Having done thousands of mini dental implants more and more of my patients are now asking why they can’t have fixed crowns or fixed teeth with dental bridges. Well no real reason if they have enough bone to place a few more mini dental implants.
He had enough bone to add in a few more mini implants so we set out to duplicate what he liked about his denture in a fixed porcelain roundhouse bridge.
I took the existing denture that my patient liked the way it looked and made a copy of it in lab putty. From that Evolution Dental Lab was able to make a exact copy of the denture but out of porcelain and pink porcelain for the gum tissue.
Final full upper roundhouse bridge that will be supported by mini dental implants.
Day of cementation of the fixed full bridge upper roundhouse. The design is the same as if the bridge was made on traditional size implants. The patient will brush, floss or water pick to keep the gums clean.
Paresh B Patel DDS
Our next patient was missing one of his front teeth….well actually he is missing a few of his teeth. However our plan is to replace these missing upper teeth with mini dental implants and crowns a few at a time as he can afford to do so.
He has an upper plastic partial denture plate. We will remove the plastic denture teeth as the crowns and mini dental implants are added.
Mini Dental Implants in place ready for impression to send to First Impressions Dental Lab for Porcelain Crowns.
Mini Dental Implants Day of Placement…..notice no gum incision or bleeding in area of placement. Minimal surgery for faster healing and less patient discomfort.
Paresh B Patel DDS Mini Dental Implants
It seems here lately we have had a lot of patients come in that are unhappy, frustrated and just don't like their partial dentures. They specifically want to just get rid of it and replace it with some mini dental implants and a set of porcelain crowns or porcelain bridges.
Photo of my patients existing upper partial denture that replaces most of her upper front teeth. I did not think it looked all that bad for being 7 years old….she just did not like it. The way it kept her from tasting her food, the way she talked with it, the bulk of metal as she put it on the roof of her mouth. She also did not like the lower but wanted to start with replacing the top partial plate with mini dental implants and a bridge.
Like most patients that seem to find me…she had what looked at initial glance good bone. However on the x-ray it was mostly tissue. It had just been too long since the teeth had been extracted and the bone had just melted away. Without roots the body over time just starts taking away the bone. If an ill fitting partial sits and rubs on the bone year after year it accelerates the process of bone resorption.
So we went over the options as usual of traditional implants and some bone augmentation or I could use what bone she had, place at least 6 minis and make her a 8 tooth bridge to replace her missing teeth.
I used her existing upper partial denture plate as a guide on where I could place the mini dental implants. I drilled a hole in the center of each tooth, placed in back in her mouth and with a marking stick located the ideal place for the mini implant.
Of course in her mouth most of the 'ideal' locations had less than ideal bone.
Photo of 6 mini dental implants placed day of. You can see 2 areas where we tried to get the last 2 mini dental implants in but found poor bone. These areas will just fill back in with gum tissue.
A impression was taken of the mini dental implants and off to First Impressions Dental Lab for them to make the 8 tooth porcelain bridge. In three weeks her mini dental implant bridge will be back and I will post the photos.
Paresh B Patel DDS mini dental implant dentist
Clinical photo of the broken lower front tooth….it was broken below the level of the gum tissue.
So I decided to extract the root tip for him with some peritomes to save as much bone on the lip side as possible to hold our ????? You guessed it, a mini dental implant.
Picture of extracted root tip and the Intra Lock MILO 3.0 x 15mm mini dental implant in the socket where the root was.
Picture of the mini dental implant 'snap' in place over the o-ball. This is what will fit inside his partial denture to hold this side of the lower partial.
Picture of the impression metal cap fitted over the mini dental implant. This will be picked up in our impression so the lab can place a replica of the implant before the pour the stone model. Once that is done they can process the 'snap' under the replacement denture tooth.
Impression of mini dental implant and partial to be sent to First Impressions Dental Lab to add a snap and a tooth.
Final x-ray of mini dental implant in place where the root tip was…day of placement.
Our goal is to add a few more mini dental implants over time and then get rid of his lower partial denture for either a full set of fixed crowns or a secure lower denture. At the end of the procedure our patient commented on how quick and painless the entire process had been. It nice that such new products exist for us as dentists to offer such a non invasive, non surgical approach to dental implants.
Paresh B Patel DDS mini dental implants
Another good use for mini dental implants is when we have a failing bridge or a tooth that has had a failing root canal treatment. Our next case is a patient that came to see us after having pain with her temporary bridge. Her old bridge she told me was wobbling around and her dentist told her the post was weak and he needed to make the bridge longer…..only if we had met sooner that might not have been what she had chose to do. G8PBAUAAQB92
We can see on this x-ray (this is the x-ray she brought from her previous dentist before he removed the bridge and made it one tooth longer)the decay under the post that continues down the root on the tooth that has had the root canal treatment. The root canal tooth was very mobile (as in when I took the bridge off to assess the teeth I could move the root in the bone.
We covered all the options with the patient from a new bridge(her previous dentist has already made the decision to make a longer bridge for her that went to the canine tooth in front of the root canal tooth). I told her I thought it would not be a good idea to keep the root canal tooth since is was already mobile.
We talked about 2 traditional implants, or a few minis and single crowns on her natural teeth.
She decided to let me extract the Root canal tooth. There was enough destruction of bone on the cheek side that I explained to her that I would place some socket preservation material (a freezed dried mixture of bone) in the hole where the root was to help her body fill in that hole with good live bone so we could come back in 12 weeks and place a mini dental implant.
Here we have the socket preservation material in the extraction site. Its easy to see how plump the ridge looks. It will stay that way without caving in and will give us lots of good bone to put a mini dental implant.
2 Mini Dental Implants in place to hold a molar size crown. The mini dental implants will be shaped to allow room for her teeth to come together. We will place a Porcelain crown over the mini dental implants.
I will continue the post with the pictures of the crowns when we get the final mini dental implant in place and the crowns back from the lab.
Paresh B Patel DDS mini dental implants
Mini Dental Implants were originally used to Secure lower dentures….but they can be used for much more. From replacing a single missing tooth to replacing several missing teeth to a full arch of missing teeth with a fixed porcelain bridge.
Mini Implants ranging in size from 1.8mm~2.0~2.3mm~2.5mm~up to 2.9mm. Anything over 3.0mm gets in my mind into the traditional implant range. Some people will state that 3.25mm is the cutoff for a conventional implant to secure a 2 piece abutment system.
To Secure a lower set of crowns on our next patient we used traditional implants to do the All on 5 concept.
Post Implant Pan x-ray with 5 implants in place that will Secure the lower fixed porcelain crowns
Clinical photo day of surgery…full flap was made to find both mental nerve bundles. The lower ridge had to be surgically made wider to accomodate a larger traditional size implant. You can see from the photo the level of surgical skill needed to due such surgery. It is quite different than placing a mini dental implant. It takes a very talented dentist to do this kind of surgery on a daily basis. I commend and compliment any dentist that takes the time to offer this kind of implant dentistry. Although I did this case and several more; I question myself each time….could I have offered a different solution that would not have required so much from my patient?
The mini dental implant solution to Secure a lower set of crowns would be 8-12 of them. With that much surface area the minis have the ability to absorb the force of chewing and can equally distribue that force over the entire lower jaw.
This case illustrates how we can Secure with Mini Dental Implants a lower set of Porcelain crowns. As you can see from x-ray there would have not been room for a larger traditional implant without additional surgery. That surgery would have been to flatten the ridge of bone or to lay a full flap similar to the prior picture and expand the bone. Both would increase the cost to the patient….in terms of $$ and healing. I have done this same concept on the upper arch as well to replace a denture plate with fixed crowns.
To review, Mini Dental Implants do not replace the need for Conventional or Regular Implants….they just offer the patient another choice in their dental treatment. Technology has made it possible to make a smaller implant out of the same dental alloy with the same surface coating as a larger implant at a reduced cost. With this we now as Dentists should offer our patients ALL the choices from doing nothing and letting millions of patients suffer with missing teeth, to traditional implants that have the longest track history of success to mini dental implants that have over 15 years of success.
Paresh B Patel DDS Secure Mini Dental Implants
This is actually a case that was done last year. My patient came in for his 6 month cleaning about 6 months late…. Not what I like for patients to do. But he was certainly not the ideal patient and I explained that to him prior to committing my time, energy and mini implants to the case. He is a heavy smoker (around 2 packs a day). A big NO NO for traditional implants or any kind of implants in general. But I told him if I could get the mini's in without having to flap his gum away from the bone the implants would have a better chance of healing. He had seen another dentist about traditional or conventional implants but could not move forward with treatment due to the cost. A familiar story. I told him we could offer another choice…the mini implant choice. Not the same solution but a different solution that might work for him. He had a upper partial to replace his missing 6 front teeth. He had an accident over 10 years ago and had been wearing a cast metal partial that he did not like. His big complaint was the metal hooks and just the bulk of it. He did not really have a complaint on the way his front teeth looked on the partial plate.
6 Mini Dental Implants in place in the upper jaw…day of placement. Note the lack of bleeding. No flap had to be made to insert the mini implants into the gum and bone on the upper.
Upper Partial Denture modified to fit over the 6 mini dental implants that were placed in the upper jaw. This way he would be able to wear the upper partial while the dental lab made his crowns/bridge.
6 crowns with pink porcelain to simulate gum tissue on the stone model from First Impressions Dental Lab
Retracted cheek view of his 6 crowns on six mini dental implants…1 year post placement. Notice all the smoking stain on his lower natural teeth.
Close up view of Crowns
Bite view of the 6 crowns on mini dental implants.
Overall I am happy. I know he is happy. I think his comment was, 'Doc now that I got my show teeth do I really need to get the rest of them fixed?' How do you answer that question as a Dentist?
Now if I could just get him to quit smoking, come in when he is required to for his cleanings and move forward with fixing the rest of his teeth….. But as they say, Rome was not built in a day so we move forward one MINI step at a time.
Paresh Patel DDS mini dental implants
Mini Dental Implants have a wide variety of uses. I find more and more uses for this as a General Dentist. I think in a matter of time mini implant dentistry will become everyday dentistry. As routine as getting a filling.
Mini Dental Implants in the lower jaw. With 4 mini implants in place you can secure a lower denture. Even with a thin ridge most of the time these can be placed without cutting the gum. If the gum is not cut then no blood supply to the bone is disrupted. The bone heals faster around the mini implants allowing the patient to function with a implant retained denture immediately.
Mini Dental implants in the upper jaw. The upper jaw bone is softer and not as dense as the lower jaw. With 6 mini implants in place you can secure an upper denture. With a good well made denture that covers the hard bone at the very end of the upper arch (maxillary tuberosity) you can remove the middle of the denture. Most patients appreciate the palate of the denture being removed. With this horseshoe shape design patients can taste food better, have better speech, decrease in gagging and less bulk of plastic. With more implants sometimes it is hard for patients to 'line up' all the o-balls and housings in the denture. What I would like as a dentist is if someone would make a Zest Locator mini dental implant. The Zest Locator is the 'gold standard' in attachments for the traditional or conventional implants. It is much smaller in height and guides the patients denture into the retentive rings. The retention rings are also made of nylon so the rings last much longer than the rubber ring used in the o-ball attachment. Right now OCO Biomedical i- mini and i-micro implants, IMTEC MDI, and Intra Lock mini implants all use the o-ball with no locator attachment available.
Zest Locator attachments with metal housings shown in picture. You can see how close to the gum they are. Increase in patient comfort, less vertical and horizontal stress to the implants due to less of a lever arm.
Image of the Zest Locator implant attachment. You can see the 'flat' top surface. The male snap that fits on the outside and inside of the Zest Locator acts as a guide for ease of inserting the denture. When you have multiple mini implants this would be a welcome advantage.
Mini Dental Implant to retain lower partials.
With just a few mini implants you can take a lower partial denture and remove the metal clasp, fit the retention housing in the partial denture and now the patient does not have any visible metal on their teeth. If the partial is well made and has proper stops in the back of the lower jaw (retromolar pad) the partial will not settle and the implants will not get overstressed.
Mini Dental Implants to retain an Upper Partial Denture
Once again even with a few of these minis you can make a case that works. Over time if the patient's desires change and they want to add more its always possible.
Mini Dental Implants to secure a fixed bridge (Multiple teeth connected together)
In this case multiple teeth were failing and mini dental implants were placed the day of extraction to support a acrylic temporary bridge made in our dental lab. I used some pink acrylic around the front teeth to help hide the extraction sites while they were healing. A final porcelain bridge was made to fit over the mini dental implants once all the gums heal. This case is now been in function for over two years.
Mini Dental Implants to replace a few missing teeth with a crown
Here mini dental implants were placed to support 2 premolar crowns. They are the two teeth in the middle of the picture behind the large canine tooth. The last tooth in the picture is a crown on a natural molar.
Paresh B Patel dentists Mooresville NC
Many thanks to Dr. Bob Caseldine for getting the first edition of the Journal of the Academy of Mini Dental Implants published. For him it has been a labor of love and it shows. Great Job! With this new addition to the Academy I hope it encourages more Dentists to see the value that the mini dental implant has to offer for our patients who all too often suffer from ill fitting dentures and missing teeth. Without these mini implants I just do not see how we can help so many patients who think there is no other option except to stay at home and suffer.