.

1. Frontal view with centric occlusion preoperative.
2. Preoperative close-up of the patient’s smile.
3. Image data for the preoperative intraoral scan.
4. Virtual simulation of the prosthetic reconstruction using 2D CAD software (Smile Cloud Biometrics; ADN3D Bioetch SRL).
5. Virtual planning of the shape and position of the anterior teeth according to the measurement criteria ..
6. … the red-and-white aesthetic, planned with the 2D Facial Smile design.

PROCEDURE
The DVT data is imported and processed by means of appropriate software in order to plan the implant positions. The planning data is then used to virtually design the drilling template for guided implant placement, which is then 3D printed and used for optimal positioning of the implants. The use of 2D dental CAD software enables the development of a face-related digital smile design. This two-dimensional data can then be imported into 3D CAD software to design 3D mock ups and immediate temporary restorations.

Advantages of immediate implantation
Immediate implantation of implant-supported prostheses is a predictable treatment option in the restoration of an edentulous jaw, as it can contribute to the preservation of the peri-implant soft and hard tissue and enable rapid patient assistance from an aesthetic and functional point of view. Important advantages of using digital technologies for the planning and execution of implant placement as well as for interim restoration are higher accuracy and precision in the fabrication of the overall rehabilitation, low invasiveness and optimal soft tissue shaping by the temporary prosthesis.

7. Frontal view of the 3D-printed model created from the diagnostic wax-up.
8. Frontal view of the preoperative mock up after transfer to the patient, checking the planning of the 2D facial smile design.
9. Superimposition of the STL data of the preoperative intraoral scan with the DVT data in the planning software (RealGUIDE, 3DIEMME).
10. Digital planning of the implants based on the anatomical situation and the previously planned prosthetic restoration.
11. Once the final implant positions were determined, they were transferred to the surgical template design.
12. Planning of the implant positions.
13. Adjustment of the drilling template on the model.
14. Gentle extraction of the teeth not worth preserving in order to preserve the hard and soft tissue dimensions.

Patient case
The 40-year-old patient presented to our dental practice complaining in particular of difficulty eating and worsened aesthetics in the maxillary anterior region (Figs. 1, 2). The clinical and radiographic examination revealed a bilateral interdental gap in the maxillary posterior region. In addition to a fracture of tooth 13 at gingival level, insufficient amalgam and composite fillings as well as carious defects were diagnosed. There were also increased probing depths and generalised, radiographically visible, horizontal bone loss. After comprehensive diagnostics, it was decided, in consultation with the patient, to extract all of the upper anterior and posterior teeth, and proceed with immediate implantation of a total of eight implants and immediate provisional restoration with screw-retained dentures made of polymethyl methacrylate (PMMA). Intraoral scans (Fig. 3), a DVT and intraoral and extraoral photos (Fig. 4) were taken as part of preoperative diagnosis. In addition, a 2D digital facial smile design was created to enable planning of the position as well as the shape and size of the teeth for the future interim prosthesis (Figs. 5, 6). A digital diagnostic wax-up was then created using 3D CAD software and transferred to a corresponding model using 3D printing (Fig. 7).

Based on the model, a silicone index was created to enable the transfer of the acrylic resin trial restorations to the patient situation and 2D smile planning was undertaken for the patient’s mouth by means of a mock-up (Fig. 8). After adjusting and matching the shape and aesthetics of the anterior teeth, all three-dimensional data (DVT, preoperative intraoral scan and 3D mock-up) were imported into software (Fig. 9) and used to plan the implant position and fabricate the surgical guide (Figs. 10-12). In the patient case under discussion, a mostly fully-navigated implant placement was planned. Special guide sleeves adapted to the implant system were therefore integrated into the surgical template (Fig. 13). The surgical guide was stabilised with tooth support on teeth 16, 12, 22, 26 and 27 and with two palatal bone screws for which two screw channels had been integrated into the surgical guide. Implant preparation was initially fully navigated in the extraction sockets of teeth 13, 11, 21, 23 without opening and in region 15 and 25 with the formation of a mucoperiosteal flap.

After insertion of the six standard implants in the anterior region, the surgical template was removed, followed by extraction of teeth 16, 12, 22, 26 and 27 (Figs. 14-25). The placement of the two short implants was carried out freehand in region 16 and 26 after removal of the posterior teeth. All implant preparations were carried out according to the manufacturer’s recommended drilling protocol. The provisional prosthesis (Fig. 26) was screwed onto the six anterior implants via abutments and immediately loaded (Fig. 27). A postoperative X-ray was taken (Fig. 28). The patient is very satisfied with her new restoration, both aesthetically and functionally (Figs. 29-31).

15. Teeth 12 and 22 were initially left in place to stabilise the surgical guide.
16. A full thickness flap was mobilised buccally in the premolar region of the quadrants to increase the soft tissue thickness.
17. Check the intraoral fit and stability of the surgical guide.
18. Additional stabilisation of the surgical guide via palatal fixation screws.
19. Template-guided implant drilling using the C-Guide drill..
20. … for C-Tech implants (C-Tech Implant, Bologna).
21. Template-guided implant placement (Esthetic Line implants, C-Tech Implants).
22. Occlusal view after placement of the six fully-navigated anterior implants.
23. Control: The markings on the transfer post correspond to the surgical guide sleeves.

24. Occlusal view of the final implant position in apicocoronal direction (subcrestal positioning of the implants!).
25. Placement of the Multi Unit abutments.
26. Temporary denture made of PMMA.
27. Situation after insertion of the temporary denture with good postoperative soft tissue condition.
28. Radiograph showing postoperative check overview.
29. Intraoral situation one week after the procedure with…
30. … healing without complications and good soft tissue condition.
31. Comparison of the patient situation before (left) and one week after the intervention (right).

Henriette Lerner, Uli Hauschild, Robert Sader & Shahram Ghanaati

Abstract
Guided implant surgery is considered as a safe and minimally invasive flapless procedure. However, flapless guided surgery, implant placement in post-extraction sockets and immediate loading of complete-arch fixed reconstructions without artificial gum are still not throughly evaluated. The aim of the present retrospective clinical study was to document the survival and success of complete-arch fixed reconstructions without artificial gum, obtained by means of guided surgery and immediate loading of implants placed also in fresh extraction sockets.

Dental Tribune Magazine • Webinar • 11 May 2020

Treatment of patients with totally edentulous arches: clinical applications of mini implants.

by Dr. Aldo De Blasi, expert in dentistry applied to mini implants.

Abstract
Mini implants are a valid alternative to traditional implants to stabilize the rehabilitation of edentulous arches. Patients with full arch prostheses can benefit from this technique which, with a minimally invasive approach, allows to stabilize them with a single operation even in anatomically unfavorable bone conditions. The advantages include a reduced post-operative symptomatology, low-cost therapy and the possibility of using the pre-existing prosthesis. The aim of the seminar is to examine a convenient therapeutic solution, to learn a simple and minimally invasive implant technique and, through the selection of the patient candidate for rehabilitation with mini implants, to discover a new tool for the stabilization of the total prosthesis.

Read the full article on Dental Tribune Magazine
Click here to access the webinar (Italian language)
To access the webinar, you need to register at the following link.

Content of the webinar
This presentation describes the use of mini implants as an anchoring device for a full prosthesis in order to provide greater stability and retention. A simple, fast, convenient and low invasiveness technique is shown, which allows to obtain in a single appointment an effective stabilization of the patient’s removable denture. Where the removable prosthesis is the therapeutic solution to the problem of edentulism, the mini implants can provide additional comfort and well-being. Finally, through the exposure of some clinical cases, the use of these implants with a reduced diameter is shown, it is explained how to select the ideal patient and how to plan the clinical case.

Educational objectives
• Learn a simple and minimally invasive implant technique
• Examin a convenient rehabilitation solution
• Discover a new tool for patient rehabilitation.

Dental Tribune Magazine • Webinar • 6 July 2020

Webinar | Digital implant planning & guided implant surgery – Work-flow and tips to do it better

by Dr. Luigi Ciacci, Dentist at the homonymous clinic, expert in guided surgery

Content of the webinar
The success of an implant rehabilitation depends on a correct diagnosis which leads to the formulation of a correct therapy plan. Modern dentistry depends on complete diagnostics and on an accurate programming and organization of the decided therapeutic plan. Guided surgery involves a reverse engineering workflow: prosthetic rehabilitation is established first, then the ideal position of the dental implants according to that restoration.

The digital planning and the consequent guided surgery based on three-dimensional radiographic data and digital recordings of the oral cavity, provide us with valuable information to allow us to “repeat” as faithfully as possible the treatment plan we have established, respecting the anatomical structures and topography of the patient, to achieve long-term success from a functional, aesthetic, biological and economic point of view.

Guided surgery was introduced in the early 2000s and has undergone many changes and progress since then. However, it is still an advanced technique for implant positioning where a fair experience of the operator and his team is required, as well as a certain economic investment and time to learn and master the techniques and work flows.

Read the full article on Dental Tribune Magazine
Click here to access the webinar (Italian language)
To access the webinar, you need to register at the following link.

Educational objectives
The purpose of this webinar is to understand the work flow from digital planning to guided surgery, knowing the basic steps and the necessary equipment to carry them out. Be informed about the advantages and reliability and therefore understand the origin of potential errors.

Magazine PIP • Practical implantology and implant prosthetics • November 2019

Small but powerful. High-quality range with C-Tech system implants.

Full Smile, under the direction of business owner Lütfü Agic, well-known in the field of dental implantology, advises on a high-quality range with C-Tech system implants, biomaterials such as Bioteck, as well as dental and surgical instruments and tools from devemed. How can such a small unit survive in times of ever greater global players in the field of dentistry and what is the reason for a dentist to look for the partnership, asked pip and talked to Stefan Grümer, M.Sc., who runs together with colleagues a large referral practice on Theaterstrasse in Aachen.

pip: Don’t you kind of lose touch with international developments and trends with such a small partner like Full Smile?
Dr. Grümer: That may well be, regarding these international trends. Here, in the Theaterstraße in Aachen, we are a practice with an impressive range of modern services, especially in the field of restorative and aesthetic dentistry. From 3D diagnostics and computer-based functional diagnostics to laser dentistry, we use state-of-the-art and exceptionally gentle treatment methods that are comfortable for the patient. We are focusing strongly on training programs so that our range of services stays up to date with the latest state of science and research. But we do not have to follow any pseudo innovation. Much more important to us is a certain consistency with our commercial partners, because as well as between us and our patients, the cooperation between us and a medical device manufacturer is a matter of trust. It would bother me to have to adjust to a new contact person every few months, who knows neither me nor my treatment philosophy nor knows what my experiences are and what might actually enrich and interest me. Since 2013 I have been running the first university teaching practice in Germany in cooperation with the RWTH Aachen, an international academy with many foreign and extensive research projects – above all in the field of implantology and laser dentistry. Therefore, we are demanding a certain level of consulting expertise and a portfolio at eye level from our partners.

pip: What impressed you most about the C-Tech Implant System?
Dr. Grümer: As a referral practice we naturally work with different systems. Personally, I especially appreciate the C-Tech Implant System because of its system-related features. It is a fully engineered system that provides different implant diameters and lengths for all common indications – up to special designs such as one-piece mini-implants for narrow spaces, abutments or anchoring of dentures. At C-Tech we experience a very high primary stability and a very easy handling and thus a method which is absolutely suitable for everyday use. Furthermore, the aesthetic demands of our patients have increased significantly. With the EL – Esthetic Line – C-Tech offers a special design for these more demanding challenges. Refinements, like the platform switch, a generous apical threading, the morse taper connection and the concave aesthetic concept create a good stability with excellent shaping of the surrounding tissue. Despite a high prosthetic design freedom, the system is very easy to use, but the prosthetic connection is identical to the other implant diameters of the series. So you can get by with a straightforward instrumentation. I also like a whole new service of Full Smile, which I have never experienced before: As a dentist, I can search for any product via Full Smile and, if I found one, I will only pay the same list price as in the catalogue!

pip: What about service and accessibility – how can such a small company compete with companies that are quite different staffed?
Dr. Grümer: In fact, we sometimes ask ourselves the famous question of how often Mr. Agic has been cloned. He’s really frequently on the move and also visits us regularly to exchange ideas with us or to prepare ourselves for a new technique. However, we always reach someone in the office or receive a callback within a very short time – and also in such a short time our request is accepted, a delivery is initiated or a technical question is answered. In fact, with other companies I sometimes spent a lot more time in some telephone loop with automated speech before I can speak to a human being. With individual consultation, the reliable assurance of the desired delivery times and practical training, Full Smile is a professional partner for us in the field of dental implantology, periodontology and surgery.

Practical implantology and implant prosthetics | PIP magazine 4 | 2010

Success factors for treatment with mini implants and their importance in practice. Prospective investigation of patient cases over a year.

Literature from the authors: Henriette Lerner, Ady Palti

The clinical success of mini-implants depends on various parameters that are also interrelated. The present study investigated whether there is a correlation between the diameter of the inserted implants and the primary stability. In addition, different bone densities specified by the respective patient were taken into account. The osseointegration and the depth of any perio-implant pockets were documented over a period of one year after implantation. In addition, the influence of the implant diameter and the type of implant structure on the success rate were determined.

Conclusion

Based on the results obtained in the course of the present study, a success rate similar to that of classic implantations can be expected when using mini-implants to stabilize the prosthesis. Since the success correlates with the primary stability, it can be assessed well after its determination with the torque ratchet directly after the insertion. If the determined numbers are in the borderline range (≈ 35 Ncm), a soft lining should be made in case of doubt. Depending on the individual case, it should also be checked whether another mini-implant can be inserted for better stabilization. If you have the choice, you should choose a somewhat larger one, i.e. instead of the 1.8 mm implant, the 2.1 or rather the MDI Hybrid with 2.9 mm diameter instead of the 2.4 mm .

It goes without saying that recall appointments that are close together are advisable, especially in order to be able to follow the scheduled osseointegration promptly. It is by no means over after six months, but rather experiences another significant improvement in the following six months.

Dr. medic.stom. Henriette Lerner

1990 Study of dentistry (University of Medicine and Pharmacy “Victor Babes” Temeschburg).
1990-1993 Oral surgery training at the Academy for Dental Training in Karlsruhe.
1995 Training at Goldman School of Dental Implantology / Boston, Massachussets.
1998 DGZI specialist.
2004 Expert in implantology at the DGOI.
2006-2007 Specialization “Dento-Alveolar Surgery” Dr. Henriette Lerner (University “Carol Davila” Bucharest).
2006 Practice at the Videnti Center for Implantology and Aesthetics, Baden Baden.
Member of: DGOI; ICOI; EAO; ASA DGÄZ; DGZMK; BDO; EFOSS.
National and international speaker on aesthetics in implantology, minimally invasive implantology, implantology curriculum, advanced augmentation techniques.

ENGLISH LANGUAGE: Click here to view
Success factors for the treatment with mini implants and their importance for the practice – December 2010

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Ningxia Med J, Dec. 2017, Vol 39, No. 12

A one year follow up examining bone level preservation utilising platform switching implants

Jianlin Chen, Yuanjie Cao, Lili Shan, Yan Li, Li Ma, Na Wang, Xiuyu Wu Author’s
Unit: Department of Stomatology, Lingwu People’s Hospital, Ningxia

Abstract

Objective The aim of this research is to observe and evaluate the clinical application of the Esthetic Line [EL] implant system (C-Tech, Bologna, Italy). The EL implant has a surface topography created by sandblasting and acid etching (SLA) and a Morse locking conical connection.

Methods 35 patients with one or more missing teeth were selected and a total of 60 EL implants were placed using either a one stage (non-submerged) placement protocol or a two stage (submerged) protocol. Where applicable, second stage surgery was undertaken 2 ~ 4 months post implantation. Subsequent to this the EL implants were permanently restored over a period of 2 ~ 4 weeks. Clinical examination and imaging analysis were undertaken to evaluate clinical success.

Results All 60 implants osseointegrated successfully, and at the one year follow up there was a 100% retention rate and no adverse reactions in the host. Mesial and distal bone heights were recorded on the day of surgery as well as at the fitting of the permanent restoration and after the implants had been functionally loaded for 12 months. Mesial bone heights were (0. 35 ± 0. 49) mm, (0. 18 ± 0. 44) mm and (0. 25 ± 0. 36) mm respectively. Distal bone heights were (0. 20 ± 0. 42) mm, (0. 08 ± 0. 45) mm and (0. 15 ± 0. 38) mm. In the first year of implant functional load, the total absorption of the mesial bone was (- 0. 11 ± 0. 38) mm and the distance was (- 0. 07 ± 0. 31) mm; There was no significant difference in blood indexes between the preoperative and postoperative three months (P < 0. 05).

Conclusion The design of the EL implant incorporating a combination of a parallel walled section with an apical taper, a beveled shoulder, platform switching, a Morse locking conical connection combined with an SLA treated surface and a sophisticated double threaded morphological design all contribute to successful treatment.

Key words Italy; C – Tech Esthetic Line [EL] implant; implant design; surface treatment; Morse-locking.

In recent years, the evolution of implant techniques combined with developments in implant design and restorative techniques has resulted in greater acceptance of implant treatment by the majority of patients. The Stomatology department of our hospital has adopted the Esthetic Line [EL] implant system (C-Tech, Bologna, Italy) for use in our clinic. A study into the clinical results of 60 EL implants placed in 35 patients was undertaken.  

Conclusions

To sum up, the innovative design of the Esthetic Line implant with its sequential thread design, micro-threads to preserve bone at the collar, sophisticated self-cutting and double lead threading preserves bone structure and increases bone to implant contact. This is combined with a SLA surface treatment, a combination of a bevelled shoulder with a platform switching design and a Morse locking conical connection to make it safe and effective in clinical application. The limitation of this study is that the number of cases included is relatively small, only 30 implants of 35 patients were followed up for 12 months. More accurate clinical effect requires more long-term retrospective and prospective clinical observation and research on larger sample size.

References

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[10] 丁旭，汪大林. 影响种植体及其周围组织应力分布的原因分析 [J]. 口腔颌面修复学杂志, 2008, 9(2):155 – 157.

[11] 董福生, 董玉英，邢汝东，等. 种植体长度对骨界面应力分布影 响 的 三 维 有 限 元 分 析 [ J ] . 中 国 口 腔 种 植 学 杂 志, 2001, 6 (3):106-108.

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[16] 刘长虹，杨晓喻. 钛种植体表面特征对种植体周细胞功能的影 响[J]. 中国口腔种植学杂志，2008, 13(2):81-84.

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Romanian Journal of Morphology and Embryology • 2010, 51(2):309–314

Aspects of oral morphology as decision factors in mini-implant supported overdenture

Elena Preoteasa, Marina MeleŞcanu-imre, Cristina Teodora Preoteasa Department of Oral Diagnosis and Ergonomics “Carol Davila” University of Medicine and Pharmacy of Bucharest, Romania, Mihaela Marin Department of Prosthodontics, Henriette Lerner Private practice, Baden Baden, Germany

Abstract

Evaluation of some morphological oral aspects perceived as decision factors in complete edentulism treatment by mini-implants overdenture. Patients, Material and Methods: An observational study was conducted on a sample of 24 patients (average age of 61 years), through clinical and imagistic methods. The variables taken into consideration were: age, gender, alveolar mucosa status, bone offer, miniimplants characteristics, insertion torque and loading type. Results: 117 mini-implants were applied. Conclusions: Mini-implant supported overdenture can be an alternative to conventional denture and conventional implant overdenture. Its advantages derives from implants’ characteristics (smaller diameter, variable length, O-ring retention system), which adapts better to the particular edentulous conditions. Insertion technique implies less surgical trauma. Choosing implants’ size, number, topography, and the loading method have a great variety, depending on anatomical feature (bone offer, mucosa and relationship with the nearby anatomical structures), functional features and patients’ wishes.

Conclusions

Mini-dental implant supported overdenture can be in complete edentulous patients a treatment alternative to both conventional dentures and conventional implant retained overdenture.

The advantages of this type of treatment derives from the characteristics of this type of implant (small diameter, variable length, O-ring retention system), which adapts better to the particular morphological conditions present in full edentulous patients. Also, the implants insertion requires less surgical trauma, this being a beneficial aspect in the context of usually poor general status.

Proceeding and achieving the treatment requires needs careful evaluation through clinical, imagistic and laboratory methods. Frequently there are identified some unfavorable conditions for implant insertion and a high degree of treatment difficulty. These issues (morphological and functional features, related to general health status, age, gender, etc.) must be linked to implants characteristics, in order to decide the particular treatment features, from surgical and prosthetic point of view. The length, diameter, number, topography, loading method of implants can present a large variety, depending on quantitative bone offer (ridge width and bone height), quality (bone density), functional features and patient’s wishes.

This type of treatment has a lower cost compared to conventional implant supported overdenture, by the lower cost of mini-implants, and also due to the use, in general, just of the panoramic radiography as imagistic method (computed tomography is an adjuvant method, but not essential in most cases). Also by eliminating some surgical intervention, we eliminate also their costs. On the other hand, the benefits related to an improved stability, better functionality and adaptation are quickly noticed by the patient and increases their level of satisfaction.

Due to the relatively simple technique, less traumatic, but with benefits that are quickly perceived, the mini-implant supported overdenture may be the elective treatment alternative for complete edentulous patients.

Emerging Trends in Oral Health Sciences and Dentistry • 2015

Narrow Diameter and Mini Dental Implant Overdentures

https://www.intechopen.com/books/emerging-trends-in-oral-health-sciences-and-dentistry/narrow-diameter-and-mini-dental-implant-overdentures
Elena Preoteasa Department of Prosthodontics, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, Marina Imre, Department of Prosthodontics, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania Henriette Lerner, Private Practice, Baden-Baden, Germany Ana Maria Tancu Department of Prosthodontics, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania and Cristina Teodora Preoteasa, Department of Oral Diagnosis, Ergonomics, Scientific Research Methodology, Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

Introduction

Complete dentures are most frequently a challenge for practitioners. The complexity of this disease is often associated with general health problems, but also with the physiological ageing phenomenon, that increases the treatment difficulty. Completely edentulous patients, usually elderly, often complain about the functionality of conventional dentures, especially the mandibular ones, claiming their instability, poor retention and discomfort during wear. Complete maxillary and mandibular dentures have been for over 100 years the standard treatment of complete edentulism. If complete maxillary denture wearers tolerate better the complete dentures, given the better conditions for support, retention and stability, the tolerance of mandibular prosthesis is generally lower. The relatively frequent instability of the mandibular denture, poor retention and associated discomfort were the starting point for the idea of setting the overdenture on 2 implants as first treatment alternative for the mandibular complete edentulism (according to McGill and York consensus) [2, 3, 4].

Concept of implant overdentures

Implant overdentures are inspired, as treatment concept, from the of the overdentures, the dental implants being used instead of tooth roots. Dental implants that are used for implant overdentures are made of high-strength alloy (TiAl-V), with good biocompatibility, with different designs and sizes that aim to address the prosthetic needs according to the oral particularities and clinical limitations of its execution. The first implants that were introduced in the dental practice were the ones with standard diameter, around 3.75mm. Later on, their diameter was increased and decreased (narrow), ranging between 3 and 6mm. Afterwards, the mini implants with one-piece design for implant overdentures appeared (IMTEC, later 3MESPE), with diameters of 1.8mm, 2.1mm and 2.4mm. Narrow Diameter Implant Overdenture (NDIO) represents a category of implants that combines features from conventional implants and mini implants, with diameters between 3 and 3.5mm and variable lengths (10-18mm), comprising two distinctive subgroups, namely two-piece design (e.g. Seven Narrow Line implants, MIS Implants Technologies Inc. 18-00 Fair Lawn Ave. Fair Lawn, NJ 07410, UNITED STATES, mini Sky 2, Bredent Medical GmbH & Co, Germany, Straumann implant, Straumann Group SIX: STMN, Basel Switzerland) and one-piece design (e.g. uno line, MIS implants). Two-piece narrow implants can be used as the conventional implants (with delayed loading), or as one-piece mini implants (with immediate loading protocol). In relation to anatomical, functional and prosthetic case particularities, the number of dental implants used can be reduced, similar to that of the conventional implants (e.g., two narrow implants for the mandibular overdenture). Mini Dental Implant Overdentures (MDIO) use mostly-one piece dental implants (miniSky1, Bredent, MDI 3MESPE) with diameters between 1,8mm and 3mm and variable lengths (10mm-18mm), that require one-stage surgery for implant placement, followed by prosthesis application in the same appointment, with soft material in the housing area (progressive loading) or fixation of the matrices in the denture base (immediate loading). Within the mini implants, those with a diameter between 2.7 and 3mm are classified as hybrid implants, these having sometimes a two-piece design and can be used as narrow dental implants (e.g., two narrow implants for the mandibular overdenture). The main features of the overdentures on dental implants with a diameter below the conventional one, considering their three main categories according to their diameter, are synthesized in table 1. The decision to use either a CDIO, NDIO or MDIO as treatment for complete edentulism, starts from the acknowledgment of patient’s preferences and expectations, within the limitations of the systemic and oral health-status. In systemic alterations with indications of limited surgery or that negatively affects the healing process, NDIO and MDIO are more indicated than CDIO, due to their reduced invasiveness. Oral particularities, such as the anatomical conditions (bone quality and quantity, the shape of the alveolar ridge, skeletal class), thickness and health of the oral mucosa (e.g., denture stomatitis, candidiasis), available prosthetic restorative space (especially as vertical dimension, given the necessary space for abutment, attachments and prosthesis thickness, in order to prevent its fracture) should all be considered when choosing between the implant prosthesis alternatives.

Conclusions

Stabilization of conventional denture with mini- or narrow-dental implants is beneficial especially for the elderly, considering the improvement achieved through a relatively easy surgical intervention, with moderate treatment costs. In this regard, for mandibular denture stabilization either 4 mini implants or 2 hybrid/narrow implants can be used. Treatment success is strongly related to acknowledgement of patient anatomical and functional particularities, rigorous planning and execution of prosthetic and surgical phase, as well as ensuring an adequate maintenance. Considering that edentulism is and most probably will continue to remain a frequent medical condition mostly found in the elderly, MDIO and NDIO overdentures, through their specific parameters, may replace in time complete dentures and may be the most used treatment alternative.

Implant Practice • February 2009 Volume 2 Number 1

Minimal invasive implantology with small diameter implants

Henriette Lerner

What are mini implants?

The highest target in our profession is the fulfilment of patient wishes. The greatest wish of our patient is always the fast, painless replacement of their missing teeth or stabilisation of the prosthesis. A fast, stable and esthetic reconstruction of the patient’s dento-facial system is the main goal of every dentist.

At the time, immediate loading was not an issue, the mini implants were used for the stabilisation of a provisional construction for the time necessary for the osseointegration of the conventional implants. Those mini implants were 1.8mm to 3.3mm in diameter. This implant was also developed with a small ball on the top of it that could be incorporated as a snap for a denture, or to secure a temporary bridge. To uncover the standard implants, it was found that around 50% of the mini implants had actually integrated or bonded to the bone. In order to increase the rate of success, the implant design was improved in to follow the rules of osseointegration and the insertion protocol was changed to give the implants the primary stability necessary for immediate occlusal loading.

Indication for insertion

The general indication for the placement of narrow diameter implants,ridges which, through resorption, become inadequate for placement of standard diameter implants: buco-lingually <5mm, mesiodistally <5mm or both.

The absolute indication will be completed in these cases where the patient does not want an augmentative bone reconstruction or is not indicated from the medical point of view.
a) Edentulous arches The indication for the lower jaw is a 1.8-2.1mm diameter implant. For the insertion of an implant with a diameter of 1.8-2.1mm we need 10mm bone height and 3mm bone width. For the upper jaw the recommended implant is 2.4mm diameter. 4mm bone width and 10mm bone height will be needed.
b) Single tooth restoration The second indication is the insertion of a mini implant in a small gap, in order to replace a front tooth or a premolar, in situations where the standard diameter implant is contraindicated or not possible. A small gap of mesio distal dimension of 5 mm can be replaced with an implant of 2.4mm and a crown if the esthetical considerations will be adequate.

Magazine PIP • Practical implantology and implant prosthetics • May 2020

A new phase of life (quality) Implant-supported fixed denture

Dr. med. dent. Peter Randelzhofer

A restoration with a full denture requires the complete loss of all teeth. Formerly it was known as an important but often not popular restoration. On implants, the removable bridge restoration with palate-free complete denture represents an aesthetically and functionally complete restoration with fixed denture.
The 60-year-old patient came to our dental clinic with discomfort, and she no longer liked the appearance of her teeth (Fig. 1-3). After clinical and radiological diagnostics, it turned out that the remaining teeth represented a potentially “empty jaw condition”, since all teeth had to be extracted due to the periodontal and prosthetic situation (Fig. 4).

Magazine PIP • Practical implantology and implant prosthetics • May 2021

Mini implants: social indication or therapy of choice?

Dr. med. dent. Arndt Christian Höhne

The real advantages of mini implants
For years the mini-implants has led a shadowy existence: despite being widespread and well-accepted in practice, the skepticism of recognized experts has been correspondingly high. Dr. med. dent. Arndt Christian Höhne tried to clarify this divisive topic in an interview with PIP magazine, explaining that mini-implants can be used in a very diverse range, with the main area of application that still consists in the stabilization of full dentures in the upper and lower jaw, be it as a full restoration or by increasing the abutment.

Magazine PIP • Practical implantology and implant prosthetics • August 2018

Italian passion for German precision

When visiting the impressive manufacturing facility, with 25 CNC machines alone, you will also come across the “Mercedes” of manufacturing technology such as the Swiss Tornos, a five-axis machine, which at C-Tech is purely tasked with the manufacture of mini-implants. Currently they are the largest manufacturer in Europe for this specific type of implant. Mini-implants are popular as a minimally-invasive option for creating an immediate restoration, which is currently a highly sought-after alternative for fast and good functional care of older patients. An impressive neighbour is the Willemin Macodell (the Rolls-Royce of CNC machines), which can be fitted with 48 different CNC cutters. It can change tools in 1.4 seconds and can be used in any conceivable axis, including for the manufacture of angled mini-abutments. C-Tech was one of the first companies to move over to cooling all computer-controlled machine tools using water-miscible bio-lubricants. The plant-based oil is odour-free, improves machining and even has a wider range of applications than mineral oil products. “And even though of course we run extensive cleaning processes for the finished parts, it’s still one risk factor less”, comments Lütfü Agic with respect to the recently published independent surface study by the University of Cologne, where the C-Tech implant surfaces were tested as an example, in testing applied to very few dental implant surfaces on the dental market.