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Top 10 Advantages of Mini (Minimally Invasive) Dental Implants

This minimally invasive approach to 21st Century dental implantology offers new opportunities for individuals who have lost one or more teeth and underlying bone. Even for those who have lost all of their teeth, FDA approved mini dental implants offer a second chance at teeth that look, feel, and function more like the teeth they were born with!

For example, one of the most respected, renouned U.S. dental educators and board certified prosthodontist, Dr. Gordon J. Christensen, states in his national newsletter of September 2009 Clinician Report: ‘Gordon and Paul’s Top 10 Concepts, Techniques, and Products’ that the #1 concept is:

Small Diameter Implants: Root form implants have been the most important innovation in dentistry since the air rotor nearly 50 years ago. Millions of people globally have need of retention and support for removable prostheses, crowns, or fixed prostheses. However, many of them do not have adequate bone quantity in which to place root form implants 3mm or over in diameter, and, for financial or health reasons, they cannot have bone grafting. Small diameter “mini” dental implants serve these patients. Small implants, ranging from 1.8mm to 2.9mm in diameter, have now proven themselves capable of supporting complete dentures, removable partial dentures, fixed prostheses, and even some single tooth replacements. Although criticized by some, the research is supportive of these implants with proper treatment planning and placement.

How is a mini dental implant different from a conventional implant?

1. Less Expensive

In many cases, mini dental implants cost around half the cost of traditional or conventional implants.

2. Less Invasive

Because the mini dental implant requires only a small pilot hole to be placed, it is less traumatic,minimally invasive to the bone and soft tissue; as compared to a traditional conventional implant that usually involves extensive surgery and bone grafts.

3. Less Healing Time

Because placing the smaller diameter mini implant does not cause as much trauma to the bone and soft tissue in the mouth, your healing time is reduced from months to days.

4: Less Discomfort

Less trauma to the gums, bone and underlying tissue means less discomfort. Many patients need only over the counter pain medication for a day or so after the procedure.

5. Less Restorative Time

In many cases, the mini implant can be loaded immediately after placement. This means that most procedures, including anchoring dentures can be done in one visit.

6. Less Bone Loss

A mini dental implant preserves the bone so that you can preserve the shape of your face.

7. Less Bone Required

Mini implants require less bone so you're less likely to need additional costly bone grafts.

Prosthetic Options Using Mini Dental Implants... Excellent Natural Alternatives to All on 4

PROVIDING THE REVOLUTIONARY BENEFITS OF MINI IMPLANTS

Our focus is on providing you with the revolutionary benefits of mini dental implant dentistry. This unique approach to modern dentistry offers new opportunities for individuals who have lost one or more teeth. Even for those who have lost all of their teeth, mini implants offer a second chance at teeth that look, feel, and function more like the teeth they were born with!

THE MINI IMPLANT ADVANTAGE.

Half the Size
Mini Implants are about half the size of traditional implant, and therefore don't require as much bone structure. With less bone needed, costly, painful and time-consuming bone grafts that are usually necessary with traditional implants are not usually needed for minis.

Less Healing Time & Fewer Office Visits
Because mini implants are much smaller, placing them is a less invasive procedure---requiring less healing time and discomfort, and fewer visits to the dentist's office..

Immediate Results
Because they are less invasive, and don't require the lengthy healing time of traditional implants, they can typically be loaded with crowns, bridges and dentures immediately.

Half the Cost
In most cases, the mini implant is less than half the cost of a traditional implant.

No More Decay
Implants are made out of titanium---the same type of material that is used on artificial joints, and they are not subject to decay and periodontal disease

Preserves Bone Structure
Implants preserve your natural bone stucture so you can maintain the shape of your face and avoid continued bone loss where teeth are missing

1. Less Size
Mini Implants are about half the size of traditional implant, and therefore don’t require as much bone structure. With less bone needed, costly, painful and time-consuming bone grafts that are usually necessary with traditional implants are not usually needed for minis.

2. Less Expensive
In many cases, mini implants cost around half the cost of traditional or conventional implants.

3. Less Invasive
Because the mini implant requires only a small pilot hole to be placed, it is less traumatic to the bone and soft tissue; as compared to a conventional implant that usually involves extensive surgery and bone grafts.

4. Less Healing Time
Because placing the smaller diameter mini implant does not cause as much trauma to the bone and soft tissue in the mouth, your healing time is reduced from months to days.

5. Less Discomfort
Less trauma to the gums, bone, and underlying tissue means less discomfort. May patients need only over-the-counter pain medication for a day or so after the procedure.

6. Less Time
In many cases, the mini implant can be loaded immediately after placement. This means that most procedures, including anchoring dentures can be done in one visit.

7. Less Bone Loss

A mini dental implant preserves the bone so that you can preserve the shape of your face

8. Less Bone Required
Mini implants require less bone so you’re less likely to need additional costly bone grafts.

9. Less Decay/Periodontal Disease
Implants are made out of titanium—the same type of material that is used on artificial joints, and they are not subject to decay and periodontal disease.

10. Less Complications
Mini dental implant failures and complications are very rare.

Mini Dental Implant Solutions

Genuinely beautiful. Naturally permanent.

Picture you Smiling!

 

Mini Dental Implants

Mini Dental Implants are titanium screws that replace the root of a tooth. The ball shaped head and collar design can be used for both permanently cemented crowns or bridges, as well as securing full dentures. When used for fixed or cemented applications, the prosthesis is cemented by Dr. Petrosky directly to the head of the implant. If the implant is to be used for a removable denture, then a housing with a rubber gasket is attached precisely to the acrylic denture and functions like a button that snaps on and off the implant. The dentures sits snugly against the gums and is retained securely allowing better chewing function and increased confidence.

Get permanent…quick!

Mini Dental Implants are placed by Dr. Petrosky quickly and easily using a microsurgical technique. Your dentist will use a small amount of local anesthetic and make a pin-sized puncture in the gum and jaw. The Mini Implant is then threaded gently and carefully into the jaw. The heads of the implants protrude from the gum tissue and provide an attachment for securing dentures, or cementing crowns or bridges. It is a one step procedure involving minimally invasive surgery.

So Many Options. One amazing result.

Dental Implant therapy has been one of the most significant advances in dentistry in the past 25 years. Tens of thousands of grateful patients testify to the benefits of replacing lost teeth and restoring confidence in their smile. Several different types of implants and restorations are available. The problem is, many of them are expensive and require a long recovery. Your options depend upon the amount of bone available, the patient’s general health, and restoration preference. Mini Dental Implants are minimally invasive and, in most cases, require only local anesthesia. With Mini Dental Implants, less bone is necessary, which is a great benefit for patients who have previously been told they would need bone grafts to receive any dental implants. Another benefit is for patients who are medically compromised and have been told they cannot get implants.

Bigger isn’t always better.

The computer and medical worlds are both striving to develop smaller and smaller components. In similar fashion, The Mini Dental Implant represents a smaller version of the dental implant. Smaller means less invasive, which makes the procedure and recovery easier on you. The microsurgical approach allows the Mini Dental Implant Solutions for more patients and represents a new option for many previously denied treatment with older conventional-style implants.

A beautiful smile should break hearts…not the bank.

Typically, Mini Dental Implants are more affordable-usually half the price of conventional implant treatment. This affordability enables people to expand their treatment options, allowing some to realize their dream of fixed bridgework instead of removable dentures. Because Mini dental Implants require less bone, this option eliminates the need for expensive, time-consuming bone graft procedures by Dr. Petrosky.

Who knew your smile has so much history.

The titanium alloy was developed about twenty years ago and was recognized as being a useful material for a variety of medical and dental implanted devices. Dr. Sendax and the Imtec Corporation, now a 3M Company, developed the Mini Dental Implant System and the important placement protocol. In an article in the Journal of the American Dental Association (JADA) the world renowned dental educator and prosthodontist Dr. Gordon J. Christensen DDS, MSD, PHD stated:

In my opinion, I find more indications for narrow-diameter implants (1.8mm) than for standard-diameter implants (3.75mm).

Thousands of patients have them to thank for their newfound confidence and ability to chew and eat any foods they want.

There is nothing to hold back your radiant grin.

A great deal of time, research and study has gone into the development of Mini Dental Implants. It is safe, biocompatible, FDA approved and provides an improved method of tooth replacements. Mini Dental Implants are FDA approved ( K031106) for “ The MDI and MDI PLUS are self-tapping titanium threaded crews indicated for long-term intra-bony applications. Additionally, the MDI may also be used for inter-radicular transitional applications. These devices will permit immediate splinting stability and long-term fixation of new or existing crown and bridge installations, for full or partial endentulism, and employing minimally invasive surgical intervention.” After 40 years of study, the technique is now used by thousands of dentists in many different countries and is recommended by some of the top implant dentists in the world.

 

Who is a Candidate for Mini Dental Implants?


Almost anyone with weak gums and in need of dental implants can go for mini dental implants. On the other hand, mini dental implants are not advised in the following situations:

  • Uncontrolled diabetes
  • History of radiation treatment for cancer (this does not include X-rays for diagnostics)
  • Substance abuse
  • Immuno-suppression

Patients with the following conditions may suffer complications or failure with MDIs.

  • Heavy smoking/drinking habits
  • Sjorgren's syndrome
  • Alzheimer's disease
  • People who clench/grind their teeth
  • Young persons in their growing years

If you do not wish to go for mini or regular dental implants, you may consider options like partial or full dentures or dental bridges. Partial dentures work for persons who have some remaining teeth. A partial denture replaces missing teeth. It is held in place using clips or other devices. If you have teeth adjacent to the affected tooth, a bridge is another option. There are several types of bridges.

Mini Dental Implants vs. Regular Dental Implants

Mini Dental Implants have many advantages over regular dental implants:

  • MDIs are much smaller than conventional implants (2 mm as against 4mm- 5.75mm for conventional implants), so it takes less drilling of the jawbones.
  • MDI surgery is minimally invasive. The surgery does not usually need cutting of gums and removal of stitches afterwards.
  • Trauma to jaw bone, bleeding, chances for injury, post-surgical discomfort are all minimized.
  • Mini dental implant failures and complications are very rare.
  • Due to their smaller size, mini dental implants can also be used when the site for implantation is too narrow for a regular implant.
  • Quite often, only local sedation of the implant site is needed in the case of MDIs.
  • The MDI procedure is quick and can be completed in one sitting as opposed to conventional implants which require several visits to the dentist.
  • MDIs cost less than conventional dental implants (average cost of conventional implants is between $2,000 and $4,500) by at least 30%.

Having Trouble With Your Dentures?
Are You Missing One or More Teeth?

Mini Dental Implants are for you!

o Can help you eat, smile, and speak with renewed confidence
o Are placed using a simple, gentle, non-surgical approach
o Are affordable - less than half the cost of old, conventional-style implants
o Can be placed to anchor dentures or cemented crowns & bridges
o Can help to preserve bone & facial appearance

Welcome to Mini Dental Implant Center

Our focus is on providing you with the revolutionary benefits of mini dental implant dentistry. This unique approach to modern dentistry offers new opportunities for individuals who have lost one or more teeth. For the first time, we can replace missing teeth with implant supported cemented and/or removable restorations in as little as one visit, without the complications of major oral surgery and long healing times.

Have Your Implants Placed in the Morning and Enjoy Your Favorite Meal That Same Evening.

o Most procedures are accomplished in one visit
o We use a simple, gentle, non-surgical approach
o Eat, smile, and speak with renewed confidence
o Less than half the cost of conventional implants
o Anchoring for dentures, cemented crowns & bridges

What are Mini Dental Implants?

The Mini Dental Implant System consists of a miniature titanium implant that acts like the root of your tooth and a retaining fixture that is incorporated into the base of your denture. The head of the implant is shaped like a ball, and the retaining fixture acts like a socket that contains a rubber 0-ring. The 0-ring snaps over the ball when the denture is seated and holds the denture at a pre-determined level of force. When seated, the denture gently rests on the gum tissue. The implant fixtures allow for micro-mobility while withstanding natural lifting forces.
This system is frequently used to support fixed crowns and bridgework for people who don't want a removable denture.

How does Mini Dental Implant Technology Broaden My Options?

Dental Implant therapy has been one of the most significant advances in dentistry in the past 25 years. Tens of thousands of grateful patients testify to the benefits of replacing lost teeth and restoring confidence in their smile. Several different types of implants and restorations are available. The choice depends upon the amount of bone available, the patient's general health, and restoration preference.

The computer and medical worlds are both striving to develop smaller and smaller components. In similar fashion, a smaller version of the dental implant has been successfully utilized. Mini Dental Implants are more versatile than older conventional-style implants because they can be used in patients who do not have enough bone to support larger, conventional implants. RecentIy many people have gained access to the benefits of implant dentistry because at MDICA, we make implants affordable---typically half the price of conventional implant treatment. This affordability also enables people to expand their treatment options, allowing some to realize their dream of fixed bridgework instead of removable dentures. Because mini dental implants require less bone, this option eliminates the need for expensive, time-consuming bone graft procedures.

How are Mini Dental Implants Placed?

Placement of the implants is accomplished quickly and easily in a process performed in the dentist's office, with local anesthesia or a light sedation to help make you more comfortable. Using a precise, controlled, minimally-invasive surgical technique, Mini Dental Implants are placed into the jawbone. The heads of the implants protrude from the gum tissue and provide a strong, solid foundation for securing your dentures or fixed crown and bridgework. It is a one-step procedure that requires no sutures, and most people begin using their teeth the same day. This is a major advantage over conventional implants which typically require multiple visits, multiple surgeries, and months of healing.

Back to top

What are Implants?

Dental Implants have been used successfully for many years. The implant itself is a post that is surgically placed in the jaw. A prosthesis (artificial tooth or teeth) is then attached to the post. Our office performs the entire procedure.

implant
Implant
restoration
Restoration

What are Dental Implants Used For?

There are two basic uses for Dental Implants:

  1. As an artificial root for a single tooth replacement.
  2. As anchors for a fixed or removable prosthesis to replace multiple teeth.

What Are the Benefits of Dental Implants?

With the exception of your natural teeth, nothing looks more natural than an implant. One important benefit of implants is that they slow the shrinking of bone and gum tissue from the area of the missing tooth, thus preventing premature aging.

  • Of Americans between the ages of 18 and 64, approximately 49% are missing at least one tooth.
  • Dental implants are the most advanced tooth replacement system ever devised.
  • More than nine out of ten implants last longer than 15 years.
  • Dental implants never develop decay.
  • Dental implants never require root canals.
  • Dental implants preserve the jawbone, which can prevent premature aging.
  • No one can be disqualified for implant treatment solely because of their age -- some patients receive implant treatment when they are in their nineties!

What are Mini Implants?

Mini dental implants are very strong, small, titanium screws that are approximately the size of wooden toothpicks. They can be used to anchor a bridge or denture, or for single tooth replacement.

Dr. Petrosky will first do an exam or consultation to determine how many mini-implants you will need. Then under mild anesthesia the mini-implants are gently placed. If you have a denture it is then created to fit over and "snap" onto the implants, resulting in a tight fitting denture that doesn't "float" around the mouth interfering with speech and trapping food underneath.

For more information on Mini Dental Implants visit the following web sites:
IMTEC site
The Advantages of Minimally Invasive Dentistry
The 'Mini-Implant has Arrived'

 


mini-implant

 


Click on Clinical Articles on Advantages and Benefits of Small Diameter Mini Implants

 

Implant-supported Fixed Prosthetic. Treatment Using Very Small-diameter. Implants: A Case Report, 2006 By Dennis Flanagan
Immediate Loading of Narrow Diameter Implants with Overdentures
in Severely Atrophic Mandibles
by SC Cho
Mini dental implants: An adjunct for retention, stability, and comfort
for the edentulous patient
, 2005 By Trevor McClain Griffitts, BS, a Chad
Patrick Collins, DMD,and Patrick Charles Collins, DDS,b Spokane, Wash
Minimal invasive implantology with small diameter implants, 2009 By Henriette Lerner
Small-diameter implants, 2008
Full-Arch Fixed Prosthetics Supported by Dental Implants and Natural Teeth: Planning, Provisionalization, Treatment Sequences: Two Case Examples, 2004 By Michael Tischler, DDS
Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical Guidelines, 2009 By Gary Greenstein, DDS, MS; John Cavallaro, DDS; Richard Smith, DDS; and Dennis Tarnow, DDS
Implant-supported Fixed Prosthetic Treatment Using Very Small Diameter Implants: A Case Report, 2006 By Dennis Flanagan, DDS
Immediate Loading With Mini Dental Implants in the Fully Edentulous Mandible, 2004 By Mi-Ra Ahn, DDS, An KM, Choi JH, Sohn DS
The Truth About Small-Diameter Implants, 2010 By Gordon J. Christensen, DDS, MSD, PhD, and Paul L. Child, Jr, DMD, CDT
Product Focus Small-Diameter Implants, 2008
Denture Stabilization With Small-Diameter Implants, 2010 By Ian Erwood, BSc, DDS
FixtTeeth...A New Approach to an Old Problem, 2008 By William Letcher, DMD
Mini Dental Implants: Immediate Gratification for Patient and Provider, 2005 By Ara Nazarian, DDS
The 'mini'-implant has arrived, 2006 By Gordon J. Christensen, DDS, MSD, PhD
The advantages of minimally invasive dentistry/ Miniature implants versus standard-size implants, 2005 By Gordon J. Christensen, DDS, MSD, PhD'
The Increased Use of Small-Diameter Implants, 2009 By Gordon J. Christensen, DDS, MSD, PhD
Mini Dental Implants for Long-Term Fixed and Removable Prosthetics: A Retrospective Analysis of 2514 Implants placed over a five-year period. 2007 By Todd E Shatkin, DDS
Gordon and Paul's Top 10 Concepts, Techniques, and Products/ #1 Small Diameter Implants, 2009 By Dr. Gordon Christensen
Ask Dr. Christensen 2010 By Dr. Gordon Christensen
Ask Dr. Christensen 2009 By Dr. Gordon Christensen
Ask Dr. Christensen 2009 By Dr. Gordon Christensen
Ask Dr. Christensen 2007 By Dr. Gordon Christensen
Ask Dr. Christensen 2006 By Dr. Gordon Christensen
The growing popularity of mini-dental implants,2006 By Raymond Choi, DDS, and Sarah E. Campbell
IMTEC
INTRA-LOCK
Replace A Posterior Mandibular Tooth 2009 By Dr. Ara Nazarian
Implant Placement and Restoration in Your General Practice 2009 By Dr. Ara Nazarian
OCO Biomedical Implants: Successful, Simple, and User-Friendly 2010 By Dr. Ara Nazarian
Simplifying the Placement of Dental Implants By Dr. Ara Nazarian

 

Peer Reviewed REFERENCES:

1: How Successful are Small Diameter Implants: A Literature Review 2012

Keyvan Sohrabi Ammar Mushantat Shahrokh Esfandiari Jocelyne Feine
Keyvan Sohrabi, Deptartment of Oral Health Policy and Epidemiology,
Harvard School of Dental Medicine, Boston, MA, Clin. Oral Impl. Res. 0, 2012 / 1–11
© 2012 John Wiley & Sons A/S
https://www.dentatususa.com/
fileadmin/user_upload/PDF/ PDF_Reference
_Articles/114_Jan_2012_Sohrabi.pdf

Conclusion:
Survival rates reported for SDI are SIMILAR to those reported for STANDARD width implants.
These survival rates did not appear to differ between studies that used flapless and flap reflection techniques. The failure rate appeared to be higher in shorter SDIs than in longer ones in the studies in which the length of the failed implants was reported.

SDIs could be considered for use with FIXED fixed restorations and mandibular overdentures, since their SUCCESS RATE appears to be COMPARABLE to that of regular diameter implants. They might also be an efficient, low-cost solution for elders who wish to reduce problems with denture instability.

2: Mini Implants Supporting Fixed Partial Dentures in the Posterior Mandible: A Retrospective (2015)

Dennis Flanagan, DDS, MSc
Journal of Oral Implantology e138 Vol. XLI/No. Four/2015
http://www.joionline.org/doi/pdf/10.1563/
AAID-JOI-D-14- 00081?code=aaid-premdev

Small-diameter, or mini dental implants have been successfully used to support removable and FIXED oral prostheses.
These implants impart about twice the per-square-millimeter force on the supporting bone and this should be addressed during treatment planning. In the posterior jaws, bite forces are of a higher magnitude than in the anterior jaws and may induce an overload of the supporting bone and failure of the osseointegration.
Thus there should not be occlusal contact in functional excursions that induce off axial loads.

The cases presented herein demonstrate that mini dental implants may be used successfully to support fixed partial dentures in mandibular sites in highly selected patients.

Mini or small-diameter dental implants (,3.2 mm) have been used successfully for many years.1,2
Probably most of these have been used to retain removable partial and complete dentures.

Nevertheless, many clinicians use mini implants to support fixed complete and partial dentures.

There have been no long-term randomized blinded controlled trials of this treatment or a failure rate established.
Many patients have site conditions, or medical or psychological conditions that preclude the use of standard-diameter implants (3.25 mm).
These patients may not be able to undergo augmentation procedures or they may object to a larger metallic foreign body being placed in the jaw.

Economics may be an issue as well.

FIGURE 1. The crowns and fixed partial dentures were fabricated with a very narrow occlusal table to minimize off-axial loads.
FIGURE 2. A recent radiograph demonstrates little or no bone loss. No graduated operative radiographs were made so bone loss measurements could not be made.

Mini implants may be placed in many of these patients without substantial augmentation procedures and surgical trauma may be much less.

In addition, the cost of mini implant surgery is substantially less than standard diameter implants.

Some clinicians may feel comfortable using mini implants to support fixed partial dentures in the posterior mandible.
The posterior mandible has a higher occlusal load magnitude with multidirectional cyclic loading. This subjects the bone-implant- prosthesis complex to more severe loading conditions than in anterior sites. This may affect the longevity of the treatment outcome so treatment planning for this parameter is of paramount importance.

The object of this effort is to demonstrate that in highly selected cases with appropriate prosthetic design and osseous support, mini implants may be successfully used to support fixed partial dentures in the mandible.

All patients had medical, economic, psychological, and or attenuated site reasons that made standard diameter implants not an option for treatment.

All implants were small diameter ranging from 2.0-3.0 mm manufactured by Imtec (Irvine, Calif), IntraLock (Boca Raton, Fla), or Biohorizons (Birmingham, Ala).

All prosthetics were single crowns, 2, 3, or 4 splinted prosthetic units fabricated in porcelain fused to noble alloy (PFM) by a commercial dental laboratory (York Dental Lab, Branford, Conn).

All implants were placed in healed, partially edentulous sites. Prosthetic design included a very narrow, rounded, occlusal table, less than premolar dimensions, with absolutely no occlusal contact in functional excursions (Figures 1 and 2). Esthetic compromises were accepted preoperatively by all patients.
All prostheses were made with a flat narrow rounded occlusal table with little artistic anatomical recreation by the technician.
The laboratory technician was instructed to place 3 coats of die separator to ensure a passive fit and account for the expansion.

TABLE 1
Forty-nine patients in 50 cases were treated. Most implants were successfully functioning for a documented average of 5.5 years

FIGURE 1. The crowns and fixed partial dentures were fabricated with a very narrow occlusal table to minimize off-axial loads.
FIGURE 2. A recent radiograph demonstrates little or no bone loss.

recemented with insoluble resin modified glass ionomer cement (FujiCEM, 3M

The percutaneous portion of mini implants is much LESS than standard sized implants and thus presents less of an opportunity for coronal epithelial attachment issues.

The circumference (pi 3 diameter) of a 2.5-mm mini implant is 7.85 mm as compared to a standard-sized implant (4.0 mm) at 12.56 mm, which is 160% longer.
This presents much LESS of an opportunity for PERI-IMPLANTITIS, but the rate of peri-implantitis in mini implants has not yet been reported.

CONCLUSIONS

  • These cases demonstrate that many patients with conditions that may preclude standard diameter implant treatment, may be treated with mini implant-supported FIXED partial dentures. This is a highly selective and exclusive group of patients that may qualify for such treatment.
  • Particular care should be given to bone density of the site, observation of a 4-month healing time, flapless placement, use of longer implants than 10 mm, treatment of any existing periodontitis, choice of an insoluble luting cement, exclusion of occlusal contact in excursions, and very slow seating rotation with intermissions and water irrigation during seating.
  • As a retrospective case series this work is a lower level of credibility. More study of occlusal design, materials, and bone resistance physiology is needed to develop this treatment concept.

3: IMMEDIATE PLACEMENT OF MULTIPLE MINI DENTAL IMPLANTS INTO FRESH EXTRACTION SITES: A CASE REPORT 2008

Dennis Flanagan, DDS
Journal of Oral Implantology Vol. XXXIV/No. Two/2008

http://www.joionline.org/doi/pdf/
10.1563/1548-1336%28 2008%2934
%5B107%3AIPOMMD%5D2.0.CO%3B2

This case report discusses the immediate placement of 3 mini dental implants into 3 fresh extraction sockets. The implants were used to support a SPLINTED FIXED PARTIAL DENTURE.

Immediately placing implants of a very small diameter into fresh extraction sockets to support a FIXED PARTIAL DENTURE is possible.
Some implant sites cannot accept standard-sized implants because of length or width deficiencies.

Very small diameter implants may be able to support FIXED prostheses in these sites.

Immediate placement of implants into fresh extraction sockets may preserve bone and speed treatment.

CONCLUSIONS
Immediate placement of multiple mini dental implants into fresh extraction sockets can support a medium- span FIXED partial denture.

4: The Mini Dental Implant in Fixed and Removable Prosthetics: A Review : A REVIEW 2011

Dennis Flanagan, DDS1* Andrea Mascolo, DDS2
Journal of Oral Implantology Vol. XXXVII/Special Issue

http://www.joionline.org/doi/pdf/
10.1563/AAID-JOI- D-10-00052.1

Mini implants may be IMMEDIATELY LOADED in the appropriate osseous situations and may provide an alternative treatment if OSSEOUS CONDITIONS preclude a standard sized implant approach.2,3,11–14

In situations where there is an INADEQUATE INTERDENTAL SPACE, REDUCED INTEROCCLUSAL SPACE ,convergent adjacent tooth roots or close proximity of adjacent tooth roots or narrow atrophic osseous contour, mini implants may be appropriate.1–

Mini implants are consistent with the trend towards MINIMALLY INVASIVE DENTISTRY. Minimally invasive dentistry has been brought to the forefront by some practitioners and may be applied to implant dentistry where appropriate.
FIXED PROSTHETICS

The esthetic zone is wherever the patient deems it to be.
Patient expectations may be unrealistic and acceptance of potentially smaller prosthetic coronas may be objectionable to certain patients.

TWO mini implants may be used for certain mandibular tooth-bound MOLAR SITES to accept a splinted crown restoration.3,22

GENERALLY, these sites have shortened site lengths where a standard diameter implant may not fit with adequate tooth-to-implant spacing.

TWO (2) mini implants can resist axial forces.

However, rounded and narrow prosthetic teeth may be required to present a small occlusal table to minimize off-axial forces.2,3

Single mini implants may support single crown restorations (Figures 7 and 8). Sites with short interdental space (less than 5 mm), such as maxillary lateral and mandibular incisors, and sites where tooth movement has imposed on the site length or the local anatomy is diminutive may accept a single mini implant.3,23 Anterior sites may be more appropriate because of lower occlusal forces.

When mini implants are SPLINTED in FIXED partial or complete dentures, the adjacent implants are ANCHORED to each other, DISSIPATING FORCE and MINIMIZING the potential for implant MICROMOVEMENT .

However, cement loosening in one abutment may cause the fixed bridge to rotate slightly on the cemented abutment and lose osseointegration. An astute clinician may choose to definitively cement only mini-implant–supported prostheses to prevent this complication.

The most retentive metal-to-metal cements are the RESINS and resin-modified glass ionomers.

CONCLUSIONS
MINI DENTAL IMPLANTS may be appropriate to retain removable prostheses and support FIXED complete and partial dentures.

Following are suggested initial GUIDELINES for MINI IMPLANT USE:

Type I and II (Misch) bone sites are most appropriate for mini implants

Minimum of 1-mm thickness of facial and lingual cortical bone

Approximately 100 mm occlusal relief for fixed prosthetics A rounded minimal occlusal table

Minimum space of 0.5 mm between tooth and mini implant

Minimum of 6 mini implants for removable complete dentures in the maxilla

Minimum of 4 mini implants for removable complete dentures in the mandible

Minimum of 10 mini implants for SPLINTED FIXED complete prosthetics in the MAXILLA

Minimum of 8 mini implants for SPLINTED FIXED complete prosthetics in the MANDIBLE.

Implant protective type of occlusal scheme for fixed Prosthetics.

Esthetic requirements are addressed preoperatively

Polyurethane working die material or material of similar durability

EXTRA DYE SEPARATOR may be indicated

Most of the mini-implant evidence is based on retrospective data, case series, or uncontrolled studies. Randomized, controlled, prospective, longitudinal human trials are needed to further validate this treatment.

5: IMPLANT-SUPPORTED FIXED PROSTHETIC TREATMENT USING VERY SMALL-DIAMETER IMPLANTS: A CASE REPORT 2006

Dennis Flanagan, DDS, is in private practice in general dentistry. Address correspondence to Dr Flanagan at 1671 West Main Street, Willimantic, CT 06226 (e-mail: dffdds@charter.net).
Journal of Oral Implantology 34 Vol. XXXII/No. One/2006

http://www.joionline.org/doi/
pdf/10.1563/778.1

Patients present for implant treatment with variable amounts of bone volume, ridge length, and interocclusal space. Some sites are NOT amenable to the standard sizes of many available implants.
Most dental-implant companies offer standard-diameter implants in the range of 3.75 to 4.2 mm, but smaller diameters are available from 2.0 to 3.3mm

Patients present for implant treatment with VARIABLE amounts of bone volume, ridge length, and interocclusal space. Some sites are NOT amenable to the standard sizes of many available implants.

Small-diameter implants have been used for retention of complete maxillary and mandibular overdentures, but there is a dearth of reports for their use in FIXED prosthetics.5 (Mazor Z, Steigmann M, Leshem R, Peleg M. Mini-implants to reconstruct missing teeth in severe ridge deficiency and small interdental space: a 5 year case series. Implant Dent. 2004;13:336–341.)

STANDARD available implants may NOT be appropriate for patients' compromised sites when the patients present for treatment.

An up-to-date and pervasive knowledge of the ARRAY of implant SIZES and SHAPES is an ASSET for treatment.

Implant diameters are available from 1.8 to 8 mm.

Many implantologists believe that a smaller-diameter implant is MORE DESIRABLE than a LARGER larger one for REASONS of BLOOD SUPPLY ,that is, LARGER -diameter implants may IMPEDE the blood supply to bone surrounding the implant.

Additionally, if an unforeseen bone density or site inadequacy is encountered during the osteotomy of a small-diameter implant, the use of a slightly larger-diameter implant that is able to attain better initial stability remains an option, if there is adequate space.
Consequently, it may be BETTER to have a BIAS TOWARD a smaller-diameter implant rather than one with a larger diameter.
At times, larger- diameter implants may be better suited in the esthetic zone for emergence profile of the crown.

Conclusion:
STANDARD available implants may NOT be appropriate for patients' compromised sites when the patients present for treatment.

An up-to-date and pervasive knowledge of the ARRAY of implant SIZES and SHAPES is an ASSET for treatment and the implantologist.

Implant diameters are available from 1.8 to 8 mm

The use of very small- or mini-diameter implants may be advantageous.

Sites with inadequate length may be suited for these implants to provide adequate support for the prosthesis.

The AVAILABLE BLOOD SUPPLY around and about a SMALL diameter implant may be BETTER than that of a LARGER -diameter implant.

Sites accepting these small-diameter implants should be of denser bone types I and II.


FIGURE 1. Preoperative radiograph. FIGURE 2. Postoperative radiograph of 1.8-mm diameter implants. ,

FIGURE 3. Slightly prepared coronals. FIGURE 4. Cemented prosthesis in place.

6: Fixed Partial Dentures and Crowns Supported by Very Small Diameter Dental Implants in Compromised Sites

Dennis Flanagan, DDS 2008
IMPLANT DENTISTRY / VOLUME 17, NUMBER 2 2008 183

http://www.id-sc.com/aricles%
20of%20webconference/Fixed%20
Partial%20dentures%20supported%
20by%20Implants.pdf

Very small diameter (1.8 –3.3 mm) dental implants may be successfully used to support FIXED partial dentures in edentulous sites of COMPROMIZED bone width or length.

Very small implants can be successfully used in highly selected sites where there is ADEQUATE bone density and bone volume for immediate implant stability.
Adequate or augmentable attached gingiva may be a requirement. A small diameter implant presents less of an obstacle for angiogenesis and there is less percutaneous exposure and bone displacement as compared with standard sized implants. In posterior sites, rounded and narrow prosthetic teeth present small occlusal tables to minimize ax- ial and off-axial directed forces.

MULTIPLE SPLINTED IMPLANTS may be necessary to minimize metal FATIGUE from cyclic loading.

Anterior restorations supported by mini implants may need occlusal relief to minimize the effects of cyclic loading. (Implant Dent 2008;17:182–191)

Key Words: mini implant, occlusal scheme, bone density, bone ridge

There are case reports that demonstrate where compromised sites are re stored with 1.8 to 3.3 mm diameter implants that support FIXED partial denture prostheses.5–7

However, these very SMALL diameter implants, when used individually or in MULTIPLES or in COMBINATION with LARGER sized implants, may offer ADEQUATE support as compared with STANDARD sized implants.

In posterior sites, rounded and narrow prosthetic teeth present SMALL OCCLUSAL TABLES to minimize axial and off-axial directed forces.

Multiple splinted implants may be necessary to minimize metal fatigue from cyclic loading. After trauma or years of bone resorption patients can present for implant treatment with variable amounts of bone volume, length and height of ridge, and interocclusal space. Some sites CANNOT accept the standard sizes of many available implants without site development.
There is some debate as to the true supportive quality of GRAFTED BONE .
Conclusion
Major bone grafting procedures of extremely resorbed mandibles may NOT be justified.
(Int J Oral Maxillofac Implants. 2006 Sep-Oct;21(5):696-710.
The efficacy of various bone augmentation procedures for dental implants: a Cochrane systematic review of randomized controlled clinical trials.
Esposito M1, Grusovin MG, Coulthard P, Worthington HV.)

CASE SR
A 61-year-old women had a cari- ous tooth #30 extracted (Figs. 4–6) (Table 1). After 4 months of healing, two 2 1.5 mm implants (Intra Lock, Ultimatics, Ardmore, OK) were placed and restored with a 2 unit por- celain fused to metal crown splint.
CASE VM
A 42-year-old women lost #30 due to failed endodontic therapy (Figs. 7–10) (Table 1). The tooth was sec- tioned and atraumatically extracted and the site allowed to heal for 4 months. Two one-piece 3 mm 12 mm (BioHorizons) were placed flap- lessly by infiltration local anesthesia (articaine). After 4 months waiting for osseointegration, the coronal ends were prepared for splinted crowns. The crowns were cemented with zinc phos- phate cement. The patient has been functioning successfully for 2 years.
CASE JC
A 40-year-old man had lost his mandibular right posterior teeth (Figs. 11–13) (Table 1). The site at #28 was adequate but the edentulous site at #29 –32 was very narrow, precluding implant placement without extra- cortical bone grafting. Four 2 1.5 mm (IntraLock) and a 4 0 mm (3-I) implants were placed and restored with a splinted fixed partial dent

These cases demonstrate that single and multiple very small implants may successfully support crowns or FIXED partial dentures where there is appropriate bone and occlusal considerations.
These sites are usually found in the POSTERIOR mandible and anterior maxilla and mandible.

Because bone volume and quality and ridge length can present the implantologist with a challenge for restorative treatment, creative but effective solutions may need to be considered.
An up-to-date knowledge of the ARRAY of implant sizes and shapes is an asset for treatment.

Bone density of type I, II or III, bone site length of at least 4 mm, bone available height of at least 10 mm and at least 1 mm of attached or augment- able gingiva are desirable. Any in- traoral locat However, LESS dense bone may require the use of LONGER small diameter implants to resist occlusal forces and present less per square millimeter of bone compression during service.

Conversely, there may be PHYSIOLOGIC ADVANTAGE to very small diame- ter implants. An ADVANTAGE that very small diameter implants have over standard diameter implants is the LESSER amount of linear or CIRCUMFERENTIAL PERCUTANEOUS EXPOSURE and BONE DISPLACEMENT.
The circumference of a 2 mm implant is ( diameter) 6.28 mm whereas the circumference of a standard 4.0 mm diameter implant is 12.56 mm.
The very small implant has HALF of the linear percutaneous exposure thus exposing LESS of the implant- gingival attachment to BACTERIAL ATTACK.

There is also a smaller silhouette of the very small diameter implant that may present a BARRIER to ANGIOGENESIS and OSTEOGENESIS .

Because dental implants are cylinders or near-cylinders, a mathematic calculation of the outline form or the silhouette area, of a 2 x 10 mm implant may be compared with a 4 x 10 mm implant. Where the area is diameter (width) height. So, 2 x 10 mm 20mm2 and4 x 10mm 40 .

The 2 mm diameter implant presents a barrier to the osseous physiology that is half that of the 4 mm diameter implant. With respect to volume of the cylinder, where volume ( 3.14) (radius squared) (cylinder height), then3.14 square mm 10mm 31.4 mm3 and, 3.14 square mm 10 mm 125.6 cm3.
So to compare these volumes: 125.6/31.4 4.
The 4 mm diameter implant has 4 times the osseous displacement as compared with the 2 mm diameter implant. This difference may be im- portant. Intuitively, this may be a physiologic advantage for the very small diameter implant in that there may be more of an available osseous blood supply for the implant support- ing bone or less of a barrier. In larger diameter implants this larger barrier to blood supply or angiogenesis may contribute to the classic "resorption to the first thread" in the larger implant. The larger barrier may hinder angio- genesis and subsequent osteogenesis around a newly placed implant. Blood supply at the osseous crest may be hindered

With respect to VOLUME of the CYLINDER , where volume = 3.14 x radius squared x cylinder height then3.14 squaremm 10mm 31.4 mm3 and, 3.14 square mm 10 mm 125.6 cm3.
So to compare these volumes: 125.6/31.4 =4
The 4 mm diameter implant has 4 times the OSSEOUS DISPLACEMENT as compared with the 2 mm diameter implant.
This difference may be important.
Intuitively, this may be a PHYSIOLOGIC ADVANTAGE for the very small diameter implant in that there may be MORE of an available OSSEOUS BLOOD SUPPLY for the implant supporting bone or less of a barrier. In larger diameter implants this larger barrier to blood supply or angiogenesis may contribute to the classic "resorption to the first thread" in the larger implant. The larger barrier may hinder ANGIOGENESIS and subsequent OSTEOGENESIS around a newly placed implant. BLOOD SUPPLY at the osseous crest may be HINDERED by the larger implant and produce the characteristic resorption to the first thread. This phenomenon does not seem to be prevalent with the 2 mm diameter implants. Figure 15 shows 3 implants

This CREST BONE RESORPTION phenomenon does not occur in submerged implants but only after second stage uncovery and placement of an abutment. With the very small 2 mm diameter implants this does NOT seem to be prevalent. This may be the result of the smaller diameter and/or the lack of an abutment with a MICROGAP.

The available bone for an implant site in many cases can leave much to be desired. In these cases, the occlusion, a REDUCED VERTICAL DIMENSION and ridge length can present a dimensional problem for space. Very small diameter implants can fit into many of these atrophic sites with adequate interimplant and interocclusal spacing. Esthetics may be a problem in certain sites and caution is advised here.

These very small diameter implants CAN FIT into sites that CANNOT accept standard diameter implants without augmentation. The implants in these case series were generally placed flaplessly or with a split thickness apically positioned flaps thus retaining the periosteum and its blood supply and retaining or increasing the attached gingiva. The bone in these atrophic sites is typically type I or II and well suited for initial implant stability.

Very small diameter implants have been used for many years in completely edentulous cases to retain overdentures without bone grafting. Extracortical bone augmentation grafting may delay implant placement and the resulting grafted bone may not be truly supportive for the implant for many months or years or possibly never.

The BONE at the CREST of the THIN ATROPHIC RIDGE may be DENSE CORTICAL BONE ,which can be VERY SUPPORTIVE for Implants. Posterior sites in the mandible, not in the esthetic zone, may be appropriate for very small diameter implants that support a fixed partial denture.
The FORCES in the POSTERIOR JAWS can be greater than 1000 N of force but this magnitude is in the axial direction of the implant.8 The off-axial vector directive of these forces is much less. The cyclic loading that characterizes human occlusion may induce metal fatigue in very small diameter implants.

Very small diameter implants may need to be used in MULTIPLES to preclude cyclic loading metal fatigue and implant fracture in the posterior mandible9 (Figs. 7, 11).

Unpublished proprietary company (Intralock) data and unpublished data from the author suggests that single 2 mm diameter implants can withstand cyclic direct horizontal coronal loads of 200 N of more than a million cycles. This force represents the maximum force in the anterior jaws that may be humanly generated in the vertical or occluso-apical direction but this force was applied directly horizontally or facio-lingually for the test.

In anterior sites that have adequate width but inadequate length, a very small implant may be appropriate for a single Implant.

In anterior sites that have adequate width but inadequate length, a very small implant may be appropriate for a single implant.5,10 The forces in the anterior jaws can be about a third of the posterior forces, 50 to 200 N. These forces in occlusion, however, are delivered not axially but off axi- ally, a vulnerable direction for the im- plant. This may require more dense bone to resist the higher per square millimeter force placed on the bone by the smaller diameter implant body. Denser bone may preclude micro- movement of the implant and failure of the implant by fibrous replacement. The crowns in these cases may be best left slightly or somewhat out of occlusal contact in centric position and all excursions.

Very small implants may be used in conjunction with standard diameter (3.75– 4.1 mm) implants to support a FIXED prosthesis where there is an area of thin bone next to or near an area that will accept a standard diameter implant.

The cost of very small diameter implants can about 20% to 50% less than standard diameter implants mak- ing treatment less expensive.

If during the osteotomy of a small diameter implant there is an unfore- seen bone density or site inadequacy, the use of a slightly larger diameter implant that is able to attain better initial stability remains an option, given adequate space and density or bone manipulation techniques such as ridge expansion or splitting. Consequently, it may be better to have a bias to placement of smaller diameter than larger diameter implants.

Larger diameter implants may be better suited in the esthetic zone to provide for the emergence profile of the crown. However, in anterior compromised sites, especially where there has been site length attenuation, smaller diameter implants may be appropriate when the occlusal forces can be minimized or eliminated.

When placing very small implants, it is the experience of this author that placement torque should not exceed 50 Ncm. Over compression of the bone may lead to osseous compression necrosis and the implant may fail to integrate. Additionally, higher torque forces may cause fracture of the implant shaft.

Tarnow et al13 determined that there is a 1.4 mm CIRCUMFERENTIAL BONE CREST RESORPTION about implants. This may mean that the appropriate implant site width is the diameter of the proposed implant plus the 1.4 mm cir- cumferential bone resorption at each perspective. Thus, a 4.0 mm diameter implant would require: 4.0 mm 1.4 mm (facially) on 1.4 mm (lingually) 6.8 mm bone width. Very small 2 mm diameter implants do NOT seem to demonstrate this phenomenon. Because of this information smaller diameter implants may be MORE APPROPRIATE for many COMPROMISED SITES.

Knowledge of the available ARRAY of IMPLANT SIZES is an asset for the implantologist. Sites accepting these small diameter implants in this case series were perceived to be of denser bone types I, II and III.

There will be an increased per square millimeter force exerted on the supporting bone by the implants during function. So, MULTIPLE implants may be necessary to dissipate forces among the implants to minimize osseous stress.

POSTERIOR PROSTHETIC TEETH were made in these cases with rounded cusps and NARROW OCCLUSAL TABLES that present a small area for functional occlusal impact and to minimize off- axial forces.
Zinc phosphate cement (Flecks) was used to lute all cases listed but resin modified glass ionomer or resin cement can also be used. Because these implants are not used with conventional osteotomy

Patients who present with a complete maxillary denture with remaining only mandibular anterior teeth may benefit from this modality.

These patients usually have thin atrophic posterior residual ridges that will not accept a standard diameter implant WITHOUT OSSEOUS GRAFTING.

Because the forces generated by these complete denture patients is generally less than with natural dentition, very small diameter implants may very successfully support FIXED posterior splinted partial dentures.
This treatment may prevent these patients from developing combination syndrome, where there is supereruption of the remaining anterior teeth, fibrous replacement of the ante- rior maxilla and continued atrophy of the posterior edentulous ridges.

Because these implants are NOT used with conventional osteotomy drills but with very thin drills. If the thin ridge is split and expanded with a #15 scalpel the appropriate bone width for a proposed site may be the sum of postoperative peri-implant bone crest resorption of 1.4 mm at facial and lingual, or 2.8 mm. However, there may not be as much resorption as a standard sized implant and the osseous resorption of 1.4 mm seems to not apply to mini implants. This type of osseous crest resorption may not be prevalent with these implants possibly because of less impedance of the blood supply.
So a very narrower ridge may successfully accommodate the mini implant.

7: Case for Smaller Diameter Implants 2016

Dr. Dennis Flannigan
Journal of Oral Implantology : 10.1563/aaid-joi-D-16-00106

http://www.joionline.org/doi/pdf/
10.1563/aaid-joi-D-16-00106

Dear Editor,
Previous work in the dental literature has discussed occlusal over load of dental implants in function.1 Thus larger diameter implants have been advocated.1

However, there are other considerations that may come into play that effect the longevity of an implant. The major parameters are DISPLACEMENT of the IMPLANT, OCCLUSAL OVERLOAD, and PERCUTANEOUS CIRCUMFERENCE.

It may be that the actual larger displacement of LARGE diameter implants IMPEDES BONE REMODELING , especially at the crest where the bone may be thinner at the facial and lingual as compared with the deep medullary bone.2,4

Even if the crestal bone is greater than 1.8 mm the larger implant may prevent adequate angiogenesis for bone remodeling.3,5 Blood supply is important for remodeling. Large diameter implants generally have higher removal torque at initial placement and better stability than smaller diameter implants.1
However, the large physical displacement of wide diameter implants may impede bone remodeling. There may be resorption but not apposition.2 There may be a physical barrier for the blood supply that would inhibit apposition but allow resorption to occur.2,6–8
Assuming, for the sake of simplicity, a length of 10 mm and the implant is a cylinder, the volume of a 5.7 mm implant is 255.047 cubic mm. The volume of a 2.5 mm 3 10 mm implant, again assuming a cylinder, is 49.06 cubic mm. This larger volume may physically impede blood supply and thus impede activity of osteoclasts and osteoblasts thereby impeding remodeling, which in turn may make the cervical supporting bone and epithelial attachment susceptible to peri-implantitis.
Occlusal overload is not generally an issue with large diameter implants due to the large surface area. Dental implants are capable of resisting an axial load beyond human capability. Off-axial loads, however, may not be adequately resisted by the facial or lingual cortices depending on bone quality and volume. A large diameter implant spreads any off axial loads over a larger area than small diameter thus lowering the per square millimeter load on the supporting bone.3

Mini implants, ,3.0 mm in diameter, may demonstrate little or no bone loss over many years of service.9
Nonetheless there is a larger per-square-millimeter load on the supporting bone.
Thus control of the off-axial occlusal load is KEY..
Nonetheless, the small surface area puts a larger per-square-millimeter load on the bone.
This necessitates more dense bone or MULTIPLE SPLINTED IMPLANTS to LESSEN the risk for overload on the supporting bone.6–8

Percutaneous circumference may put LARGER diameter implants at risk for PERI-IMPLANTITIS .2,4
Large diameter implants have a much larger percutaneous circumference as compared with small diameter implants. The small diameter/circumfer- ence may lessen the risk for late peri-implantitis. At least 1 study suggested that larger diameter implants may be more prone to peri-implantitis.5 The percutaneous circumference of a 5.7 mm implant is 15.7 mm whereas that of a 2.5 mm diameter implant is 7.85 mm, which is a dramatic difference. The smaller circumference presents less of an opportunity for invasive bacteria and less risk for any epithelial detachment and infection. 6–8

CONCLUSIONS
Impeded remodeling and increased percutaneous exposure may increase the risk for peri-implantitis in large diameter implants. There may be less risk for peri-implantitis with small diameter implants. Large diameter implant fixtures could be more prone to late peri-implantitis. Long-term randomized controlled studies are needed to elucidate this issue. It may be appropriate to only place implants of a diameter to a maximum of 4.7 mm because larger diameters may impede bone remodeling and present a longer percutaneous exposure.
It is NOT known what thickness, volume, or quality of bone is needed to adequately resist a given occlusal load. It may be that small diameter implants may be surprisingly able to survive long-term occlusal loads. Thus, when selecting an implant for a site, it may be better to err on the side of THIN.
Dennis Flanagan, DDS, MSc Willimantic, Conn

8: Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations: a 7-year retrospective study. 2004

Vigolo P1, Givani A, Majzoub Z, Cordioli G.
Int J Oral Maxillofac Implants. 2004 Sep-Oct;19(5):703-9.

https://www.researchgate.net/
publication/8208219 _Clinical_
evaluation_of_small-diameter_
implants_in_ single-tooth_and_
multiple-implant_restorations_A_
7-year_retrospective_study

Abstract
PURPOSE:

Placement of small-diameter implants often provides a solution to space-related problems in implant restoration. This 7-year retrospective study presents results from 192 small-diameter implants placed in 165 patients from 1992 to 1996.
MATERIALS AND METHODS:
The dental records of each patient were reviewed. The implants, which were either 2.9 mm or 3.25 mm in diameter, were placed by 2 different surgeons. All prosthetic appliances were fabricated by the same prosthodontist. Ninety-four implants supported single-tooth cemented restorations; the remaining 98 implants supported cemented or screw-retained partial prostheses.
RESULTS:
The total implant survival rate was 95.3%. Four implants were lost at second-stage surgery, and 5 more were lost after loading.
DISCUSSION:
SMALL-diameter implants demonstrated a SURVIVAL RATE SIMILAR to those reported in previous studies of STANDARD-size implants.

CONCLUSIONS:
The results suggest that small-diameter implants can be SUCCESSFULLY INCLUDED in implant treatment. They may be PREFERABLE in cases where space is limited.

9: The Truth About SMALL Diameter Implants

Implants Dent Today. 2010 May;29(5):116, 118, 120.
Christensen GJ1, Child PL.

http://www.dentistrytoday.com/
articles/178-articles magazine/
dental-products/2646-the-truth-
about-small-diameter-implants

Abstract
SDIs that are treatment planned correctly, placed and loaded properly, and are within a well-adjusted occlusion, are working in an EXCELLENT manner for the patients described in this article.
It is time for those practitioners unfamiliar with SDIs and their uses to discontinue their discouragement of this technique.
SDIs are easily placed, minimally invasive, and a true service to those patients described. They do not replace conventional diameter implants; however, they are a significant and important augmentation to the original root-form implant concept. There is obvious evidence of the growing acceptance of small-diameter implants by both general practitioners and specialists.

If we listened to and believed some of the comments about small-diameter implants (SDIs) (or "mini" implants) that we hear coming from some areas of surgical dentistry, we would be led to think that these devices simply do not work. However,the TRUTH is DIAMETRICALLY opposed to what some are saying, and it has been our observation that some of the most severely negative comments come from dentists who have NEVER PLACED SDIs.

This article includes: the definition of "mini" or SDIs; a discussion of the evolution of SDIs, including their clearance by the US Food and Drug Administration (FDA) and research support; reasons for SDI use instead of conventional diameter implants; the indications for SDI use; and suggestions on how to use them successfully.

The FDA cleared these conventional-diameter root-form implants for clinical use in 1976. Millions of conventional-diameter implants have been placed for more than 4 decades, and their cumulative success rate of around 95% is impressive.

Table. Use of SDIs in Approximate Order of Decreasing Frequency of Use
Edentulous mandible
Removable partial denture
Edentulous maxilla (this use has higher failure rate than edentulous mandibles)
Augmentation of fixed prosthesis
Sole support of FIXED PROSTHESIS
Salvage of previously made prosthesis

SUMMARY AND CONCLUSION
SDIs that are treatment planned correctly, placed and loaded properly, and are within a well-adjusted occlusion, are working in an EXCELLENT manner for the patients described in this article.
It is TIME for those practitioners unfamiliar with SDIs and their uses to DISCONTINUE their DISCOURAGEMENT of this technique.
SDIs are easily placed, MINIMALLY INVASIVE , and a true service to those patients described.
They do not replace conventional diameter implants; however, they are a significant and important AUGMENTATION to the original root-form Implant concept.
There is obvious evidence of the growing acceptance of small-diameter implants by both general practitioners and specialists.

10:The 'mini'-implant has arrived 2006

Gordon J. Christensen, DDS, MSD, PhD
http://jada.ada.org March 2006 387 Copyright ©2006 American Dental Association.
JADA, Vol. 137

http://www.smileartsny.com/wp-content/
uploads/download.pdf

What Are Mini- Implants
When the original root-form implants were introduced, they had a diameter of about 3.75 millimeters.
Although I have heard various REASONS for selection of this diameter, the LOGIC for RESEARCH supporting these reasons has been UNCLEAR .

An implant of nearly 4 mm in diameter requires at least 6 mm of bone in a facial-lingual dimension for placement without grafting additional bone to augment the site.

After years of placing implants in all locations of the mouth, it is my observation that SELDOM do I see 6 mm of bone in a facial-lingual dimension.

Often, an osteotome must be used to widen the osteotomy and the minimal bone, thereby allowing placement of the 3.75-mm implant in the less-than-adequately sized bony site.

In the last few years, root- form implants ranging from 1.8 mm to slightly more than 2 mm in diameter have been promoted for long-term service.

IN WHAT SITUATIONS ARE MINI-IMPLANTS INDICATED?
In my opinion, I find MORE indications for narrow-diameter implants (≈ 1.8 mm) than for STANDARD- diameter implants

(≈3.75 mm).
When inadequate bone is present for placement of standard-diameter implants, most practitioners have been taught to suggest bone grafting, either using autogenous bone (from various sites in the patient's body) or one of the many available bone substi- tutes. However, few patients desire to have, or can afford, bone grafting. The expense of dental implants already is prohibitive for most patients, without the added cost, trauma, pain and uncertainty of bone grafting. In my opinion, if dental implants are ever to achieve their optimum service potential for typical, average-income dental patients, methods need to be found to allow placement of implants in areas of remaining natural bone, using minimally invasive procedures without grafting. The mini-diameter implants have the potential to assist this challenge.

Extra support and retention under fixed partial dentures (FPDs).
Occasionally, situations arise in which an FPD is planned that has questionable potential retention from natural teeth, and the patient has refused RPD treatment or grafting and standard implants. Mini-implants can be placed in the edentulous areas and used to support the PONTIC AREAS of the FPD. When an FPD becomes loose on one end, and the prosthesis can be removed from the other abutment without destroying it, the prosthesis often can be salvaged. A small- diameter implant is placed in the pontic area, a hole is cut in the underside of the pontic, the abutment retainers of the FPD are cleaned and roughened internally, and the FPD is re- cemented using the mini- implant as additional support and retention under the pontic. Research is under way to study the long-term use of small- diameter implants as the full support and retention for fixed partial dentures.

SUMMARY
There is no question that dental implants have been the most influential change in dentistry during the last half-century. In general, they are well-proven and highly useful. However, the diameter of standard implants (≈ 3.75 mm), along with the fre- quent need to graft bone to allow for their placement, have limited their use for those who most need implants. The introduction, approval and continuing observation of success of smaller-diameter mini-implants have stimulated use of implants in situations in which standard- sized implants could not have been used without grafting. The result has been more patients who have been served successfully at reduced cost with minimized pain and trauma patients who could not have been treated with implants otherwise. Continuing research is needed for further verification of the acceptability of mini- implants.

11: Mini Dental Implants for the General Dentist A Novel Technical Approach for Small Diameter Implant Placement

Todd Shatkin,DDS ,Samuel Shatkin,DDS,MD,
JADA 2003 Vol. 24,No. 11
Compendium / November 2003

http://www.israimplant.com/
vault/Publications %203M% 20
ESPE/04%20 mini%20dental%20i
mplants%20for%20the%20
general%20dentist.pdf

12: Mini Dental Implants for Long-Term Fixed and Removable Prosthetics: A Retrospective Analysis of 2514 Implants Placed Over a Five-Year Period

Todd E Shatkin, DDS; Samuel Shatkin, DDS, MD; Benjamin D. Oppenheimer, DDS; Adam J. Oppenheimer, MD 2007 February 2007 Issue - Expires February 28th, 2009
Compendium of Continuing Education in Dentistry

https://cced.cdeworld.com/courses/99

Abstract
Over the past decade, endosseous implants of increasingly smaller diameters have been introduced into the field of dentistry. Small diameter implants (SDIs) are generally 2.75 mm to 3.3 mm in diameter. They are frequently used in cases of limited alveolar anatomy. Mini dental implants (MDIs) are smaller than their SDI counterparts, with diameters ranging from 1.8 mm to 2.4 mm.

They are suitable for long-term use—a task for which the device was approved by the Food and Drug Administration.
The following study describes the authors' experience with MDIs under this indication. Over a 5-year period, 2514 MDIs were placed in 531 patients. The mean duration of follow-up was 2.9 years.

The implants supported FIXED (1278) and removable prostheses (1236), with nearly equal placement in the mandible and maxilla (1256 and 1258, respectively).
The overall implant survival was 94.2%. Based on a Cox proportional hazards model, statistically significant predictors of failure include use in removable prostheses (hazard ratio = 4.28), the posterior maxilla (3.37), atrophic bone (3.32), and cigarette smokers (2.28). Implant failures (145) were attributed to mobility with or without suppuration (19% vs 81%, respectively). The mean failure time for these implants was approximately 6.4 months (193 ± 42 days). This temporally correlates with the osseointegration period. A learning curve was established for this procedure, and implant survival improved with placement experience.
Based on these results, the authors have devised treatment guidelines for the use of MDIs in long-term FIXED and removable prostheses.
MDIs are not a panacea; however, proper training enables the general dentist to successfully implement MDIs into clinical practice.
- See more at:
https://cced.cdeworld.com/courses/
99#sthash.6VvFKZP5.dpuf

13: Mini Dental Implants: A Retrospective Analysis of 5640 Implants Placed Over a 12-Year Period 2012

Todd Ellis Shatkin, DDS; and Christopher Anthony Petrotto
Compendium , Volume 33,Special Issue 3. September 2012

http://www.dentalaegis.com/
special-issues/ 2012/09/mini-
dental-implants- a-restrospective-
analysis-of-5640-implants-placed-
over-a-12-year-period

Abstract:
Mini dental implants are becoming increasingly popular in dental care today. Because of their smaller size they are often used in cases of limited bone anatomy. Mini dental implants have diameters ranging from 1.8 mm to 3 mm and are suitable for long-term use.
This article describes a retrospective analysis of 5640 mini dental implants placed into 1260 patients over a 12-year period. The mean length of follow-up was 3.5 years. The implants placed supported removable (2319) and FIXED prostheses (3321), with placement in the maxilla (3134) and mandible (2506).
The overall implant survival was 92.1%. Failures of implants (445) were attributed to mobility of the implant; the mean time to failure for these implants was 14.4 months. The small size of these implants has led to the development of techniques that enable placement and use in a short amount of time for both the doctor and patient.
The high rates of success show that mini dental implants are suitable for use in supporting FIXED and removable prosthetics.

Using mini dental implants that enable immediate denture stabilization, or single and multiple-tooth replacement in as little as one visit,3 is clearly desirable to patients.
The relatively lower cost of mini dental implants allows for a larger patient-selection base.
Christensen described these implants as simple, predictable, minimally invasive, and relatively inexpensive.4
Additionally, the osseointegration period required for mini dental implants can be significantly shorter than that for conventional implants because of a less aggressive insertion procedure (ie, minimized disruption of the periosteum).

- Because mini implant insertion requires minimal disruption of the periosteum, there is reduced damage to the insertion area.2
Mini dental implants and their function in immediate loading for denture stabilization and FIXED fixed restorations have become increasingly prevalent in the literature.

Implants supporting fixed prostheses were considerably more successful than those supporting removable prostheses, having success rates of 94.7% and 88.4%, respectively.

Further analysis of location of placement revealed a lower mini implant success rate in the maxilla (90.3% anterior; 92.5% posterior) relative to the mandible (92.3% anterior; 94.1% posterior). The reduced implant success rate in the maxilla was likely due to its poorer bone quality relative to the mandible.

Though there exists greater OCCLUSION in the posterior regions of the mouth, higher implant success rates in those areas may be attributed to the use of MULTIPLE implants to support a prosthesis, mimicking the natural root anatomy. Often, TWO(2) implants were used to replace single molars and MULTIPLE implants were used for posterior restorations involving more than one tooth.
Gender also played a role in the survival of implants. Of the 3378 implants placed in females, the overall success was 93.0%, while the success rate of the 2262 implants placed in males was only 90.8%.
Implants were placed in patients aged 13 years old to 95 years old. The distribution of implants by patient's age is shown in Figure 17. Patients 21 to 30 years of age had the highest rate of success at 95.8%.
There were 445 implant failures observed.
Implants considered as failed presented as being mobile or fractured.

Of those implants that failed, the majority did so in the first 6 months following implantation. Implants not failing in this time following insertion likely attained osseointegration. This correlates with Brånemark's classical definition of osseointegration of 3 to 6 months in the mandible and 6 to 9 months in the maxilla.21

Conclusion
With the growing demand from patients for fewer office visits, lower cost procedures with immediate results, and shorter recovery time, dental rehabilitation techniques have been developed for minimally invasive, single-stage implant placement. The mini dental implants used in these procedures have been demonstrated to have high success rates. Over a 12-year period, 5640 mini dental implants were placed with an overall survival of 92.1%.
With the proper training,22 consideration for prosthetic subtype, implant location, size, and patient variables, mini dental implants can provide exceptional outcomes. These results are rewarding for the dentist, minimally invasive and affordable to the patient, and have long-term success for both FIXED and removable prosthetics.

14: SplintedZirconiaFixedPartial DentureSupportedby Small Diameter (Mini Implants) in the Posterior Mandible: A Case Letter 2013. (Three 2.5 x12mm)

Andrea Mascolo, DDS1* Paresh Patel, DDS2
Journal of Oral Implantology 287 288 Vol. XXXIX/Special Issue/2013

http://www.joionline.org/doi/
pdf/10.1563/ AAID-JOI-D-12-
00043?code=aaid-premdev

The purpose of this case letter is to demonstrate that splinted mini implants may successfully support a FIXED zirconia partial denture in the POSTERIOR mandible in highly selected patients and with an appropriate prosthetic design. The use of 2 small- diameter (mini) implants can reduce the cantilever effect created when using the procedure recom- mended by Misch (4-mm implant for a 7-mm mesial distal width).2

Three 2.5 x 12mm one- piece mini dental implants (OCO Biomedical, Albuquerque, NM) were placed.

In situations where there may be an inadequate interdental space, reduced interocclusal space, convergent adjacent tooth roots, close proximity of adjacent tooth roots, narrow atrophic osseous contour, and adequate osseous quality, mini implants may be appropriate to support a FIXED prosthesis in highly selected patients.3,4

In this case example, to reduce the potential for implant overload, the decision was made to use 3 mini implants SPLINTED together.
This would allow for an INCREASE increase in implant surface area while MINIMIZING the volume of bone removal during the osteotomy.

The final fixed restoration would also be designed with a narrow occlusal table to keep off axis forces to a minimum and to help prevent metal fatigue and cyclic-loading stress.
There are ADVANTAGES to using 2 to 3 mini implants to support a MOLAR restoration instead of a single wide-diameter implant.
Quite OFTEN , the loss of mandibular molars results in a mesial-distal dimension that is insufficient in length for the placement of 2 conventional, standard-size implants.
The use of mini implants in this case letter allows for minimal cantilevers in the final restoration.
There is greater flexibility to maximize placement in compromised bone sites engaging the facial and lingual plates, and there may be better retention of crestal bone levels around mini implants.5

However, the use of mini implants does have significant limitations, with reduced surface area being the foremost. When an occlusal force is applied, the strain to the supporting bone around small-diameter implants will be greater than a standard body implant.6–8
CONCLUSIONS
Splinted mini implants may successfully support zirconia fixed partial dentures in the posterior mandible in highly selected patients with an appropriate prosthetic design.
The implant dentist should consider many diverse implant and prosthetic designs to treat appropriately the anatomic conditions with which patients present.

15: Replacement of a Molar With 2 Narrow Diameter Dental Implants 2012

Ziv Mazor, DMD,* Adi Lorean, DMD,† Eitan Mijiritsky, DMD,‡ and Liran Levin, DMD§
IMPLANT DENTISTRY / VOLUME 21, NUMBER 1 2012

http://planmed.com.tr/tr/
kurumsal/upload/ yayinlar/
yayin_03022013205017.pdf

The use of 2 implants to replace a single MOLAR seems a LOGICAL treatment solution to AVOID prosthetic complications.6,12
The aim of the present study was to present results of single molar area rehabilitated by 2 narrow diameter dental implants.

SINGLE regular-diameter implants might be incapable of predictably withstanding molar masticatory function and occlusal loading forces.
WIDE -diameter implants are a suitable alternative for replacing a missing MOLAR in some cases; however, the use of 2 implants has been successfully demonstrated to be a FUNCTIONAL and MORE BIOMECHANICALLY SOUND METHOD of MOLAR replacement.15

Wide-diameter implants are not always a treatment option for replacing a single molar, especially when the buccolingual dimension is deficient.

The USE of 2 IMPLANTS might also provide BETTER PROSTHETIC STABILITY and PREVENT ROTATIONAL FORCES on the prosthetic components.

Restoration of missing molars with 1 wide-diameter implant has a greater incidence of screw loosening16 and, compared with 2 implants, has a greater incidence of prosthesis mobility6 and a higher failure rate.17
When narrow implants are used as single- tooth replacement, especially in the molar region, an increased risk of screw loosening or fracture exists due to the combination of high masticatory forces, buccal-lingual mandibular movement, and cusp-groove orientation.18
Therefore, the use of 2 implants to replace a single molar is a logical treatment solution to avoid prosthodontic complications.12
One significant barrier to the widespread use of this concept is the limitation of the size of implants and their associated prosthetic components.
Nevertheless, when using narrow implants, 2 implants could be used even when the distance between the adjacent teeth is rather limited.
This case series provided an evidence for the usefulness of 2 narrow diameter implants to replace a single molar.
There is, however, a need for further long-term comparison studies to confirm and reaffirm the result pre- sented here.
CONCLUSION
Replacing a single missing MOLAR with 2 narrow dental implants might serve as a viable treatment option providing good and predictable LONG-TERM RESULTS.

16: Critical Appraisal MINI IMPLANTS: GOOD OR BAD FOR LONG-TERM ? 2008

Author Gordon J. Christensen, DDS, MSD, PhD* Associate Editor
© 2008, COPYRIGHT THE AUTHORS
JOURNAL COMPILATION © 2008, WILEY PERIODICALS, INC.
DOI 10.1111/j.1708-8240.2008.00204.x VOLUME 20, NUMBER 5, 2008 343

Small-diameter implants combined with natural teeth supporting a fixed prosthesis for 4 years.
In my experience, the majority of patients needing implant support for FIXED or removable prostheses do not have adequate bone present to comfortably place implants 3 mm in diameter and wider without time-consuming, painful, and expensive grafting.

NEED FOR SDIs
The following situations are the most significant clinical indications for SDIs:
1. Inadequate bone present for root-form implants 3 mm in diameter and over

Figure 1 Root-form implants 3 mm and larger in diameter need at least 6 mm of bone in a facial-lingual orientation and 10 mm of bone in a crestal-apical orientation

1. Patient lack of acceptance of grafting for reasons previously stated.
2. Health challenges precluding extensive surgical procedures.
3. Inadequate funds for compre- hensive conventional implant placement and extensive restorative restoration.

I find these indications on a daily basis, and I am thankful that alter- natives other than conventional- diameter (3 mm and over) implants are now available.

My opinion, after using SDIs for over 7 years, is that I have no question about the use of SDIs in appropriate edentulous arches or for augmentation of retention and support for removable partial dentures.
I have had success using SDIs for FIXED fixed partial dentures supported by TEETH and SDIs as well as sole support for fixed partial dentures.

In certain situa- tions, I can support the use of SDIs for sole support of single crowns. Maxillary lateral incisors and lower anterior teeth are excellent examples for single-tooth support.2 My failure rate has been far below that reported in the previous reported survey

My opinion, after using SDIs for over 7 years, is that I have no question about the use of SDIs in appropriate edentulous arches or for augmentation of retention and support for removable partial dentures.
I have had success using SDIs for fixed partial dentures supported by teeth and SDIs as well as sole support for fixed partial dentures.
In certain situa- tions, I can support the use of SDIs for sole support of single crowns. Maxillary lateral incisors and lower anterior teeth are excellent examples for single-tooth support.2 My failure rate has been far below that reported in the previous reported survey.

17: Small Diameter Implants: Specific Indications and Considerations for the Posterior Mandible: A Case Report

Journal of Oral Implantology 2011
DOI: 10.1563/AAID-JOI-D-09-00142.1
Brian J. Jackson, DDS* Private practice, Utica, NY.
e-mail: BJJDDSIMPLANT@AOL. com

http://www.joionline.org/doi/
pdf/10.1563/ AAID-JOI-D-09-
00142.1?code=aaid-premdev

The utilization of small diameter implants in limited osseous regions increases patients' ability to choose implants as a viable restorative option.
Although SMALL diameter implants have been indicated in the incisor region for the maxilla and mandible primarily, their usage SHOULD BE CONSIDERED in select posterior regions.
These 2 case reports demonstrate the incorporation of small diameter implants to replace missing mandibular posterior teeth.

Small diameter (1.8–3.0 mm diameter) implants have been widely accepted beause they can be utilized in regions of the mouth that are deficient in arch length, as well as alveolar width.1–3
Although small diameter single-stage implants have been indicated mainly for the maxillary lateral incisors and the mandibular incisor region, another clinical situation may warrant their application.
Loss of maxillary and mandibular molars results in a mesial-distal dimension that may be insufficient in length for the placement of 2 conventional, standard size implants (3.75 mm diameter). In addition, a single large implant (4.7 mm or 6.0 mm diameter) may demonstrate limitations caused by existing osseous structures or with regard to established implant occlusal principles.

The utilization of small diameter implants has become more widespread because of the demand for endosseous implants in a wide range of osseous dimensions. Although bone-grafting procedures can idealize the width of the alveolar ridge, many patients decline because of the additional time, cost, and morbidity.
Additionally, bone-grafting procedures do not resolve the issue of length in the mesial-distal dimension.
As a result, small diameter implants are being used as an alternative diameter choice to gain case acceptance.13
The main advantages of this type of endosseous implant are its size, 1-piece design, and precontoured abutment, as well as the ease of the restorative phase.14
Predictability in strength of the implant is largely due to the lack of an abutment-fixture connection (micro-gap) and retention screw commonly found in the 2-stage design.

Alternative surgical approaches to ideal- ize ridge width for incorporating standard size implants (3.75 mm) include block onlay grafting, ridge expansion, and/or alveolo- plasty. The surgical process of block onlay grafting leads to additional surgeries, as well as increased treatment time and costs and morbidity.
Additionally, a secondary donor site is required, which involves risks of infection and parasthesia.17
The surgical concept of ridge expansion is possible in the maxilla but is limited in the mandible.18
Alveoplasty can widen the crest of the ridge but often is not an option in the mandible because of the proximity of the superior aspect of the inferior alveolar nerve and the density of the bone.

The 2-implant concept to replace a single molar allows for an enhanced prognosis by increasing implant surface area by splinting. Also, it eliminates the complication of abutment screw loosen- ing by reducing detrimental rotational move- ments such as wobble or tipping. In addition, it reduces the size of the gingival embrasures often present when a single implant replaces a mandibular first molar.
This clinical problem often becomes the patient's chief complaint after final restoration placement.

of 1 implant per root has been recommended as the appropriate treatment plan for implant mandibular molar replace- ment.19

Small diameter implants have become a VIABLE ALTERNATIVE to STANDARD conventional implants in a LARGE number of clinical situations.
The MANDIBULAR POSTERIOR regions of the mouth may present an opportunity to incorporate these types of implants to REDUCE surgeries, morbidity, and treatment time.

Additionally, small diameter implants can increase the long-term prognosis of the prosthesis by increasing surface area and reducing screw loosening.
The precontoured abutment and impression copings make the restorative stage simple and effective for the experienced or novice practitioner.
It is critical that the clinician design the prosthesis in accordance with implant occlusal principles to maximize long- term success.
Although small diameter implants have been utilized in many mandibular clinical areas, additional long-term stud- ies focused on maxillary and/or mandibular posterior regions of the mouth will lead to greater acceptance by clinicians.

18. Mini-Implants to Reconstruct Missing Teeth in Severe Ridge Deficiency and Small Interdental Space: A 5-Year Case Series 2004

Ziv Mazor, DMD,* Marius Steigmann, DMD,† Roy Leshem, DDS,‡ and Micahel Peleg, DMD§

https://www.academia.edu/22902650/
Mazor_Z_Steigmann_M_Leshem_R_et_
al._Mini- implants_to_reconstruct
_missing_teeth_in_severe _ridge_
deficiency_and_small_interdental_space_
A_5-year_case_series

The purpose of this article is to describe the use of mini-implants for fixed restorations (with a follow up of up to 5 years) to enable the practitioner to overcome the anatomic obstacles of ridge width and narrow interdental space by immediate loading and reconstruction.

Two of the major obstacles for dental implant placement to replace missing teeth are the lack of adequate bone width and interdental space.
Overcoming these limitations requires bone augmentation procedures that transform the deficient ridge into a ridge that is capable of receiving conventional tooth-form implants.
In the case of inadequate interdental space, orthodontic tooth movement is advocated before implantation.
Using narrow-diameter mini-implants allows the clinician to overcome both of these obstacles without the need for additional grafting procedures or orthodontic tooth movement.

The mini-implants are immediately loaded and restored so as to enable the patient to have satisfactory mastication and aesthetic appearance.
A 5-year followup of 32 implants demonstrates the benefit of this treatment modality. (Implant Dent 2004;13:336–341)

The problem of ridge deficiency and interdental space can be solved with the use of narrow-diameter implants. Placement of mini-implants (1.8–2.4 mm in diameter) that are retrieved is a well-established procedure used to support fixed or removable prosthesis.

Mini-implants provide immediate FIXED provisional prosthe- sis, avoid premature implant loading, and protect augmented sites. In most patients, the transitional implants were retrieved at the time of implant uncov- ering, unlike the present clinical study in which implants were loaded imme- diately, maintaining function up to 5 years. This clinical study used mini- implants to reconstruct single missing teeth in narrow anterior and posterior ridges and narrow interdental spaces, are loaded immediately, then followed for 5 years.

CONCLUSION
Within the limits of this pilot study, the proposed treatment modal- ity of mini-implants may serve as a useful option to rehabilitate a single tooth in both deficient ridges and in narrow interdental spaces. Future studies should be conducted to evaluate the long-term survival of these implants.

19: Small Diameter Implants (SDIs) in Fixed Restorations: Clinical Cases Considerations During 4 Years Follow-Up 2016

Andrea Mascolo* D.D.S, Master in Oral Surgery and Odontostomatological Urgency, Expert in Minimally Invasive Procedures, Research & Reviews: Journal of Dental Sciences
RRJDS | Volume 4 | Issue 1 | March, 2016

https://www.rroij.com/open-
access/small- diameter-implants
-sdis-in-fixed- restorations
clinical-cases-considerations
-during-4-years-followup-.pdf

Small diameter implants (SDIs), which were introduced to stabilize temporary dentures, were soon found to have several other clinical applications due to their high versatility [8,9]. For example, they have been used with a success in cases of limited interdental spaces [10,11]. Signi cant ndings have been reported in the literature about the long-term survival of small diameter implants [12,13]. Guidelines are available in the literature about the surgical techniques and rehabilitation, and several evidences suggest xed restorations with excellent long-term survival data [14,15]. Mini-invasive techniques offer both intraoperative and postoperative advantages, and they facilitate the healing of the tissues [16].

Some of the notable ADVANTAGES are as follows:
1. Quicker healing postoperatively
2. Decreased potential of future bone loss around SDIs for the one-body design
3. Simpler placement protocols
4. Decreased waiting period until nal prosthesis delivery compared to conventional implant treatment.
5. Anatomical limitations are lowered due to smaller diameters of the implants.
6. A less invasive implant treatment option for medically compromised patients.

The SDIs were loaded as follows: 5 SDIs were immediate loaded while 43 SDIs were loaded after 3 months considering the initial critical stability period around to 3 weeks and the osseointegration period of 3 months as suggested in the initial guidelines [14]. When the implants were loaded, the crowns and bridges were loaded with light contacts as with the conventional implants.

In attempts to reduce patient morbidity and convalescence, minimally invasive surgical techniques are becoming more and more discussed and practiced. Accurate planning and case evaluation are imperative for a success. The versatility of the SDI offers the opportunity to propose an implant treatment to patients of wider ranges. Failures in some cases have dissuaded some clinicians from using SDI's. Some of these failures may have resulted from loading them too soon in areas with soft bone, use of implants of inadequate lengths, and or patients' para-functional habits. With decreased surface areas of the SDI's, it is recommended to choose longest possible implants without causing harms to surrounding vital structures [8,12-14]. The advantages in certain situations, registered in the clinical experience have been:
• Multiple SDIs can offer an adequate surface area needed for a successful xed prosthetic.
• Engagement of the cortical plates in thin ridges for excellent primary stabilization.
• No micro-gap as the SDI's are one body design.
• A apless approach to maximize the available blood supplies and reduce healing time
• A less amount of bone is removed per placement thus leaving more native tissue to disperse forces
• A pre-contoured abutment that can be shaped in vivo if needed

Conclusion
The clinical experience shows good performance of small diameter implants in xed solutions; the results are appreciated from clinicians and from patients for the minimal invasive approach and functional standpoint. During the follow-up period we have not registered peri-implant bone resorption; we have noticed healthy gingival remodeling around the implants. The reduced diameter of the abutments helps to secure a favorable remodeling of the soft tissues; the abutment connection is able to seal the perimplant area eliminating micro-leakages. The results achieved in the clinical trial encourage the use of small diameter implants in some clinical situations as example thin bony ridges and or limited interdental spaces, NOT just in anterior areas as initially proposed from earlier literatures. Some of the important factors for a success are: a clinically considerate patient selection, a planning according to the guidelines, and emphasizing judicious checking on occlusion after restoration is completed.

Figure 11. Initial clinical view.
Figure 12. Intra surgery: apless procedure no bleeding.
Figure 14. PFM restoration.
Figure 15. PFM restoration cemented.
Figure 16. Clinical revaluation 50 months.

20: New approach towards mini dental implants and small-diameter implants: an option for long-term prostheses.2012

Gleiznys A1, Skirbutis G, Harb A, Barzdziukaite I, Grinyte I. Stomatologija. 2012;14(2):39-45

http://www.sbdmj.com/
122/122-01.pdf

Conclusions. Implants with small diameters can be used successfully in a variety of clini- cal situations. Less surgical time, less postoperative pain, ability of direct loading after surgery with no harm to bone and cost effectiveness are the advantages. The reduced surface implants require correct treatment planning so that the loading force would not cause bone loss or implant failure. MDI and SDI show high survival rates, but special cautions for bone quality and good oral hygiene should be maintained.

However, nowadays, science, technology and number of researches have made it possible to improve our choice for better care of teeth and understanding the oral health lead- ing to perfect deal with most of the oral problems. Osseointegration has become the main concept in modern implantology, this lead to introduction and refinement of the osseointegrated root form implant. Nowadays, available implants vary in di- ameter between 1.8 mm and 7 mm: implants with diameter less than or equal to 2.7 mm are called mini diameter implants (MDI) (1-5), while those of 3 to 3.3 mm (6, 7) diameter are called small diameter implants (SDI), and conventional implants are those up to 7 mm (1, 8). In the beginning,

After this had been found, the SDI and MDI have been approved for long-term use in 1997 by the FDA (8) resulting in avoiding bone augmentation or enlarging the mesiodistal space and giving the op- portunity for more patients with severe cases to gain implant therapy. Conventional implants appeared problematic in: small space between the teeth in the place implant was supposed to be placed, in areas in which bone resorption had occurred, in cases where edentulous arches were with minimal bone in Table 2. MDI and SDI survival rates (continued on p. 42)
a facial-lingual or mesiodistal direction, that could lead to excluding such patients from treatment (8). In order to place dental implant in partially edentu- lous patients, it has been recommended to maintain 2 mm to 3 mm of available space between the surface of the implant and the residual dentition to avoid impinging or damaging the periodontal ligaments of the adjacent teeth (9).

Primary stability of small diameter and mini-dental implants showed sufficiency for immediate loading, they can be used as an alternative to treatment with fixed partial dentures in terms of both clinical and aesthetic criteria, as well for retention of complete maxillary and mandibular overdentures (20). Smaller diameter implants are preferred rather than conventional ones for reasons of blood supply, that is, conven- tional implants may disturb the blood supply to the bone around the implant (22). Additionally, if there is adequate space and an unforeseen bone density or site inadequacy is encountered during the osteotomy of a small-diameter implant, the use of a slightly larger-diameter implant that is able to attain better initial stability stays an option (23)

CONCLUSIONS
Implants with small diameters are one of the major advancements in dental history; they can be used successfully in a variety of clinical situations.
Researches continue to demonstrate the surgical and prosthodontic success of those implants.
They offer patients satisfaction due to less surgical time, less postoperative pain and ability of direct loading after surgery with no harm to bone.
Also they are more cost effective option, since they can support a denture with a reduced cost.
It must be emphasized that the reduced surface implants require correct treatment planning so that the loading force would not cause bone loss or implant failure. Nevertheless, MDI and SDI showed high survival rates, but special cautions of bone quality and good oral hygiene should be maintained.
Due to simplified procedures, this could be a good choice for unexperienced dentists for their first steps.

21: Applications of the Small-Diameter Implant in Dentistry

Ian Erwood,DDS
Inside Dentistry. Sept 2007. Special Issue 2

The use of small diameter implants SDI's which are less than 3 mm in diameter is only recently gaining popularity for both FIXED and removable stabilization of a dental prosthesis as well as temporary anchorage for various applications in the dental field.

Small diameter implants SDI's that are less than 3 mm in diameter have been in use in Europe for over 40 years and getting food and drug administration FDA approval for long-term use in 2003.

SDIs have only recently gained popularity among the North American dental community as a viable option for fixed removable temporary anchorage applications.

The long-term survival of MDI implants for a FIXED and removable prosthetics is SIMILAR to regular diameter endosseous implants.

Because MDI implants require less bone witdth,have an atraumatic surgery and placement ,can be loaded immediately ,and are more economical when compared to regular diameter and endosseous implants ,their use in oral rehabilitation will continue to rise.

22: CRA Foundation Newsletter

Clinician's Guide to Dental Products & Techniques
Dr. Gordon Christensen
November 2007 Issue 11.

Long term use : Because of the success of minis Minnie as transitional implants & the observed osseointegration, many clinicians began to use them as LONG TERM IMPLANTS.In 1997 Intech miniplant received FDA clearance for Intra bony and intra-radicular ...ongoing fixation",& and in 2003 the "long term intro bony applications".

Use of minis : Minis were reported most used in edentulous jaws about of both arches & for augmentation of removable partial dentures .
Augmentation of support and retention for fixed partial dentures & support for sole support of single crowns in the areas of minimal bone presence were next ,followed by transitional & orthodontic use.

CRA Conclusions
Currently long-term use of small diameter implant is moving from a relatively experimental mode to MAINSTREAM PRACTICE .Small diameter implants are indicated when patients have minimal bone, denial of grafting ,poor health,minimal financial resources ,and the desire to have minimally invasive surgery accomplished .

Whether or not they will REPLACE conventional diameter implant placement in situations where EITHER COULD BE USED is yet to be determined but is LIKELY TO HAPPEN.
Mini or small diameter implants or minimally invasive, have moderate cost ,are easily accomplished and easily removed if they fail,and have excellent patient acceptance.

23: Fixed Partial Denture Treatment With Mini Dental Implants 2014

Brian J. Jackson, DDS
Journal of Oral Implantology Vol. XL/No. Six/2014

http://www.joionline.org/
doi/pdf/10.1563/ aaid-joi-
D-14-00037?code=aaid-premde

Very small diameter implants or mini dental implants (MDI) are a treatment alternative due to their reduced size. MDI does not require bone augmentation procedures, which are tech- nique sensitive, time consuming, and vary in predictable results.1,2 The option of utilizing MDI provides a minimally invasive, safe, and cost- effective approach for restoring the patient with deficient bone volume.3,4

The idea that very small diameter implants could osseointegrate and be used long term was conceived when retrieval was difficult or impossible without separation of the implant. Subsequent research supported that the biological phenomenon of osseointegration oc- curred on the surface of very small diameter implants.9,10 Recent research has demonstrated that mini dental implants can be utilized successfully to retain fixed multi-unit partial dentures.11,1

The concept of minimally invasive surgical proce- dures has escalated in the past several years. The option of mini dental implant therapy as an implant reconstruction modality aligns with this emerging idea.19 The flapless, non-bone grafting approach to implant surgery provides the patient with a safe, effective means for prosthetic reconstruction. The success

The biological concept of osseointegration has been established for very small diameter implants. Long-term survival depends on initial rigid fixation via thread design as well as the strength of the implant.20 The macrostructure thread design and roughene

Patients present with missing teeth with resultant bone loss. Dentists see this clinical situation worsen over time, with clinical management becoming more challenging, requiring extensive procedures prior to implant surgery. The utilization of very small diameter implants for highly selected patients can provide a minimally invasive, safe, and predictable alternative to conventional bone grafting proce- dures. Although the usage of very small diameter or mini dental implants (MDI) continues to evolve and expand, there exists a need for an increase in the body of research.

FIGURE 1. Initial intraoral-centric relation. FIGURE 2. Initial periapical radiographs. FIGURE 3. Initial intraoral- presurgical facial view. FIGURE 4. Surgical template. FIGURE 5. Bleeding points indicating future implant sites. FIGURE 6. Transgingival penetration with a #2 round surgical bur. FIGURE 7. Mucoperiosteal flap. FIGURE 8. (4) 2.1mm x 10mm collared square-head mini dental implants (MDI)-facial view.
FIGURE 9. (4) 2.1mm x 10mm collared square-head MDI-centric rich plasma (PRP). FIGURE 12. Mandibular left canine (#22) pre-extraction surgery. FIGURE 13. Mini dental implant (MDI) impression transfers. FIGURE 14. MDI impression transfers captured in polyvinyl siloxane material. FIGURE 15. Implant analogs/ transfers secured in impression material. FIGURE 16. 5-unit metal framework try in. FIGURE 17. 5-unit porcelain fused to metal- facial occlusal view. FIGURE 18. 5-unit porcelain fused to metal prosthesis-centric relation.

24: USE OF MINI IMPLANTS FOR REPLACEMENT AND IMMEDIATE LOADING OF 2 SINGLE-TOOTH RESTORATIONS: A CLINICAL CASE REPORT 2006

Azfar A. Siddiqui, DMD, MSc Mark Sosovicka, DMD Mark Goetz, CDT
Journal of Oral Implantology 2 Vol. XXXII/No. Two/2006

http://www.joionline.org/doi/pdf/
10.1563/794.1

This article reports on the clinical use of mini implants in a patient with congenitally missing mandibular canines with limited mesiodistal bone dimension.

Dental implants are now considered the treatment of choice for replacement of all forms of tooth loss. Apart from providing function and esthetics similar to natural dentition, they also provide the most conservative treatment option, especially for single-tooth restoration. Until recently, dental- implant treatment was limited to patients with a minimum of 7 mm to 8 mm of available mesiodistal bone width to enable the placement of a 3.0-mm-diameter im- plant without impinging on the roots of the adjacent teeth. The availability of mini implants 1.8 mm and 2.2 mm in diameter, and FDA approval for use as definitive prosthesis support and retention, has opened new di- mensions in oral-implant restoration. Mini implants obviously have less surface area available for osseointegration compared to narrow-diameter implants, and this may be a handicap in some clinical situations. In the present case report, the patient's minimal mesiodistal space precluded the use of narrow-diameter implants, but also presented a very favorable occlusal scheme that enabled immediate loading of two 2.4-mm-diameter implants with single-tooth restorations. Apart from a conservative approach and no adjacent tooth modification, additional benefits to the patient were reduced cost and fixed restorations.
CONCLUSIONS
Mini implants are indicated for areas where the use of narrow- diameter implants ( 3.0 mm) are contraindicated. Until long-term longitudinal clinical data on mini dental implants are unavailable, their use should be limited to areas with potentially less occlusal load.

FIGURE 1. Patient with congenitally missing mandibular canine teeth. FIGURE 2. Preoperative panoramic radiograph. Note the distal inclination of the lateral incisors. FIGURE 3. Right lateral contacts. FIGURE 4. Left lateral contacts. FIGURE 5. A crestal incision exposed the osteotomy site. FIGURE 6. The 1.0-mm drill with a rubber stopper at a predetermined length. FIGURE 7. A 2.4-mm- diameter mini implant initiated to engage the osteotomy. FIGURE 8. The implant was tightened using the titanium finger driver. FIGURE 9. A winged driver was used when increased resistance was felt. FIGURE 10. A ratchet was only used as a final step to submerge the implant threads. FIGURE 11. Both implants in position. FIGURE 12. Postoperative panoramic radiographs demonstrated the desirable positioning of both implants. FIGURE 13. A final impression was made at the time of surgery. FIGURE 14. Provisional crowns were placed on the day of surgery. FIGURE 15. Placement of the final, implant-supported crowns at the 2-week follow-up appointment.

25: Treatment of Congenitally Missing Maxillary Lateral Incisors: AnInterdisciplinaryApproach 2013

Brian J. Jackson, DDS* Mark R. Slavin, DDS
Journal of Oral Implantology Vol. XXXIX/No. Two/2013

http://www.joionline.org/
doi/pdf/10.1563/ AAID-JOI-
D-12-00025?code=aaid-premdev

Patients that present with congenitally missing lateral incisors are a common dental concern. Although dentists can restore a partially edentulous patient with various prosthetic options, the use of endosseous implants should be considered. The synergy of orthodontics and implant dentistry can resolve this condition in an ideal manner. It is critical that dentists and orthodontists present this option to their patients to achieve an optimal functional and esthetic result.

After stable orthodontic incisor stability and con- solidation of excess maxillary space were estab- lished, a residual diastema existed between the left maxillary canine and first premolar (Figure 5). The space measured 5.5 mm in the mesial-distal and 5.0 mm in the buccal-palatal dimension. A 2.4 3 15 mm2 collared mini-implant (3M ESPE, St Paul, Minn) was planned to resolve the edentulous space. The

Research has demonstrated that the use of MINI ENDOSSEOUS IMPLANTS elicits a predictable long-term success.13,14
The 1-piece, nonsubmergible design has advantages of width, strength, early biological width development, and use of simple restorative techniques. The use of a MINI implant retaining a single crown can manage a space of 5 mm in the mesial-distal dimension.
The smaller width allows for implant placement in the required space needed between an adjacent tooth and an implant for long- term success.15
In addition, the 1-piece design eliminates the micro gap, thereby reducing the harbor of pathogenic microorganisms and screw loosening.

Also, the design allows for early biolog- ical width development, which enhances stable soft and hard tissues. The snap-on impression cap is used to capture the margin of the implant platform for final restoration fabrication.

FIGURE 1. Preoperative view of the centric occlusion. FIGURE 2. Panorex view of the congenitally missing maxillary lateral incisors. FIGURE 3. Prosthetic teeth bracketed and incorporated into orthodontic arch wire. FIGURE 4. Preimplant sites #7 and #10. FIGURE 5. Preimplant site, diastema distal to maxillary left canine.

FIGURE 6. Mini dental implant (MDI), 2.4 3 15 mm acid etched. FIGURE 7. Alumni copings: pick-up polyvinyl siloxane impression. FIGURE 8. The 2.4 mm impression cap, MDI. FIGURE 9. Final, centric occlusion left sextet. FIGURE 10. Final, centric occlusion.

Patients that present with congenitally missing lateral incisors are a common dental concern. Although dentists can restore a partially edentulous patient with various prosthetic options, the use of endosseous implants should be considered.

26: Survival Rates of Mini Dental Implants are Comparable to Standard Sized Implants for Prosthetic Support 2014

Tanner Hunsaker
hunsakert@livemail.uthscsa.edu

27: The Advantages of Minimally Invasive Implants :Observations 2005

Dr Gordon Christensen
J Am Dent Assoc,Vol 136,No. 11, 1563-1565

In my opinion, during the past several years, there has been an obvious trend in dentistry toward COMPLEX techniques and accomplishing MORE treatment THAN REQUIRED . The trend has been mentioned to me many times by colleagues as I have traveled around the world.

Recently ,I had the opportunity to speak at the annual meeting of the World Congress of Minimally Invasive Dentistry. It was refreshing to be with a group of fellow practitioners were attempting to provide OPTIMUM services for patients with the MINIMUM amount of treatment.

OFTEN ,patients do not have the minimum six millimeters of bone in a facial-lingual dimension needed for placement of conventional 4-mm–diameter implants.
The use of "mini" 1.8-mm–diameter implants allows conservative placement of implants in bone that is only 3 mm thick in a facial-lingual dimension, thus avoiding bone grafting and significant trauma and expense for patients.
Placement of these SMALL-diameter implants in MULTIPLES should be considered for optimum resistance and retention of FIXED or removable prostheses.

One widely used brand of mini-implants is IMTEC Sendax MDI (IMTEC, Ardmore, Pa.); another brand is MTI Monorail System (Dentatus, New York).
Mini-implants' minimal cost and ease of placement make them desirable to patients and dentists.2

28: Clinical Outcome of Narrow Diameter Implants: A Retrospective Study of 510 New approach towards mini dental implants and small-diameter implants: an option for long-term prostheses 2012

Alvydas Gleiznys, Gediminas Skirbutis, Ali Harb, Ingrida Barzdziukaite, Ieva Grinyte
Stomatologija, Baltic Dental and Maxillofacial Journal, 14: 39-45, 2012

http://www.sbdmj.com/
122/122-01.pdf

Conclusions. Implants with small diameters can be used successfully in a variety of clinical situations. Less surgical time, less postoperative pain, ability of direct loading after surgery with no harm to bone and cost effectiveness are the advantages. The reduced surface implants require correct treatment planning so that the loading force would not cause bone loss or implant failure. MDI and SDI show high survival rates, but special cautions for bone quality and good oral hygiene should be maintained. Primary stability of small diameter and mini-dental implants showed sufficiency for immediate loading, they can be used as an alternative to treatment with fixed partial dentures in terms of both clinical and aesthetic criteria, as well for retention of complete maxillary and mandibular overdentures (20).

Smaller diameter implants are PREFERRED rather than CONVENTIONAL ones for reasons of blood supply, that is, conventional implants may disturb the blood supply to the bone around the implant (22). Additionally,

CONCLUSIONS
Implants with SMALL DIAMETERS are one of the MAJOR ADVANCEMENTS in DENTAL HISTORY ; they can be used successfully in a variety of clinical situations. Researches continue to demonstrate the surgical and prosthodontic success of those implants.
They offer patients satisfaction due to ...
less surgical time,
less postoperative pain and
ability of direct loading after surgery with no harm to bone.
Also they are more cost effective option, since they can support a denture with a reduced cost.

It must be emphasized that the reduced surface implants require correct treatment planning so that the loading force would not cause bone loss or implant failure. Nevertheless, MDI and SDI showed high survival rates, but special cautions of bone quality and good oral hygiene should be maintained. Due to simplified procedures, this could be a good choice for unexperienced dentists for their first steps in implantology.

29:Clinical and radiographic evaluation of small-diameter (3.3-mm) implants followed for 1–7 years: a longitudinal study 2006

Eugenio Romeo Diego Lops Leonardo Amorfini Matteo Chiapasco Marco Ghisolfi Giorgio Vogel
Clin. Oral Impl. Res. 17, 2006 / 139–148

https://www.researchgate.net
/profile/Matteo_ Chiapasco
/publication/7196399_Clinical
_and_ radiographic_evaluation
_of_small-diameter_ 33-mm_
implants_followed_for_1-7_
years_A_longitudinal_ study/
links/0a85e532ff7bda537a000000
/Clinical- and-radiographic-
evaluation-of-small-diameter
-33-mm- implants-followed-
for-1-7-years-A-longitudinal-study.pdf

Cumulative survival and success rates of small-diameter implants and standard-diameter implants were not statistically different (P40.05).
Type 4 bone was a determining failure factor, while marginal bone loss was not influenced by the different implant diameters. The results suggest that small-diameter implants can be successfully used in the treatment of partially edentulous patients.

From the outcomes of the present study, using small-diameter implants seems to be a treatment option as predictable as using standard-diameter implants.
The cumula- tive survival and success rates of the two groups of implants were comparable, both for the maxillary and mandibular implants.

Narrow implants medium-term prognosis is comparable to the one of standard-diameter implants followed up in the present study.
Therefore, the high reliability of small-diameter implants is confirmed.
Standard and narrow implant prog- noses were influenced by peri-implant bone infection more than biomechanical factors, such as implant over- loading.
Peri-implant bone resorption was not significantly influenced by different implant diameters (3.3 and 4.1 mm). Bone quality seems to be an impor- tant prognosis factor both for stan- dard- and small-diameter implants; spongy bone (type4)may increase implant failures. This trend needs to be confirmed by the clinical evaluation of a larger number of implants. (v) Survival of standard and narrow implants does not seem to be affected by implant location. However, because of the low number of implant failures observed in the current study, further research is required to elucidate the most appropriate implant distribution.

30: Minimal invasive implantology with small diameter implants

By Henriette Lerner
Implant practice 31 February 2009 Volume 2 Number 1

https://www.researchgate.net
/file.PostFile Loader.html?id=
55b95d6a5cd9e344b38b456c&
assetKey=AS%3A2738217754
00961%401442295607096

Single tooth replacement with 2.9mm diameter implant (Figure 14). The absolute indication for this kind of narrow diameter implants, are:

• Replacement of a single tooth where the gap is 5-6 mm mesio distally (anterior lower incisor, premolar, anterior upper lateral incisor.)
• Replacement of a single or MULTIPLE teeth with CROWNS /BRIDGES where the bone width (buccal - lingual dimension) is 5-6 mm

• Stabilisation of the upper and lower denture

31: Connecting Teeth to Implants: A Critical Review of the Literature and Presentation of Practical Guidelines

Compendium September 2009—Volume 30, Number 7
Gary Greenstein, DDS, MS;1 John Cavallaro, DDS;2 Richard Smith, DDS ,Dennis Tarnow, DDS4

Abstract: Historically, connecting a tooth to an implant to function as an abutment to replace a missing tooth was discouraged. It was believed differences in mobility patterns of a tooth and an implant would result in the prosthesis being cantilevered off the implant, thereby stressing the implant. Several papers concluded increased stress caused technical and biologic complications, which led to a decreased survival rate for a tooth-implant supported prosthesis (TISP) when compared with an implant-only supported prosthesis (ISP).
However, problems attributed to TISPs may have been overstated.
This paper reviews animal studies and human clinical trials that monitored successful use of TISPs. In addition, numerous issues are addressed that question the data, which have been interpreted to indicate that a tooth should not be connected to an implant. Recommendations are made to facilitate attaining high success rates with TISPs.

Table 1: Benefits of Connecting Teeth to Implants

1. Splinting teeth to implants broadens treatment possibilities: a. When anatomic limitations restrict insertion of addi- tional implants (eg, maxillary sinus, mental foramen). b. Lack of bone for implant placement. c. Patient refusal to undergo a bone augmentation procedure.
2. Desire to splint a mobile tooth to an implant.
3. Teeth provide proprioception.
4. Reduced cost for teeth replacement.
5. Additional support for the total load on the dentition.
6. Reduction of the number of implant abutments needed for a restoration.
7. Possibly avoid the need for a cantilever.
8. To preserve the papilla adjacent to the tooth for esthetic or functional concerns (eg, phonetics).

CONCLUSION
Despite the fact that the potential mobility between a tooth and an implant are different and the precise etiology of tooth intrusion is unknown, it is REASONABLE to RIGIDLY CONNECT a TOOTH to an IMPLANT.
This is particularly true if the anatomy dictates that placement of an additional implant(s) is contraindicated or if there are economic concerns.
This deduction is based on almost every study that addressed this issue and found the survival rates were similar when TISPs and ISPs were compared.
At present, there are no large long-term studies that assessed textured surface im- plants as an integral part of a TISP.
The literature supports the idea that a RIDGID CONNECTION between a tooth and an implant usually precludes intrusion of teeth.
The following guidelines can help prevent intrusion of teeth (items 1 to 9) and enhance patient care when contemplating fabricating a TISP.

1. Select healthy teeth—periodontally stable and in dense bone.
2. Rigidly connect the tooth and implant (no stress break- ers), employ large solder joints to enhance rigidity (Fig- ure 3), or use one-piece castings.
3. Avoid telescopic crowns (no copings) (Figure 4A and Figure 4B).
4. Provide retention form with minimal taper of axial walls on abutment teeth. Enhance resistance form with boxes and retention grooves if the clinical crown is not long (Figure 5).
5. Parallel the implant abutment to the preparation of the tooth and use a rigid connection.
6. Use permanent cementation (no screw retention or tem- porary cementation).

32: Connecting Teeth and Implants: Yes, No, Maybe?

By Frank Spear on November 12, 2015
7201 E Princess Boulevard, Scottsdale,AZ 85255

Whether or not it is acceptable to connect an implant to a tooth, or teeth, in a restoration is ONE of the MOST MISUNDERSTOOD areas of implant dentistry.
The reason so much confusion exists is simple: there isn't one correct answer. To understand why, you must look at the mechanics of connecting an implant and a tooth; recognizing that the implant is essentially ankylosed with effectively no mobility, the tooth has a PDL and may have minimal to significant levels of mobility. (See Figure 1.)
In conclusion,
it would be safe to say that the most predictable and least risky restoration would leave the teeth and implants free standing, but experience and the literature make it CLEAR...that IMPLANTS CAN BE SAFELY CONNECTED TO NATURAL TEETH... as long as consideration is given to the challenges of implant overload, and preventing intrusion of the natural teeth.12,13, 14

Frank Spear, D.D.S., M.S.D. : Prosthodontist
One of dentistry's most respected clinicians and educators, Dr. Spear is the founder and director of Spear Education. His lectures, seminars and workshops have transformed how dentists approach dentistry today.

33: Connecting teeth to implants :The truth about a debated technique 2009

Frank Spear,DDS,MSD
JADA,Vol. 140. May2009

If history and science have taught us anything ,it is that all "TRUTH" in dentistry is definable only at the time and instance of its application.
Dentist must evaluate TRUTH continuously as new information and technology emerge.

Today ,the truth is that connecting implants two teeth is a RESTORATIVE OPTION that can increase predictability of outcome in appropriate cases.

The dentist can and should consider connecting natural teeth implants ...
if there's no other option ,
if the patients implants need the support or
if this course of action would help the dentist manage the aesthetics more predictably.

As always, the most important step in every restorative case is treatment planning .
The greater the number of potential solutions ,the more predictable treatment becomes .
Connecting teeth and implants is A TOOL that ,when applied appropriately ,and increase the predictability and quality of restorative dentistry.

34: Ask Dr. Christensen: Dental Economics

In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics® readers. If you would like to submit a question to Dr. Christensen, please send an e-mail to info@pccdental.com.

Q I have been told that implants should not be attached with fixed bridges to natural teeth. However, I have made several bridges, attaching natural teeth to implants, without any problems. Should implants be connected to natural teeth?

A The answer to your question is both "yes" and "no." There is very little research that has been accomplished on this important subject. I will provide my own conclusions for you, based on hundreds of implant-supported fi xed prostheses I have accomplished personally.

There are situations where natural TEETH and IMPLANTS need to be CONNECTED because of inadequate bone in potential pontic areas, or to avoid placing more implants for financial reasons.
The following technique is successful if carried out exactly as outlined below. For our example, I will assume that one natural tooth is being connected to one implant, with one missing tooth being replaced with a pontic:

• Make a full-crown tooth preparation on the abutment tooth. The preparation should be parallel and as long from the occlusal to the gingival area as possible.
• Place an appropriate abutment on the implant. The abutment should be as parallel as possible with the abutment tooth.
• Make the fixed prosthesis.
• On the cementation appointment, make relatively deep rotary-diamond scratches on the tooth preparation.
• Make sure that the abutment is securely attached to the implant.
• Cement the fixed prosthesis with strong bonded-resin cement.
• Adjust occlusion carefully, placing heavy occlusal forces on the articulation marking ribbon or paper, and reducing the marked areas to allow equal load on the implant and tooth-supported restoration and the adjacent natural teeth. The implant will not move apically, but the tooth can move slightly apically. Inadequate occlusal adjustment can cause premature failure.
• Expect successful service from the natural tooth/implant-supported fixed prosthesis.

Dr. Gordon Christensen: Prosthodontist:
Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known"CRA Newsletter." He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.

35: DENTAL ECONOMICS:Ask Dr. Christensen Nov 2009

by Gordon J. Christensen, DDS, MSD, PhD

Q I have heard many contraindications and rules for placing dental implants, but I have also seen successful implants placed when nearly all of those contraindications or rules have not been observed. When should I advise patients against having implants placed, and what are the current beliefs and evidence about implant placement?

A Your observations of the success of implants placed in many contraindicated locations and when the rules have not been observed are correct, yet many of them still integrate and continue to serve. More than 20 years ago, when I was learning implant placement and restoration, there were many rules which have subsequently been disproved.

Still present is the rule that you never ATTCAH IMPLANTS to NATURAL TEETH. All of the above rules have been shown to be UNTRUE.

I have a few others to add to the list:

If the patient has had horrible oral hygiene before extractions, it has been my observation that the same oral hygiene characteristics will prevail after the implants are placed, and these conditions will potentially endanger the gingival health around the implants.
• If the patient is noncommittal about his or her desire for the implants, I do not try to convince him or her to have the procedure done. Implant patients have to be a positive part of the team to make the trauma, time, and changes involved with implants worthwhile.

Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization initiated in 1981 for dental professionals.
Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-know

36: Tooth implant supported Prosthesis: A Literature reviewREVIEW ARTICLE 2013

Year : 2013 | Volume : 3 | Issue : 3 | Page : 143-150
Vidya Kamalaksh Shenoy1, Shobha J Rodrigue2, E Prashanti3, Sharon J. R.
Saldanha2
Journal of Interdisciplinary Dentistry

http://www.jidonline.com/article
.asp?issn= 2229-5194;year=
2013;volume=3;issue=3; spage
=143;epage=150;aulast=Shenoy

Background: Implants are connected to the natural teeth in the management of partially edentulous patients. The use of this concept has been a subject of discussion as some authors have recommended it while others stress on the potential complications associated with splinting implants to natural teeth. Purpose: The purpose of this article was to systematically review the literature regarding the rationale, difference in the biomechanical behavior of the implant and the natural teeth, nature of connection, potential complications associated with splinting of implants and teeth, and guidelines to be followed. Materials and Methods: Various databases like PubMed, Ebscohost, Science Direct were searched between 1980 to December 2011 to retrieve articles regarding the implant natural teeth connection. A manual search for the references from the retrieved articles was also completed. The articles published only in English, randomized clinical trials, prospective and retrospective clinical studies, laboratory and computer generated research were included. Abstracts, opinion articles, technique articles and questionnaire based studies were excluded. Results: The biomechanical impact of mismatch in the mobility pattern of natural teeth and implants has been controversial. Various complications associated with tooth implant supported prosthesis has been reported with intrusion and implant overloading being the cause of concern. Marginal bone loss associated with overload around the implant has been reported and found to be within acceptable levels. The reports also suggested no significant differences between various types of connections utilized and to use the non rigid connections with caution.
Conclusion: Whenever possible implant supported prostheses should be the treatment of choice. However, certain clinical situations DEMAND connecting teeth to implants.

37: Risks and benefits of connecting an implant and natural tooth.

Implant Dent. 2014 Jun;23(3):253-7. doi: 10.1097/ID.0000000000000101.
Davis SM1, Plonka AB, Wang HL.

https://www.ncbi.nlm.nih.gov
/pubmed/24819813

Background: Implants are connected to the natural teeth in the management of partially edentulous patients. The use of this concept has been a subject of discussion as some authors have recommended it while others stress on the potential complications associated with splinting implants to natural teeth. Purpose: The purpose of this article was to systematically review the literature regarding the rationale, difference in the biomechanical behavior of the implant and the natural teeth, nature of connection, potential complications associated with splinting of implants and teeth, and guidelines to be followed. Materials and Methods: Various databases like PubMed, Ebscohost, Science Direct were searched between 1980 to December 2011 to retrieve articles regarding the implant natural teeth connection. A manual search for the references from the retrieved articles was also completed. The articles published only in English, randomized clinical trials, prospective and retrospective clinical studies, laboratory and computer generated research were included. Abstracts, opinion articles, technique articles and questionnaire based studies were excluded. Results: The biomechanical impact of mismatch in the mobility pattern of natural teeth and implants has been controversial. Various complications associated with tooth implant supported prosthesis has been reported with intrusion and implant overloading being the cause of concern. Marginal bone loss associated with overload around the implant has been reported and found to be within acceptable levels. The reports also suggested no significant differences between various types of connections utilized and to use the non rigid connections with caution.
Conclusion: Whenever possible implant supported prostheses should be the treatment of choice. However, certain clinical situations DEMAND connecting teeth to implants.

38: The implant-tooth connection: a 10-year perspective

Richard J. Lazzara, Stephan S. Porter and Diego H. Santamarina
tandläkartidningen årg 90 nr 17 1998

http://www.tandlakartidningen
.se/media/ 869/Lazzara_17_1998.pdf

Summary
The implant-tooth connection: a 10-year perspective
The rigid and non-rigid connection of teeth and dental implants remains one of the most contro- versial methods of restoring implants in the parti- ally edentulous patient. The purpose of this retro- spective study is to review treatment outcomes in patients who had implants rigidly connected to teeth for up to 10 years (average 5.28 years). A total of 45 patients, consecutively restored with fixed bridges rigidly connecting both implants and teeth are reviewed. The 45 patients are resto- red with 55 fixed bridges supported by 136 teeth and 110 implants. Twenty-six (47.3%) of the fixed restorations are in the maxilla and 29 (52.7%) in the mandible. There is an average of 2.00 implants and 2.47 teeth included per fixed bridge. The re- sults show a post-loading implant survival rate of 99.1% and 97.1% for teeth. Four of 136 teeth, one maxillary and three mandibular, were lost during the study period. One was removed because of severe caries, one due to severe bone loss, one for endodontic complications and one as a result of intrusion. A comparison of measurements taken from the initial post-loading and most recent post-loading radiographs reveal an average bone loss of 0.06 mm around teeth and 0.16 mm aro- und implants.

In conclusion:
From the data provided by this study, it appears that the RIGID connection of IMPLANTS and TEETH does NOT accelerate bone loss around either the implant or the tooth,that the implant and tooth survival is high and that complications with this type of prosthesis are minimal.

39: Tooth-implant connection: A critical review

REVIEW ARTICLE
Year : 2013 | Volume : 3 | Issue : 2 | Page : 142-147
N Aparna, S Rajesh
Department of Prosthodontics, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India

http://www.jdionline.org/temp/JDent
Implant32142-6079449_014119.pdf

Conclusion
Despite the fact that the potential mobility between a tooth and an implant are different and the precise etiology of intrusion is unknown, IT IS REASONABLE to rigidly CONNECT a tooth to dental implant.

This is particularly true if the anatomy or economic concern precludes the placement of an additional implant. This inference is made from almost every study that addressed this issue and found the survival rates were similar when TISPs and ISPs were compared.

The most common complication of splinting teeth to implants is intrusion. The literature supports the idea that a rigid connection between a tooth and an implant usually precludes intrusion. The literature supports the idea that a rigid connection between a tooth and an implant usually precludes intrusion of teeth. [22] The following inferences were made from the various studies that dealt with the TISPs which can help us to prevent tooth intrusion and to enhance patient care when

40: Dental Secrets : Third addition. Hanley & Belfus,Inc.

Dr. Stephen T. Sonis,DMD,DMSc
Dept. of Oral Medicine and Diagnostic Services
Harvard School of Dental Medicine.

Q: Do definitive data support the contention that implanted supported teeth should not be splinted to natural teeth?

A: This is controversial,all but available data REFUTE the claim that bridges with both implant and natural tooth abutments do more poorly than bridges supported only by implants.
(Gunne J,Astrand P,Allen K, et al: Implants in partially edentulous patients: A longitudinal study of bridges supported by both implants and natural teeth.
Clin Oral Implant Res 3:49-56,1992

41: Long-term outcomes for cross-arch stabilizing bridges in periodontal maintenance patients--a retrospective study.

Fardal O1, Linden GJ.
J Clin Periodontol. 2010 Mar;37(3):299-304. doi: 10.1111/j.1600-051X.2009.01528.x. Epub 2010 Jan 13.

https://www.ncbi.nlm.nih.gov/
pubmed/20070860

Abstract
BACKGROUND:

Cross-arch bridges are used to stabilize teeth for patients with reduced periodontal support. Little is known about technical or biological complications, whether teeth and implants can be combined in this type of bridge and the long-term effects on tooth loss.
MATERIALS AND METHODS:
All patients treated in a specialist periodontal practice who received cross-arch stabilizing bridgework and were subsequently maintained for at least 7 years were included in the study. The patients were selected from all patients who underwent initial periodontal therapy after 1986 in a Norwegian periodontal practice. The bridges were assessed for biological and technical complications. Bridges retained by teeth or by a combination of teeth and implants were included in the study.
RESULTS:
Ninety-four rigid fixed bridges (77 teeth supported, 17 teeth and implant supported) in 80 patients (46 females, 34 males) were observed for an average of 10 years (range 7-22 years). In four patients, a bridge became loose and had to be re-cemented, and in one case the metal framework of a bridge fractured and the bridge had to be remade. In total, eight abutment teeth were lost from five patients but no implant abutments were lost. Overall, a higher rate of tooth loss was observed for patients provided with stabilizing bridges compared with control maintenance patients not treated with bridgework (p<0.0001); however, the rates in both groups were very low.
CONCLUSION:
Cross-arch stabilizing bridges constructed for periodontal patients as part of their periodontal maintenance therapy had few complications and were associated with low rates of abutment tooth loss.
Combining teeth and implants did NOT affect the performance of these bridges.

42: Retrospective evaluation of complete-arch fixed partial dentures connecting teeth and implant abutments in patients with normal and reduced periodontal support.

Cordaro L1, Ercoli C, Rossini C, Torsello F, Feng C.
J Prosthet Dent. 2005 Oct;94(4):313-20.

https://www.ncbi.nlm.nih.gov/
pubmed/16198167

Abstract
STATEMENT OF PROBLEM:

The clinical outcome of complete-arch fixed prostheses supported by implants and natural tooth abutments in patients with normal or reduced periodontal support has been reported by few studies, with controversial results.
PURPOSE:
The purpose of this study was to report on the implant success rate, prosthetic complications, and the occurrence of tooth intrusion, when complete-arch fixed prostheses, supported by a combination of implants and teeth, were fabricated for patients with normal and reduced periodontal support.
MATERIAL AND METHODS:
Nineteen patients with residual teeth that served as abutments were consecutively treated with combined tooth- and implant-supported complete-arch fixed prostheses and were retrospectively evaluated after a period varying from 24 to 94 months. Nine patients showed reduced periodontal support as a result of periodontal disease and treatment (RPS group), and 10 patients had normal periodontal support of the abutment teeth (more than 2/3 of periodontal support [NPS group]). Ninety implants and 72 tooth abutments were used to support 19 fixed partial dentures. Screw- and cement-retained metal-ceramic and metal-resin prostheses were fabricated with rigid and nonrigid connectors. Implant survival and success rates, occurrence of caries and tooth intrusion, and prosthetic complications were recorded. The number of teeth, implants, prosthetic units, fixed partial dentures, and nonrigid connectors were compared with a t test to assess differences between the 2 groups, while data for the occurrence of intrusions and prosthetic complications were compared with the Fisher exact test (alpha=.05).
RESULTS:
One of the 90 implants was lost (99% survival rate) over 24 to 94 months, while 3 implants showed more than 2 mm of crestal bone loss (96% success rate) over the same period. No caries were detected, but 5.6% (4/72) of the abutment teeth exhibited intrusion. Intrusion of abutment teeth was noted in 3 patients who had normal periodontal support (13% of teeth in NPS group) of the abutment teeth and was associated with nonrigid connectors. No intrusion of teeth was noted in the patients exhibiting reduced periodontal support regardless of the type of connector or when a rigid connector was used for either group. The number of intruded teeth was significantly greater in patients with intact periodontal support (P=.03).
CONCLUSIONS:
Complete-arch fixed prosthesis supported by implant and tooth abutments may be associated with intrusion of teeth with intact periodontal support when nonrigid connectors are used to join the implant- and tooth-supported sections of the prostheses.
However, fixed partial dentures supported by implants and teeth with reduced periodontal support were NOT associated with tooth intrusion, regardless of the type of connectors used.

43: Combination of Natural Teeth and Osseointegrated Implants as Prosthesis Abutments: A 2-Year Longitudinal Study. 1991

Authors:
Åstrand, Per Borg, Kenneth Gunne, Johan Olsson, Morgan
Source:International Journal of Oral & Maxillofacial Implants. Fall1991, Vol. 6 Issue 3,

Abstract:
Twenty-three patients with Kennedy Class I mandibular dentition were supplied with prostheses in the posterior parts of the mandible. On one side they were given a prosthesis supported by two implants (prosthesis Type I) and on the other side they received a prosthesis supported by one implant and one natural tooth (prosthesis Type II). Sixty-nine fixtures were inserted and 46 prostheses constructed. Eight of the fixtures were lost during the observation period. The failure rate of the implants was about the same in the two types of prostheses; five fixtures belonged to prostheses Type I (10.9%) and two fixtures belonged to prostheses Type II (8.7%), while one fixture was lost prior to loading. From a theoretical point of view, the combination of a tooth and an osseointegrated implant should encounter problems with regard to the difference in bone anchorage and there should be a risk of biomechanical complications.
However, the results of this study did NOT indicate any disadvantages in connecting teeth and implants in the same restoration. [ABSTRACT FROM AUTHOR]

44: Tooth implant supported Prosthesis: A Literature review 2013

Year : 2013 | Volume : 3 | Issue : 3 | Page : 143-150
Vidya Kamalaksh Shenoy1, Shobha J Rodrigue2, E Prashanti3, Sharon J. R. Saldanha2
1 Department of Prosthodontics, AJ Institute of Dental Sciences, Mangalore,

Background: Implants are connected to the natural teeth in the management of partially edentulous patients. The use of this concept has been a subject of discussion as some authors have recommended it while others stress on the potential complications associated with splinting implants to natural teeth. Purpose: The purpose of this article was to systematically review the literature regarding the rationale, difference in the biomechanical behavior of the implant and the natural teeth, nature of connection, potential complications associated with splinting of implants and teeth, and guidelines to be followed. Materials and Methods: Various databases like PubMed, Ebscohost, Science Direct were searched between 1980 to December 2011 to retrieve articles regarding the implant natural teeth connection. A manual search for the references from the retrieved articles was also completed. The articles published only in English, randomized clinical trials, prospective and retrospective clinical studies, laboratory and computer generated research were included. Abstracts, opinion articles, technique articles and questionnaire based studies were excluded. Results: The biomechanical impact of mismatch in the mobility pattern of natural teeth and implants has been controversial. Various complications associated with tooth implant supported prosthesis has been reported with intrusion and implant overloading being the cause of concern. Marginal bone loss associated with overload around the implant has been reported and found to be within acceptable levels. The reports also suggested no significant differences between various types of connections utilized and to use the non rigid connections with caution.
Conclusion: Whenever possible implant supported prostheses should be the treatment of choice. However, certain clinical situations DEMAND connecting teeth to implants.

45: Clinical Outcome of Narrow Diameter Implants: A Retrospective Study of 510 Implants

Marco Degidi,* Adriano Piattelli,† and Francesco Carinci‡
Abstract
Journal of Periodontology
January 2008, Vol. 79, No. 1, Pages 49-54 , DOI 10.1902/jop.2008.070248
(doi:10.1902/jop.2008.070248

Background: Narrow diameter implants ([NDIs]; diameter <3.75 mm) are a potential solution for specific clinical situations such as reduced interradicular bone, thin alveolar crest, and replacement of teeth with small cervical diameter. NDIs have been available in clinical practice since the 1990s, but only a few studies have analyzed their clinical outcome.
Methods: From November 1996 to February 2004, 237 patients were selected, and 510 NDIs were inserted. Implant diameter ranged from 3.0 to 3.5 mm, multiple implant systems were used, and 255 implants were restored immediately without loading (IRWL). No statistical differences were detected among the studied variables. Consequently, marginal bone loss (MBL) was considered an indicator of the success rate (SCR) to evaluate the effect of several host-, surgery-, and implant-related factors. A general linear model (GLM) was used to detect those variables statistically associated with MBL.
Results: Only three of 510 implants were lost (survival rate [SRR] = 99.4%), and no differences were detected among the studied variables. On the contrary, the GLM showed that delayed loading and longer (>13 mm) and larger (3.4 and 3.5 mm) NDIs reduced MBL.

Conclusions: NDIs have a high SRR and SCR, similar to those reported in previous studies of regular diameter implants. Moreover, IRWL of NDIs is a reliable procedure, although a slightly higher bone resorption is reported compared to delayed loading. No implant fractures were detected in the present series.
KEYWORDS: Dental implants, linear model

46: Tooth-implant connection: A critical review

REVIEW ARTICLE 2013
Year : 2013 | Volume : 3 | Issue : 2 | Page : 142-147
N Aparna, S Rajesh
Department of Prosthodontics, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India

Conclusion
Despite the fact that the potential mobility between a tooth and an implant are different and the precise etiology of intrusion is unknown, IT IS REASONABLE to rigidly CONNECT a tooth to dental implant.

This is particularly true if the anatomy or economic concern precludes the placement of an additional implant. This inference is made from almost every study that addressed this issue and found the survival rates were similar when TISPs and ISPs were compared.

The most common complication of splinting teeth to implants is intrusion. The literature supports the idea that a rigid connection between a tooth and an implant usually precludes intrusion.
The literature supports the idea that a rigid connection between a tooth and an implant usually precludes intrusion of teeth. [22]
The following inferences were made from the various studies that dealt with the TISPs which can help us to prevent tooth intrusion and to enhance patient care when fabricating a TISP.

47: Critical Appraisal
MINI IMPLANTS: GOOD OR BAD FOR LONG-TERM SERVICE? 2008

Author
Gordon J. Christensen, DDS, MSD, PhD* Associate Editor
© 2008, COPYRIGHT THE AUTHORS
JOURNAL COMPILATION © 2008, WILEY PERIODICALS, INC.
DOI 10.1111/j.1708-8240.2008.00204.x VOLUME 20, NUMBER 5, 2008 343

Small-diameter implants combined with natural teeth supporting a fixed prosthesis for 4 year

48: Role of supportive maintenance therapy on implant survival: a university-based 17 years retrospective analysis 2016

IC Gay, Department of Periodontics, East Carolina University, Greenville, NC, USA DT Tran, M Walji, Department of Diagnostics and Biomedical Sciences, School of Dentistry, University of Texas, Houston, TX, USA
R Weltman, K Parthasarathy, J Diaz-Rodriguez, L Friedman, Department of Periodontics and Dental Hygiene, School of Dentistry, University of Texas, Houston, TX, USA
Y Fu, Human Genetics Center, Division of Biostatistics, School of Public Health, University
Int J Dent Hygiene 14, 2016; 267--271

Abstract: Objective: The objective of this study was to determine whether professional maintenance appointments were related to a DECREASE on dental IMPLANT LOSS.

Conclusion: From this research, we conclude that a PROFESSIONAL professional administered PERIODONTAL MAINTENANCE at least on an ANNUAL basis is a CRITICAL FACTOR for IMPLANT SURVIVAL.

The results of this study showed that the FREQUENCY of maintenance visits played an important role in IMPLANT SURVIVAL.
Patients should have a MAINTENANCE VISIT AT LEAST ONCE A YEAR to improve the SURVIVAL RATE of their IMPLANTS.

49: Guidance for the maintenance care of dental implants: clinical review. 2012

Todescan S1, Lavigne S, Kelekis-Cholakis A.
J Can Dent Assoc. 2012;78:c107.

http://www.jcda.ca/
article/c107

Abstract
As implant treatment becomes part of mainstream dental therapy, dental offices should implement protocols for individualized, systematic and CONTINUOUS supportive care of the peri-implant tissues.
This review article suggests guidelines for maintenance care of dental implants. The preliminary assessment should begin with updating the patient's medical and dental histories. The clinical implant should be examined to evaluate the following: condition of the soft tissues, plaque index, clinical probing depth, bleeding on probing, suppuration, stability of soft-tissue margins, keratinized tissue, mobility and occlusion. If the clinical signs suggest the presence of peri-implantitis, radiography of the site is advisable, to confirm the diagnosis. Appropriate treatment should be pursued according to any diagnosis reached during the examination, including (but not limited to) instructions on oral hygiene, removal of supra- and sub-gingival plaque and calculus, occlusal adjustment, relining of a removable prosthesis or surgery.

50: Bruxism and prosthetic treatment: A critical review 2011

Anders Johansson DDS, PhDRidwaan Omar BSc, BDS, LDSRCS, MSc, FRACDS, FDSRCSEdGunnar E. Carlsson DDS PhD
J Prosthodont Res. 2011 Jul;55(3):127-36. doi: 10.1016/j.jpor.2011.02.004. Epub 2011 May 18.

https://www.ncbi.nlm.nih.gov/
pubmed/21596648

PURPOSE:
Based on the findings from available research on bruxism and prosthetic treatment published in the dental literature, an attempt was made to draw conclusions about the existence of a possible relationship between the two, and its clinical relevance.
STUDY SELECTION:
MEDLINE/PubMed searches were conducted using the terms 'bruxism' and 'prosthetic treatment', as well as combinations of these and related terms. The few studies judged to be relevant were critically reviewed, in addition to papers found during an additional manual search of reference lists within selected articles.
RESULTS:
Bruxism is a common parafunctional habit, occurring both during sleep and wakefulness. Usually it causes few serious effects, but can do so in some patients. The etiology is multifactorial. There is no known treatment to stop bruxism, including prosthetic treatment. The role of bruxism in the process of tooth wear is unclear, but it is not considered a major cause. As informed by the present critical review, the relationship between bruxism and prosthetic treatment is one that relates mainly to the effect of the former on the latter.
CONCLUSIONS:
Bruxism may be included among the risk factors, and is associated with increased mechanical and/or technical complications in prosthodontic rehabilitation, although it seems not to affect implant survival. When prosthetic intervention is indicated in a patient with bruxism, efforts should be made to reduce the effects of likely heavy occlusal loading on all the components that contribute to prosthetic structural integrity. Failure to do so may indicate earlier failure than is the norm.
Copyright © 2011 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.
PMID: 21596648 DOI: 10.1016/j.jpor.2011.02.004

51: Dental implants in patients with bruxing habits : Review Article 2006

Lobbezoo F1, Brouwers JE, Cune MS, Naeije M.
J Oral Rehabil. 2006 Feb;33(2):152-9.

https://www.ncbi.nlm.nih.gov/
pubmed/16457676

Abstract
Bruxism (teeth grinding and clenching) is generally considered a contraindication for dental implants, although the evidence for this is usually based on clinical experience only.
So far, studies to the possible cause-and-effect relationship between bruxism and implant failure do NOT yield consistent and specific outcomes.
This is partly because of the large variation in the literature in terms of both the technical aspects and the biological aspects of the study material.

Although there is still NO PROOF for the suggestion that bruxism causes an overload of dental implants and of their suprastructures, a careful approach is recommended.

There are a few practical guidelines as to minimize the chance of implant failure. Besides the recommendation to reduce or eliminate bruxism itself, these guidelines concern the number and dimensions of the implants, the design of the occlusion and articulation patterns, and the protection of the final result with a hard occlusal stabilization splint (night guard).
PMID: 16457676 DOI: 10.1111/j.1365-2842.2006.01542.x
[Indexed for MEDLINE]

52: Assessment of the Effect of Two Occlusal Concepts for Implant-Supported Fixed Prostheses by Finite Element 2014
Analysis in Patients With Bruxism

Evrim Go ̈re, PhD* Gu ̈lu ̈mser Evliog ̆lu,
Prof Journal of Oral Implantology , Vol. XL/No. One/2014
Department of Maxillofacial Prosthodontics, Faculty of Dentistry, Istanbul University,
DOI: 10.1563/AAIDFor -JOI-D-11-00044

http://www.joionline.org/doi/pdf/
10.1563/AAID-JOI-D-11-00044

The aim of this study was to evaluate the effects of bruxing forces on implants configured under 2 different occlusal schemes by dynamic finite element analysis.

According to the results of this study, use of canine guidance is encouraged in bruxers with implant-supported prostheses.

Although this parafunctional habit is considered a critical factor in implant success, there is NO SCIENTIFIC PROOF that bruxism is a definite contraindication for control factors.

Occlusion may dramatically influence the effect of bruxism in patients with implant-supported prostheses.10,14 Implant occlusion principles mostly agree with occlusal principles in natural tooth restorations.15 Yet the mechanical effects of the occlusal concepts on oral implant components have not been clearly shown in the literature.
Therefore, the aim of the present study is to compare the effects of canine guidance and group-function occlusal concepts on implant loading under heavy bruxing forces using a 3-dimensional dynamic finite element analysis method.

in an implant-retained posterior fixed partial denture and where bruxism exists, group function loading may result in excess stresses on the components compared with canine guidance loading. The results of this in silico study should be confirmed by further longitudinal clinical studies to reveal the potential impact of bruxing on implants and related prostheses.

53: Relation between bruxism and dental implants 2014

On-line version ISSN 1981-8637
RGO, Rev. Gaúch. Odontol. vol.62 no.4 Campinas Oct./Dec. 2014

http://dx.doi.org/10.1590/1981-
8637201400040000032658

Leonardo Bueno TORCATO 1 Paulo Renato Junqueira ZUIM 1 Daniela Atili BRANDINI 2 Rosse Mary FALCÓN-ANTENUCCI 1

The aim of this study was to gather information and discuss the predictability of implant-supported prostheses in patients with bruxism by performing a literature review.

CONCLUSION:
Although there is still NO general consensus on this matter, most of the literature review articles do provide clinical guidelines that contribute to implant supported prostheses longevity and stability in patients with bruxism.

54: FDA : Food and Drug Administration 501(k)

55: Mini Dental Implants :Patient Brochure
American Dental Association 2008

56: Restoring Esthetics and Function in a Patient with Amelogenesis Imperfecta – A Multidisciplinary Approach 2015

Neeraja Turagam* and Durga Prasad Mudrakola
Department of Prosthodontics, AIMST University, Semeling, Jalan Bedong, 08100, Kedah, Malaysia
5 • Issue 3 • 1000285

https://www.omicsonline.org/
open-access/ restoring-
esthetics-and-function-in-a-
patient-with- amelogenesis-
imperfecta-- a- multidisciplinary
-approach-2161-1122-1000285.pdf

Abstract
Amelogenesis imperfecta has been described as a complex group of inherited conditions that disturbs the developing enamel structure and exists independent of any related systemic disorder. It is a rare dental disease but represents a great restorative challenge for dentists. This clinical case report describes the oral rehabilitation of a young adult male patient diagnosed with hypoplastic amelogenesis imperfect, anodontia and decreased vertical dimension. This challenge was corrected by gingivectomy, gingivoplasty, by achieving the desired crown length keeping in view the biological width.
Fixed metal ceramic restorations were given to enhance the aesthetics, masticatory function, eliminate the teeth sensitivity and to enhance the overall personality of the patient.
Follow-up visits were scheduled at 3 months, 6 months and 1 year. No esthetic or functional problems were seen after the follow up period. The goal of the treatment was to achieve function, reduce sensitivity, protect enamel and improve esthetics.

Treatment
After radiographic examination of crown/root ratio, root number and morphology of the present teeth, construction of full-mouth metal reinforced porcelain xed bridge restoration was planned sparing the third molars.

Maxillary and mandibular complete-arch impressions were made using irreversible hydrocolloid (Zelgan, Alginate, Fast Set; Dentsply Intl ) impression material. Diagnostic casts were fabricated from Type- III dental stone (Pankaj Industries, Mumbai, India) and mounted on a semi-adjustable articulator (Articulator #3140; Whip Mix Corp) using a face-bow transfer (#8645 Quick Mount Face-Bow; Whip Mix Corp) and a centric relation record (Take 1 Bite; Kerr Corp, Orange, Calif) (Figure 4).
The articulator was programmed using protrusive and lateral records (Coprwax Bite Wafers; Heraeus Kulzer, South Bend, Ind). e diagnostic waxing was done. e interdisciplinary was followed because of the complex needs of the patient. e patient was informed of the diagnosis and the treatment plan, which he accepted.

57: Removable Partial Denture in a Cleft Lip and Palate Patient: A Case Report

Ayşe Meşe and Eylem Özdemir

Maxillary and mandibular complete-arch impressions were made using irreversible hydrocolloid impression material (Jeltrate, Alginate, Fast Set; Dentsply Intl, York, PA, U.S.A.). Diagnostic casts were fabricated from Type IV dental stone (Silky- Rock; Whip Mix Corp, Louisville, KY, U.S.A.) and mounted on a semi-adjustable articulator (Articulator #3140; Whip Mix Corp) using a face-bow transfer (#8645 Quick Mount Face-Bow; Whip Mix Corp) and a centric relation record (Take 1 Bite; Kerr Corp, Orange, CA, U.S.A.).
The articulator was programmed using protrusive and lateral records (Coprwax Bite Wafers; Heraeus Kulzer, South Bend, IN, U.S.A.). The occlusal scheme was developed through a diagnostic waxing.

58: Quantification of the Individual Characteristics of the Human Dentition 2010

L omas Johnson ,Marquete University, thomas.johnson@marque e.edu
omas W. Radmer,Marquete University, thomas.radmer@marque e.edu
Thomas S. Wirtz ,Marquete University
Nicholas M. Pajewski ,Medical College of Wisconsin
David E. Cadle
Published Version. Journal of Forensic Identi cation, Volume 59, No. 6, (2009:609-625. ©2010 International Association for Identification

A suitable material for registering the imprints of the teeth was necessary. There are several accurate dental materials available for the registration of the exemplars bearing the American Dental Association (ADA) Seal of Acceptance. The considerations for the selection for this project were accuracy of the material, simplicity of the technique, a product and technique already familiar to the research group, the ability to judge the depth of penetration, a material having superior contrast for scanning, minimal inconvenience and time for the volunteers, minimal preparation time, clean to use, and a manageable cost per unit because of the volume of material necessary to complete the study.
The registration material selected was CoprWax Bite Wafers (Heraeus Kulzer, Inc., NY). It is an ADA-accepted dental product for bite registration. The method of obtaining exemplars, scanning techniques, and data management has been previously reported [13].

Journal of Forensic Identification 612 / 59 (6), 2009

59: Assessment of the Effect of Two Occlusal Concepts for Implant-Supported Fixed Prostheses by Finite Element
Analysis in Patients With Bruxism 2014

Evrim Go ̈re, PhD* Gu ̈lu ̈mser Evliog ̆lu, Prof
Vol. XL/No. One/2014 Journal of Oral Implantolog

http://www.joionline.org/doi/pdf/
10.1563/AAID-JOI-D-11-00044

The aim of this study was to evaluate the effects of bruxing forces on implants configured under 2 different occlusal schemes by dynamic finite element analysis. A main model consisting of a 5-unit fixed partial denture supported by 3 implants was simulated with bone, implants, and superstructures. All calculations were made individually for each component, namely porcelain crowns, abutments, abutment screws, implants, and bone. Maximum stresses were found in the group-function occlusion. Group-function loading may result excess stresses on the components compared with canine-guidance loading.
According to the results of this study, use of canine guidance is encouraged in bruxers with implant-supported prostheses.

59: Use of Narrow-Diameter Implants in Treatment of Severely Atrophic Maxillary Anterior Region With Implant- Supported Fixed Restorations

Stuart J. Froum, DDS; Sang-Choon Cho, DDS; Salvatore Florio, DDS; and Craig M. Misch, DDS, MDS

https://dentatususa.com/
wp-content/ uploads/2016/
11/126_May_2016_Froum1.pdf
.

60: A Literature Review On The Performance Of Narrow- Diameter Implants For Long-Term Overdenture Applications In Maxillary And Mandibular Jaws

Conclusion
1. NDI systems have transitioned from being used as temporary support devices to long-term stabilization implants.
2. An abundance of long-term clinical data is available to document their utility and performance for overdenture applications in both jaws.
3. Clinical performance rates of NDIs are similar to those of standard-diameter implants.

http://www.biomet3i.com/
Resource% 20Center/Clinica
l%20Information/Performance
%20 Of%20Narrow%20Diame
ter%20Implants_ART1269.pdf
.

61: Clinical evaluation of Tiny® 2.5- and 3.0-mm narrow-diameter implants as de nitive implants in different clinical situations: a retrospective cohort study. 2010

Anitua E, Errazquin JM, de Pedro J, Barrio P, Begoña L, Orive G.
Eur J Oral Implantol. 2010;3:315-322.

62: Achieving Success With Small-Diameter Implants

Dentistry Today
Category: Prosthodontics Created: Thursday, 08 January 2015 20:16 Paresh B. Patel, DDS

CLOSING COMMENTS
With the use of guided surgery and SDIs, more patients can undergo implant surgery to achieve their desired goals to have teeth. SDIs, along with minimally invasive dentistry, are an ideal treatment solution to consider when standard-body implants are not feasible without additional procedures.

http://www.dentistrytoday.com/
articles/10017

63: A COMPARISON OF NARROW-PLATFORM (3.0-3.6mm) vs WIDER PLATFORM (3.7-6mm) DENTAL IMPLANTS

http://d-scholarship.pitt.edu/12260/
13/A_COMPARISON_OF_NARROW-
PLATFORM_%283.0-3.6mm% 29_vs_WIDER
_PLATFORM_%283.7-6mm%29_DENTAL_
IMPLANTS%28final%29.pdf

by Husain Alarfaj
BS, University of Pittsburgh, 2002 DMD, University of Pittsburgh, 2006
Submitted to the Graduate Faculty of the School of Dental Medicine in partial fulfillment of the requirements for the degree of Master of Dental Science
University of Pittsburgh
2012

CONCLUSION
This research presents clear evidence of the success of the narrow-diameter dental implants restoring posterior edentulous area in the maxilla and the mandible. The data is statistically significant. The rate of bone loss around the narrow-diameter dental implants is slightly higher than the rate of bone loss around regular/wide-diameter dental implants. This may or may not have a direct clinical impact. In other words, those values are statistically significant but clinically not significant. To confirm these preliminary findings and indications, further prospective future research is necessary.

64: The Small-Diameter Implant: A Valuable Treatment Option for Many Patients

Inclusive Magazine: Volume 7, Issue 2
article by Raymond Choi, DDS

CE Course:GlidewellLab

http://glidewelldental.com/
education/ on-demand-ce-
courses/the-small-diameter-
implant- a-valuable-treatment
-option-for-many-patients

65: New approach towards mini dental implants and small-diameter implants: an option for long-term prostheses.

http://www.sbdmj.com/
122/122-01.pdf

Alvydas Gleiznys, Gediminas Skirbutis, Ali Harb, Ingrida Barzdziukaite, Ieva Grinyte

"Implants with small diameters are one of the major advancements in dental history; they can be used successfully in a variety of clinic ..."

SUMMARY
Background. Mini dental implants (MDI) and small diameter implants (SDI) have been extensively used as temporary or orthodontic anchorage; however there have been studies that proved their availability as a mean for long term prosthodontics. Our aim was to review the indications, advantages of MDI and SDI, and their long-term survival. Methods. Computerized searches were conducted for clinical studies between year 2000 and 2011 that involved either implants with 3.3 mm diameter or less, used in prosthodontics; or provided a follow up of MDI or SDI duration of at least 4 months following implant placement including survival rate data. All studies about implants used in orthodontics were excluded. The range of available MDI and SDI has been found in cataloges of the companies: 3M ESPE IMTEC, Bicon Dental, Zimmer, Implant Direct, Intra lock, Hiossen, Simpler Implant, KAT Implants, OCO Biomedical, American Dental Implant. Results. 41 studies meeting the above criteria were selected, 22 out of them reviewed survival rates of MDI and SDI. The follow up duration varried from 4 months to 8 years with survival rates between 91.17 and 100%. Nevertheless, the companies showed a big variety of MDI and SDI provided in the market for long term prostheses.

Conclusions. Implants with small diameters can be used successfully in a variety of clini- cal situations. Less surgical time, less postoperative pain, ability of direct loading after surgery with no harm to bone and cost effectiveness are the advantages. The reduced surface implants require correct treatment planning so that the loading force would not cause bone loss or implant failure. MDI and SDI show high survival rates, but special cautions for bone quality and good oral hygiene should be maintained. Implants with small diameters are one of the major advancements in dental history; they can be used successfully in a variety of clinical situations. Researches continue to demonstrate the surgical and prosthodontic success of those implants. They offer patients satisfaction due to less surgical time, less postoperative pain and ability of direct loading after surgery with no harm to bone. Also they are more cost effective option, since they can support a denture with a reduced cost. It must be emphasized that the reduced surface implants require correct treatment planning so that the loading force would not cause bone loss or implant failure. Nevertheless, MDI and SDI showed high survival rates, but spe- cial cautions of bone quality and good oral hygiene should be maintained. Due to simplified procedures, this could be a good choice for unexperienced den- tists for their first steps in implantology.
Prosthet Dent 2005;94:377-81.

Key word

Stomatologija, Baltic Dental and Maxillofacial Journal, 2012, Vol. 14,No

66: Minimally invasive implant therapy in geriatric patients using small diameter implants

Drs. Paresh B. Patel and Andrea Mascolo explore the benefits of mini dental implants for senior patients

Implant practice Volume 4 Number
Article · September 2011
Conclusion
The demand for minimally invasive dentistry is growing from both clinicians and patients. This concept, applied to implantology, offers advantages intra-operatively, postoperatively, and during the healing process. It also offers considerable advantages to patients with systemic conditions. "Progressive treatment planning" is a new concept and incorporates the use of mini implants. This will allow the treatment of geriatric patients through progressive steps. When patients present with edentulous areas combined with a restoratively and functionally sound dentition, mini Figure 8: Mini implant bridge 1 month post-op implants are well suited to support both removable and fixed solutions. As time, function, and age continue their relentless effects on the oral cavity, additional mini implants can easily be placed to support a larger prosthesis when needed. The progressive treatment plan is founded on the demands of patients but takes into consideration the physical response to mini implants and the capacity to maintain oral hygiene. Mini implant-retained dentures offer functional advantages in chewing and stability. In geriatric patients, where manual skills are often reduced, having a removable appliance can allow for proper hygiene maintenance. However as this geriatric population ages,insertionandremovalofamulti- implant-supported prosthesis often is quite difficult ,due in most cases to lack of physical force required. At this point, a fixed solution may provide better function and better compliance in oral hygiene. This staggered approach of the progressive treatment plan allows patients to function properly, and gradually brings the patient, when possible and requested, to the ideal goal in prosthodontics: a xed solution.

Request article ADA

Narrow-Diameter versus Standard-Diameter Implants and Their Effect on the Need for Guided Bone Regeneration: A Virtual Three-Dimensional Study
• Dimitrios E.V. Papadimitriou DDS Research scholar1, Bernard Friedland BChD, MSc, JD Head2, Camille Gannam DDS DMD candidate3, Samira Salari MSc DMD candidate3 andGerman O. Gallucci DMD, Dr. Med. Dent. PhD Head1,*
Version of Record online: 6 JUN 2014
DOI: 10.1111/cid.12224
© 2014 Wiley Periodicals, Inc.
Issue
Clinical Implant Dentistry and Related Research

1. Norton MR. The history of dental implants. US Dentistry 24-26, 2006.
2. Arbree N. DENT 0312 Implant Dentistry Summer 2005. Chapter 1. TuftsOpenCourseware. http://ocw.tufts.edu. Accessed 04- .
8. Ivanoff CJ. Gröndahl K. Sennerby L. Bergström C. Lekholm U. Influence of variations in implant diameters: a 3- to 5-year retrospective clinical report. Int J Oral Maxillofac Implants 14(2):173-80, 1999.
9. Ahlqvist J. Borg K. Gunne J. Nilson H. Olsson M. Astrand P. Osseointegrated implants in edentulous jaws: a 2-year longitudinal study. Int J Oral Maxillofac Implants 5(2):155-63, 1990.
12. Vigolo P. Givani A. Majzoub Z. Cordioli G. Cemented versus screw-retained implant-supported single-tooth crowns: a 4-year prospective clinical study. Int J Oral Maxillofac Implants 19(2):260-265 2004.
13. Vigolo P. Givani A. Majzoub Z. Cordioli G. Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations: a 7-year retrospective study. Int J Oral Maxillofac Implants 19(5):703-709, 2004.
14. Pikner SS. Gröndahl K. Jemt T. Friberg B. Marginal bone loss at implants: A retrospective, long- term follow-up Brånemark System implants. Clin Implant Dent Relat Res 11(1):11-23, 2009.
17. Flanagan D. Fixed partial dentures and crowns supported by very small diameter dental implants in compromised sites. Implant Dentistry 17(2):182-91, 2008.
15. Laurell L. Lundgren D. Marginal Bone Level changes at dental implants after 5 years in function: a meta analysis, Laurell L and Lundgren D, Clin Implant Dent Relat Res. 2011 Mar;13(1):19-28.
16. Wennerberg A. Jemt T. Complications in partially edentulous implant patients: a 5-year retrospective follow-up study of 133 patients supplied with unilateral maxillary prostheses. Clin Implant Dent Relat Res 1(1):49-56, 1999.
18. Kinsel RP. Liss M. Retrospective analysis of 56 edentulous dental arches restored with 344 single-stage implants using an immediate loading fixed provisional protocol: statistical predictors of implant failure. Int J Oral Maxillofac Implants 22(5):823-30, 2007.
19. Degidi M. Piattelli A. Carinci F. Clinical outcome of narrow diameter implants: a retrospective study of 510 implants. J Periodontol 79(1):49-54, 2008.

1. Tooth implant supported Prosthesis: A Literature review 2013 REVIEW ARTICLE
Volume : 3 | Issue : 3 | Page : 143-150

Vidya Kamalaksh Shenoy1, Shobha J Rodrigue2, E Prashanti3, Sharon J. R. Saldanha2
1 Department of Prosthodontics, AJ Institute of Dental Sciences, Mangalore, Karnataka, India
2 Department of Prosthodontics, Manipal College of Dental Sciences, Mangalore, Karnataka, India
3 Department of Prosthodontics, Melaka Manipal Medical College, Melaka Manipal University, Karnataka, India

http://www.jidonline.com/
article.asp?i ssn=2229-94;
year=2013;volume=3;issue
=3;spage=143;epage=150;
aulast=Shenoy

1. Tooth-to- implant connection: A systematic review of the literature and a case report utilizing a new connection design. Clin Implant Dent Relat Res 2010;12:122-33
Chee WW, Mordohai N.
CONCLUSION: Totally implant-supported prostheses should be the treatment of choice. However, there are cases where combining teeth and implants is inevitable. The authors propose a rationale design of connecting implants and teeth. This design minimizes the biologic and technical complications.