Dr. Aldo De Blasi, Italy
Conventional mini implant surgery in the edentulous mandible is in most cases, a very quick and minimal invasive procedure. The implants are usually placed trans gingivally and if initial primary stability is achieved then they can be loaded immediately following the surgery.
Dr. Alexandre Minis, France
Case description
68-year-old man, fully edentulous, smoking patient, lack of medical history.
Surgical dental history:
– maxillary rehabilitation by full implant-supported bridge
– failure of 2 mandibular implant surgeries
What are mini implants?
Mini implants are in all respects implants, but with a small diameter, not exceeding 3 mm.
They are produced in a titanium alloy, which is classified as grade 5, and has excellent mechanical properties. They have a sandblasted and etched surface which once inserted into the bone undergoes osseointegration such of that of implants with a larger diameter.
In times of skilled labor bottlenecks and a fundamental lack of staff, the first thing that many lose is the services that were once seen as so essential. But the more a piece of hardware is interchangeable and discount battles want to be avoided, the more a company stands out from the customer with the many free little help.
Interview with dentist Michael Weiland and his team
pip: How did your first contact with the implant manufacturer C-Tech and Mr. Lütfü Agic come about?
Michael Weiland: I’ve known Mr. Agic for a very long time, for more than ten years, from my time in practice. Four years ago I set up my own practice, but at first I had too much to do with getting the practice up and running. At the same time, a lot was happening within our family – as it is at our age, that often happens alltogether. That’s why I didn’t deal with implantology myself at first and only provided prosthetics at first. Nevertheless, contact with Mr. Agic was never lost, especially since my basic interest continued to exist. Mr. Agic then drew my attention to the further training here at the municipal clinic with Prof. Anton Dunsche.
pip: What is particularly important to you at a training event?
Michael Weiland: Everyone is always talking about ‘take home messages’, and that’s actually what it’s all about. I would like to learn something that I can use in my practice in the relatively short term. In addition to the theory, which you can read up on or acquire through an online event, it is important to me to have the opportunity to try out and practice techniques yourself, preferably with someone at your side who can immediately give you one or two good ones can show tricks and tips. It’s about getting more security for me in my practice. The first course with Prof. Dunsche was just super organized, we learned theory, but also a lot of practice with exercises on the pig’s jaw and later the opportunity to assist Prof. Dunsche himself with surgeries.
pip: So it didn’t stop at this event?
Michael Weiland: No, after that I was given the opportunity to attend a four-day course in Palermo, Italy. They do things slightly differently there, with personal warmth and beautiful surroundings. Everything was very well organized, we even got two translators at our side, so there were no problems here either. For two days we were introduced to the C-Tech system and various surgical techniques, and we were able to use the third and fourth day very intensively for practical exercises and treatments directly on the patient. The two very experienced speakers also supervised this part and took over more complex situations myself, which I might never want to do myself in my practice, but which were exciting to watch. But I also learned an enormous number of new techniques for my areas of application and was able to practice them in such a way that I now feel safe with them. After all, I want to offer my patients the ‘state of the art’ of today’s implantology.
pip: How important is the support provided by Mr. Agic to you?
Michael Weiland: We work directly with and on people, and I personally prefer it if I too am seen as a person. Mr. Agic has never promised too much, is always available and implements my requests incredibly quickly, even if I reach him on the way. I receive all important information promptly and in Mr. Agic I have a good partner for the exchange of ideas, at the same time I never feel pressured. I sometimes think that my time is more important to Mr. Agic than his own, and I can feel that through this great service.
Abstract
Mini implants are a valid alternative to traditional implants to stabilize the rehabilitation of edentulous arches. Patients with full arch prostheses can benefit from this technique which, with a minimally invasive approach, allows to stabilize them with a single operation even in anatomically unfavorable bone conditions. The advantages include a reduced post-operative symptomatology, low-cost therapy and the possibility of using the pre-existing prosthesis. The aim of the seminar is to examine a convenient therapeutic solution, to learn a simple and minimally invasive implant technique and, through the selection of the patient candidate for rehabilitation with mini implants, to discover a new tool for the stabilization of the total prosthesis.
Read the full article on Dental Tribune Magazine
Click here to access the webinar (Italian language)
To access the webinar, you need to register at the following link.
Content of the webinar
This presentation describes the use of mini implants as an anchoring device for a full prosthesis in order to provide greater stability and retention. A simple, fast, convenient and low invasiveness technique is shown, which allows to obtain in a single appointment an effective stabilization of the patient’s removable denture. Where the removable prosthesis is the therapeutic solution to the problem of edentulism, the mini implants can provide additional comfort and well-being. Finally, through the exposure of some clinical cases, the use of these implants with a reduced diameter is shown, it is explained how to select the ideal patient and how to plan the clinical case.
Educational objectives
• Learn a simple and minimally invasive implant technique
• Examin a convenient rehabilitation solution
• Discover a new tool for patient rehabilitation.
Full Smile, under the direction of business owner Lütfü Agic, well-known in the field of dental implantology, advises on a high-quality range with C-Tech system implants, biomaterials such as Bioteck, as well as dental and surgical instruments and tools from devemed. How can such a small unit survive in times of ever greater global players in the field of dentistry and what is the reason for a dentist to look for the partnership, asked pip and talked to Stefan Grümer, M.Sc., who runs together with colleagues a large referral practice on Theaterstrasse in Aachen.
pip: Don’t you kind of lose touch with international developments and trends with such a small partner like Full Smile?
Dr. Grümer: That may well be, regarding these international trends. Here, in the Theaterstraße in Aachen, we are a practice with an impressive range of modern services, especially in the field of restorative and aesthetic dentistry. From 3D diagnostics and computer-based functional diagnostics to laser dentistry, we use state-of-the-art and exceptionally gentle treatment methods that are comfortable for the patient. We are focusing strongly on training programs so that our range of services stays up to date with the latest state of science and research. But we do not have to follow any pseudo innovation. Much more important to us is a certain consistency with our commercial partners, because as well as between us and our patients, the cooperation between us and a medical device manufacturer is a matter of trust. It would bother me to have to adjust to a new contact person every few months, who knows neither me nor my treatment philosophy nor knows what my experiences are and what might actually enrich and interest me. Since 2013 I have been running the first university teaching practice in Germany in cooperation with the RWTH Aachen, an international academy with many foreign and extensive research projects – above all in the field of implantology and laser dentistry. Therefore, we are demanding a certain level of consulting expertise and a portfolio at eye level from our partners.
pip: What impressed you most about the C-Tech Implant System?
Dr. Grümer: As a referral practice we naturally work with different systems. Personally, I especially appreciate the C-Tech Implant System because of its system-related features. It is a fully engineered system that provides different implant diameters and lengths for all common indications – up to special designs such as one-piece mini-implants for narrow spaces, abutments or anchoring of dentures. At C-Tech we experience a very high primary stability and a very easy handling and thus a method which is absolutely suitable for everyday use. Furthermore, the aesthetic demands of our patients have increased significantly. With the EL – Esthetic Line – C-Tech offers a special design for these more demanding challenges. Refinements, like the platform switch, a generous apical threading, the morse taper connection and the concave aesthetic concept create a good stability with excellent shaping of the surrounding tissue. Despite a high prosthetic design freedom, the system is very easy to use, but the prosthetic connection is identical to the other implant diameters of the series. So you can get by with a straightforward instrumentation. I also like a whole new service of Full Smile, which I have never experienced before: As a dentist, I can search for any product via Full Smile and, if I found one, I will only pay the same list price as in the catalogue!
pip: What about service and accessibility – how can such a small company compete with companies that are quite different staffed?
Dr. Grümer: In fact, we sometimes ask ourselves the famous question of how often Mr. Agic has been cloned. He’s really frequently on the move and also visits us regularly to exchange ideas with us or to prepare ourselves for a new technique. However, we always reach someone in the office or receive a callback within a very short time – and also in such a short time our request is accepted, a delivery is initiated or a technical question is answered. In fact, with other companies I sometimes spent a lot more time in some telephone loop with automated speech before I can speak to a human being. With individual consultation, the reliable assurance of the desired delivery times and practical training, Full Smile is a professional partner for us in the field of dental implantology, periodontology and surgery.
We present you a Surgical Clinical Case with Flapless Technique performed by Doctor Aldo De Blasi using SD Mini Implants. You will be able to observe all the steps necessary for the stabilization of the lower prosthesis in the interforaminal region.
When visiting the impressive manufacturing facility, with 25 CNC machines alone, you will also come across the “Mercedes” of manufacturing technology such as the Swiss Tornos, a five-axis machine, which at C-Tech is purely tasked with the manufacture of mini-implants. Currently they are the largest manufacturer in Europe for this specific type of implant. Mini-implants are popular as a minimally-invasive option for creating an immediate restoration, which is currently a highly sought-after alternative for fast and good functional care of older patients. An impressive neighbour is the Willemin Macodell (the Rolls-Royce of CNC machines), which can be fitted with 48 different CNC cutters. It can change tools in 1.4 seconds and can be used in any conceivable axis, including for the manufacture of angled mini-abutments. C-Tech was one of the first companies to move over to cooling all computer-controlled machine tools using water-miscible bio-lubricants. The plant-based oil is odour-free, improves machining and even has a wider range of applications than mineral oil products. “And even though of course we run extensive cleaning processes for the finished parts, it’s still one risk factor less”, comments Lütfü Agic with respect to the recently published independent surface study by the University of Cologne, where the C-Tech implant surfaces were tested as an example, in testing applied to very few dental implant surfaces on the dental market.
Der klinische Erfolg von Mini-Implantaten hängt von verschiedenen Parametern ab, die auch untereinander in Beziehung stehen. In der vorliegenden Studie wurde untersucht, ob eine Korrelation zwischen dem Durchmesser der inserierten Implantate und der Primärstabilität existiert. Dabei wurden zudem unterschiedliche, durch den jeweiligen Patientenfall vorgegebene Knochendichten berücksichtigt. Außerdem erfolgte eine Dokumentation der Osseointegration und der Tiefe etwaiger perioimplantärer Taschen über einen Zeitraum von einem Jahr post implantationem. Darüber hinaus wurden der Einfluss des Implantatdurchmessers und der Art des Implantataufbaus auf die Erfolgsrate ermittelt.
Aufgrund der im Rahmen der vorliegenden Untersuchung ermittelten Ergebnisse darf bei einer Verwendung von Mini-Implantaten zur Prothesenstabilisierung mit einer Erfolgsrate ähnlich wie bei klassischen Implantationen gerechnet werden. Da der Erfolg mit der Primärstabilität korreliert, lässt er sich nach deren Bestimmung mit der Drehmomentratsche direkt im Anschluss an die Insertion bereits gut abschätzen. Liegen die ermittelten Zahlen im grenzwertigen Bereich (≈ 35 Ncm), so sollte im Zweifelsfalle eine weiche Unterfütterung vorgenommen werden. Je nach individuellem Fall ist auch zu prüfen, ob zur besseren Stabilisierung ein weiteres Mini-Implantat inseriert werden kann. Hat man die Wahl, so sollte eher ein etwas größeres gewählt werden, d.h. statt des 1,8-mm-Implantats lieber das 2,1er bzw. statt des 2,4-mm-Implantats lieber das MDI Hybrid mit 2,9 mm Durchmesser.
Es versteht sich von selbst, dass eng beieinander liegende Recall-Termine angeraten sind, insbesondere um die planmäßige Osseointegration zeitnah verfolgen zu können. Sie ist keinesfalls nach sechs Monaten abgeschlossen, sondern erfährt in den darauffolgenden sechs Monaten in der Regel noch einmal eine signifikante Verbesserung.
1990 Studium der Zahnmedizin (Universität für Medizin und Pharmazie „Victor Babes“ Temeschburg).
1990-1993 Oralchirurgische Weiterbildung an der Akademie für Zahnärztliche Fortbildung Karlsruhe.
1995 Training in Goldman School of Dental Implantology/Boston, Massachussets.
1998 Spezialist DGZI.
2004 Expert Implantologie der DGOI.
2006-2007 Spezialisierung „Dento-alveoläre Chirurgie“ Dr. medic.stom. Henriette Lerner (Universität „Carol Davila“ Bukarest).
2006 Praxis im Videnti Zentrum für Implantologie und Ästhetik, Baden Baden.
Mitglied in: DGOI; ICOI; EAO; ASA DGÄZ; DGZMK; BDO; EFOSS.
Nationale und Internationale Referententätigkeit über Ästhetik in der Implantologie, Minimal Invasive Implantology, Curriculum Implantologie, fortgeschrittene Augmentationstechniken.
Evaluation of some morphological oral aspects perceived as decision factors in complete edentulism treatment by mini-implants overdenture. Patients, Material and Methods: An observational study was conducted on a sample of 24 patients (average age of 61 years), through clinical and imagistic methods. The variables taken into consideration were: age, gender, alveolar mucosa status, bone offer, miniimplants characteristics, insertion torque and loading type. Results: 117 mini-implants were applied. Conclusions: Mini-implant supported overdenture can be an alternative to conventional denture and conventional implant overdenture. Its advantages derives from implants’ characteristics (smaller diameter, variable length, O-ring retention system), which adapts better to the particular edentulous conditions. Insertion technique implies less surgical trauma. Choosing implants’ size, number, topography, and the loading method have a great variety, depending on anatomical feature (bone offer, mucosa and relationship with the nearby anatomical structures), functional features and patients’ wishes.
Mini-dental implant supported overdenture can be in complete edentulous patients a treatment alternative to both conventional dentures and conventional implant retained overdenture.
The advantages of this type of treatment derives from the characteristics of this type of implant (small diameter, variable length, O-ring retention system), which adapts better to the particular morphological conditions present in full edentulous patients. Also, the implants insertion requires less surgical trauma, this being a beneficial aspect in the context of usually poor general status.
Proceeding and achieving the treatment requires needs careful evaluation through clinical, imagistic and laboratory methods. Frequently there are identified some unfavorable conditions for implant insertion and a high degree of treatment difficulty. These issues (morphological and functional features, related to general health status, age, gender, etc.) must be linked to implants characteristics, in order to decide the particular treatment features, from surgical and prosthetic point of view. The length, diameter, number, topography, loading method of implants can present a large variety, depending on quantitative bone offer (ridge width and bone height), quality (bone density), functional features and patient’s wishes.
This type of treatment has a lower cost compared to conventional implant supported overdenture, by the lower cost of mini-implants, and also due to the use, in general, just of the panoramic radiography as imagistic method (computed tomography is an adjuvant method, but not essential in most cases). Also by eliminating some surgical intervention, we eliminate also their costs. On the other hand, the benefits related to an improved stability, better functionality and adaptation are quickly noticed by the patient and increases their level of satisfaction.
Due to the relatively simple technique, less traumatic, but with benefits that are quickly perceived, the mini-implant supported overdenture may be the elective treatment alternative for complete edentulous patients.
[3] MELESCANU M, PREOTEASA E, Mandibular panoramic indexes predictors of skeletal osteoporosis for implant therapy, Curr Health Sci J, 2009, 35(4):291–296.
[7] ***, IMTEC Corporation official website, retrieved December 13, 2009, http://www.imtec.com/europe/.
[13] ORDOÑEZ A, EASTMOND V, Mini-dental implants – they’re here to stay, Postgraduate Dentist Caribbean, 3(1):7–12.
Complete dentures are most frequently a challenge for practitioners. The complexity of this disease is often associated with general health problems, but also with the physiological ageing phenomenon, that increases the treatment difficulty. Completely edentulous patients, usually elderly, often complain about the functionality of conventional dentures, especially the mandibular ones, claiming their instability, poor retention and discomfort during wear. Complete maxillary and mandibular dentures have been for over 100 years the standard treatment of complete edentulism. If complete maxillary denture wearers tolerate better the complete dentures, given the better conditions for support, retention and stability, the tolerance of mandibular prosthesis is generally lower. The relatively frequent instability of the mandibular denture, poor retention and associated discomfort were the starting point for the idea of setting the overdenture on 2 implants as first treatment alternative for the mandibular complete edentulism (according to McGill and York consensus) [2, 3, 4].
Implant overdentures are inspired, as treatment concept, from the of the overdentures, the dental implants being used instead of tooth roots. Dental implants that are used for implant overdentures are made of high-strength alloy (TiAl-V), with good biocompatibility, with different designs and sizes that aim to address the prosthetic needs according to the oral particularities and clinical limitations of its execution. The first implants that were introduced in the dental practice were the ones with standard diameter, around 3.75mm. Later on, their diameter was increased and decreased (narrow), ranging between 3 and 6mm. Afterwards, the mini implants with one-piece design for implant overdentures appeared (IMTEC, later 3MESPE), with diameters of 1.8mm, 2.1mm and 2.4mm. Narrow Diameter Implant Overdenture (NDIO) represents a category of implants that combines features from conventional implants and mini implants, with diameters between 3 and 3.5mm and variable lengths (10-18mm), comprising two distinctive subgroups, namely two-piece design (e.g. Seven Narrow Line implants, MIS Implants Technologies Inc. 18-00 Fair Lawn Ave. Fair Lawn, NJ 07410, UNITED STATES, mini Sky 2, Bredent Medical GmbH & Co, Germany, Straumann implant, Straumann Group SIX: STMN, Basel Switzerland) and one-piece design (e.g. uno line, MIS implants). Two-piece narrow implants can be used as the conventional implants (with delayed loading), or as one-piece mini implants (with immediate loading protocol). In relation to anatomical, functional and prosthetic case particularities, the number of dental implants used can be reduced, similar to that of the conventional implants (e.g., two narrow implants for the mandibular overdenture). Mini Dental Implant Overdentures (MDIO) use mostly-one piece dental implants (miniSky1, Bredent, MDI 3MESPE) with diameters between 1,8mm and 3mm and variable lengths (10mm-18mm), that require one-stage surgery for implant placement, followed by prosthesis application in the same appointment, with soft material in the housing area (progressive loading) or fixation of the matrices in the denture base (immediate loading). Within the mini implants, those with a diameter between 2.7 and 3mm are classified as hybrid implants, these having sometimes a two-piece design and can be used as narrow dental implants (e.g., two narrow implants for the mandibular overdenture). The main features of the overdentures on dental implants with a diameter below the conventional one, considering their three main categories according to their diameter, are synthesized in table 1. The decision to use either a CDIO, NDIO or MDIO as treatment for complete edentulism, starts from the acknowledgment of patient’s preferences and expectations, within the limitations of the systemic and oral health-status. In systemic alterations with indications of limited surgery or that negatively affects the healing process, NDIO and MDIO are more indicated than CDIO, due to their reduced invasiveness. Oral particularities, such as the anatomical conditions (bone quality and quantity, the shape of the alveolar ridge, skeletal class), thickness and health of the oral mucosa (e.g., denture stomatitis, candidiasis), available prosthetic restorative space (especially as vertical dimension, given the necessary space for abutment, attachments and prosthesis thickness, in order to prevent its fracture) should all be considered when choosing between the implant prosthesis alternatives.
Stabilization of conventional denture with mini- or narrow-dental implants is beneficial especially for the elderly, considering the improvement achieved through a relatively easy surgical intervention, with moderate treatment costs. In this regard, for mandibular denture stabilization either 4 mini implants or 2 hybrid/narrow implants can be used. Treatment success is strongly related to acknowledgement of patient anatomical and functional particularities, rigorous planning and execution of prosthetic and surgical phase, as well as ensuring an adequate maintenance. Considering that edentulism is and most probably will continue to remain a frequent medical condition mostly found in the elderly, MDIO and NDIO overdentures, through their specific parameters, may replace in time complete dentures and may be the most used treatment alternative.
[1] WHO. Active Aging. A Policy Framework. Madrid; 2002. http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf?ua=1 (accessed 3 October 2014).
[19] Misch CE. Contemporary Implant Dentistry 2nd edition. St. Louis: Mosby Inc; 1999.
[20] Rossein KD. Alternative treatment plans: implant supported mandibular dentures. Inside Dentistry 2006; 2(6) 42-43.
The highest target in our profession is the fulfilment of patient wishes. The greatest wish of our patient is always the fast, painless replacement of their missing teeth or stabilisation of the prosthesis. A fast, stable and esthetic reconstruction of the patient’s dento-facial system is the main goal of every dentist.
At the time, immediate loading was not an issue, the mini implants were used for the stabilisation of a provisional construction for the time necessary for the osseointegration of the conventional implants. Those mini implants were 1.8mm to 3.3mm in diameter. This implant was also developed with a small ball on the top of it that could be incorporated as a snap for a denture, or to secure a temporary bridge. To uncover the standard implants, it was found that around 50% of the mini implants had actually integrated or bonded to the bone. In order to increase the rate of success, the implant design was improved in to follow the rules of osseointegration and the insertion protocol was changed to give the implants the primary stability necessary for immediate occlusal loading.
The general indication for the placement of narrow diameter implants,ridges which, through resorption, become inadequate for placement of standard diameter implants: buco-lingually <5mm, mesiodistally <5mm or both.
The absolute indication will be completed in these cases where the patient does not want an augmentative bone reconstruction or is not indicated from the medical point of view.
a) Edentulous arches The indication for the lower jaw is a 1.8-2.1mm diameter implant. For the insertion of an implant with a diameter of 1.8-2.1mm we need 10mm bone height and 3mm bone width. For the upper jaw the recommended implant is 2.4mm diameter. 4mm bone width and 10mm bone height will be needed.
b) Single tooth restoration The second indication is the insertion of a mini implant in a small gap, in order to replace a front tooth or a premolar, in situations where the standard diameter implant is contraindicated or not possible. A small gap of mesio distal dimension of 5 mm can be replaced with an implant of 2.4mm and a crown if the esthetical considerations will be adequate.
[3] Todd Shatkin, Samuel Schatkin, Benjmin D Openheimer, Adam J Openheimer (2007). Mini Dental Implants for Long-Term Fixed and Removable Prosthetics: A Retrospective Analysis of 2514 Implants Placed Over a FiveYear Period. Compendium 28 (2): 36-41
[13] Sendax VI (1995). Mini implants strategy offers a broad range of uses. Dent Today 14(1): 227–232
[21] Misch CE (1993). Patient force factors. In: CE Misch, ed. Contemporary Implant Dentistry. St. Louis, MO: CV Mosby
[23] Branemark PL (1983). Osseointegration and its experimental background. J Prosthet Dent 50(3):399–410
A 55 year old female patient was referred to our office for a full mouth rehabilitation. Upon clinical examination and a CBCT, we have decided to implant 4 EL C-Tech conical Morse tapered connection implants in the upper jaw for a bar retained over denture and due to financial considerations; was to perform extraction of all remaining lower teeth and immediate post extraction implantation of SD C-Tech mini dental implants. A full muco-periosteal flap was released, teeth were extracted, an alveotomy was performed to achieve an optimal bone platform for the SD mini dental implants and to obtain a bigger vertical dimension for the overdenture!
A 58 years old female patient has come to our clinic for lower jaw rehabilitation. After the clinical examination and OPG, We have decided to extract tooth 33, which is the only one remaining. As thepatient has not accepted a big augmentation procedure, we have decided to implant 4 C-Tech SD mini dental implants for retention and stabilization of the lower denture.
Why should you read this article?
This case report is a guide, how mini-implants can be used as strategic abutments for the stabilization of removable partial dentures and for the support of the remaining teeth.
Introduction: The use of conventional dental implants as strategic abutments for existing removable partial dentures is expensive and requires a sufficient alveolar ridge width. The one-piece mini dental implants (< 2.8 mm) provide an alternative treatment option for this indication. Treatment method: A therapy scheme for strategic mini dental implants (MDI, 3M ESPE Dental GmbH, Seefeld, Germany) includes 3 abutments (teeth + implants) per maxillary quadrant and 2 abutments per mandibular quadrant.
Results: In the first case report, a female patient lost one of her 2 mandibular canine conical crown abutments. Subsequently, 2 mini dental implants were inserted with sufficient primary stability (insertion torque > 35 Ncm) and were immediately loaded with the matrices by using intraoral polymerisation.
The second female patient had 2 remaining molars. After the placement of 4 MDIs (insertion torque 20–25 Ncm), the removable partial denture, which is retained by conical crowns, was relined using a soft material. Four months later, the matrices were polymerized into the denture in the dental laboratory across impression.
Conclusion: Supplementary strategic abutments using mini dental implants requires following the recommendations for the number and location of MDIs, load approach, anatomical knowledge, surgical experience especially in dealing with the jawbone, and sufficient prosthetic experience.
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