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Upgrade your Snap in Denture to a Fixed Full Arch Bridge Roundhouse with Mini Dental Implants

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.

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My patient when we first put in 6 mini dental implants to support a full upper denture.

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.

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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.

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Final full upper roundhouse bridge that will be supported by mini dental implants.

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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

mini dental implants

Dental Implants Charlotte Mooresville Lake Norman NC

Dental Implants Lenoir Hickory Wilkesboro Asheville NC

Dental Implants to get rid of a Upper Partial Denture

If you are missing a few teeth and wear a partial denture I can empathise with your situation. 

Who wants to wear all that metal and plastic in their mouth if there was another option?

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Typical design of a cast metal partial denture. 

Metal hooks that are visible around the teeth that it holds onto.

 

 

 

If this describes your situation then you should consider dental implants – mini dental implants or traditional. 

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My patient without her upper partial denture in.  She is missing her front three teeth and the tooth behind her canine tooth.

 

 

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4 mini dental implants were placed with minimal surgery (no cutting of the gum, no stitches)  The temporary crown is on the mini dental implant behind the canine tooth (right side of picture).

 

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Temporary crowns in place over the mini dental implants.  My patient gets to leave without her partial denture.  I will let her 'test drive' the temporary crowns for a few weeks.  Any changes we want to make to the look of the crowns can then be communicated to the dental lab that will make the final mini dental implant crowns.  The 'test drive' period also allows me to assess the function and phonetics (how her speach is). 

 

R21

 

X ray of the OCO Biomedical mini dental implant used to replace the missing premolar tooth.

 

 

 

 

 

Paresh B Patel Dental Implants Charlotte NC

Mini Dental Implants

Dental Implants Hickory Boone Wilkesboro Asheville NC 

OCO Mini Dental Implant to Replace a Missing Lateral Tooth with a Porcelain Crown

About 2% of the population has a congenitally missing upper lateral tooth.

Lateral missing

My patient after orthodontic treatment.  He is missing one of his upper lateral teeth.

He is 17 and just wants to enjoy being a kid with teeth.  The solution he has right now is a clear plastic retainer with a denture tooth in it to replace the missing tooth.  His Mom was unable to consider a traditional two piece dental implant due to cost.  In this case I think a one piece dental implant is a better service to the patient and at a much more affordable price point. 

 

 

 

After measuring the space we determined that a OCO 3.0mm Mini Dental Implant could be placed.  It is a one piece immediate load dental implant.

 

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Partially seated OCO implant x-ray to confirm that it is at the correct angle.

 

 

 

 

 

 

 

 

 

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OCO Mini

 

 

OCO immediate load one piece implant being placed.

 

 

 

 

 

OCO 3.0 in

 

OCO Dental Implant fully in place.  Notice the lack of gum being cut and or any bleeding.

 

 

 

 

 

The final porcelain crown will be placed next week from First Impressions Dental Lab

Paresh B Patel Dentist Mooresville

Dental Implants Lenoir Hickory Wilkesboro Asheville NC

Mini Dental Implants Charlotte NC

Easy Dental Implant Placement to Replace a Missing Tooth with a Fixed Crown

Lets face it….we are getting older and our teeth age along with us.  Some of us will have missing teeth due to decay or injury or just daily use.  With tooth loss comes other potential problems.  Such as aesthetic concerns and not being able to eat the things you like.  Bone loss

With the advent of a dental implant (a small titanium screw that is gently rotated into the gum and bone) we can now use that as a new root to anchor a replacement porcelain crown or bridge. 

 

 

 

 

Missing molar

Here is a good example of how the bone starts to melt away after a tooth is lost.  This also shows show the sinus cavity starts to drop down giving us even less volume of bone to place the dental implant.  This is a great spot to use two mini dental implants or if there is enough width one larger regular size dental implant.  I like using a one piece dental implant.  It has the advantages of being cost effective, no microgap, and immediate use just like a mini dental implant. 

 

Occlusal

 

Here we can see the missing molar tooth.  Plenty of width of bone.  Options given to the patient were 2 mini dental implants or one regular size one.  In this case we decided to use a OCO Biomedical ISI one piece dental implant 4.0mm in diameter.  Lots of times I have been asked, is it not harder to place the larger size implant.  I don't think so.  With the logical progression design of the OCO dental implants it is very similar in placement protocol to what I am use to doing with mini dental implants.  One pilot bit and one final bit to form the bone.  No flap of gum tissue is made.  Patients go home with no blood or stitches.

 

Parallel pin

 

Parallel pin in place to check for proper angle and depth.  I will use some SalvinOsteotomes to push up the sinus and some DynaBlast bone putty to fill in around the end of the implant.  Chris Totty at Salvin can provide additional information on these products. 

 

 

 

OCO ISI 4.0mm

 

Final photo of the OCO Biomedical ISI 4.0mm dental implant to replace the missing upper molar.  As you can see, no blood and no stitches.  It will have the same surface area as two mini dental implants. Either solution would provide this patient the opportunity to have her missing molar tooth once again.

 

 

Sinus bump

 

Final x-ray with the sinus membrane bumped up to allow for the end of the OCO dental implant to be covered with added bone.  This will fill in and turn into live bone in a few months.  A i-TERO impression was taken and First Impressions Dental Lab will make a porcelain crown to fit over the OCO ISI one piece dental implant. 

 

 

Paresh B Patel Dentist Mooresville NC

Mini Dental Implants

 

 

 

 

 

OCO ISI Dental Implant to Replace a Missing Upper Molar Tooth

My patient came to see me because she was tired of her gum hurting when she would eat where she was missing her upper molar.Occlusal Pre OCO 5.0

Food would poke her in the gum and she was just unhappy.

 

 

 

 

 

Buccal Pre OCO 5.0

She also did not like when she smiled everyone seeing the empty space.

 

 

 

 

Pre PA

 

I had extracted the molar tooth about 5 months ago due to a failed Root Canal.  We packed the extraction socket with a bone grafting material so her own bone would fill in where the tooth roots used to be. As you can see on the x-ray it filled in very nicely.

 

 

 

OCO ISI 5.0 x 12mm

 

I explained to my patient her choices in implants…either two mini implants to support the molar size crown or one regular size implant.  It would cost a bit more to do the traditional implant but that is what she decided on after our treatment planning and consultation.  I measured the space and a OCO ISI One Piece Regular size implant would work just fine here.

 

 

With the OCO ISI dental implant system only 2 burs are necessary to place the implant.  Here we see the pilot bit with a drill stop to keep it from going any farther in the bone than we want.  Its right in line and we proceed to the next step.Slide9

 

 

 

OCO 5.0 parallel pin

 

The next size bit is used and a implant replica is placed to verify fit and angle.  All looks good so we gently rotate the OCO ISI one piece dental implant into the gum and bone.

 

 

 

 

Final OCO ISI 5.0

 

Clinical view of the OCO ISI 5.0mm implant in place ready for a traditional impression like you would have for a crown on a tooth.  Notice the lack of blood, stitches or any real trauma to the area.  With the OCO implant protocol it is very similar to the placement of a mini dental implant.  No flap of gum tissue is made.  It is one piece in design, so no extra parts and pieces for the dentist to buy. 

Final PA

 

Final x-ray of the OCO ISI 5.0 x 12mm dental implant in place. 

In the end a missing upper molar tooth can be replaced quite easily for both the dentist and patient with either:

A regular implant that is one piece in design or

A 2 mini dental implants to support the larger size crown.

Slide10

 

The impression is off to First Impressions Dental Lab for them to make a Upper Molar Crown.

 

Paresh B Patel Dentist Mooresville NC

Mini Dental Implants

Dental Implants Charlotte NC

Broken Tooth ~ Extraction ~ Dental Implant Procedure Upper Tooth

My patient who alternates between our office and the periodontist office came in today.  She had been told a few months ago by the periodontist that her upper canine tooth crown was failing and would come out soon. But as most patients and people are we hate to go see our dentist until…..it breaks

Broken Canine

 

Broken upper canine tooth.  She had super glued the post and Porcelain fused to Metal crown to the root for the weekend.  Not a great solution as you can see from the gum tissue.  But I thought it was quite creative.

 

 

PFM and post broken

 

 

 

 

 

 

X-ray of the broken tooth with the crown and post missing.

 

 

 

 

 

To get the rest of the root out without damaging the delicate plate of bone on the cheek side I had ordered some SalvinPDL-elevators.  These are thin bladed instruments used by the dentist to remove the broken root without damaging the bone.  Thanks Chris Totty for sending them out.  I had another brand but needed another set and I quite like these.  Plus Salvin Implant Supply is here in Charlotte NC.Salvin pd-Elevators

 

 

 

Salvin PDElevtors

 

Canine root being removed and as much bone being preserved as possible for an OCO Biomedical ISI 4.0mm dental implant placement.

 

 

 

Canine out

 

 

Now with the canine root out I could check the quality of bone and pick what dental implant would make the most sense to place.  We could let the area heal and place a few mini dental implants or consider a one piece OCO Biomedical Immediate Stabilized Implant. 

 

OCO 4.0 x 14mm

 

Having a stock of OCO Biomedical Implants that Matt Baron and Chris Sanchez had sent me I quickly found a OCO ISI 4.0 x 14mm that would work great in a situation like this.

 

 

 

 

 

 

 

 

 

Pilot bit

 

 

Following the simple OCO dental implant placement protocol I used the pilot bit to ensure the correct angle was being followed and took an xray to confirm.

 

 

 

 

 

 

 

 

OCO 4.0 ISI in

 

OCO Biomedical ISI 4.0 x 14mm dental implant in the extraction site.  Notice the gold color Titanium Nitride finish.  This will give a good warm color to the implant and final crown under the gum tissue.

 

 

Final OCO ISI 4.0 x 14 in

 

Final x-ray showing the OCO Biomedical ISI dental implant in place spaced correctly between the two adjacent teeth and capturing 3mm of bone past the end of the extracted root for immediate stability.  I used her existing PFM crown as her temporary by grinding out the old post from the inside of the crown and cementing it over the OCO dental implant with temporary cement.

 

 

 

 

 

 

PFM temp

 

I used her old PFM crown as a temporary and fit it right over the OCO ISI dental implant.

 

 

 

 

 

OCO ISI 4.0 x 14mm Pan

 

Final Pan x-ray with the OCO ISI dental implant and PFM temporary crown in place.  The patient will come back in 6 weeks for a tissue and healing check.  If all looks good an impression will be taken for First Impressions Dental Lab to make the all porcelain crown to fit over the dental implant.  I will post the final crown picture at that time.

I think this case could have been solved either with a mini dental implant capturing the palatal slope of bone or a traditional implant as shown.  I have done both and they both will work well with the proper training.  I am encouraged by the number of dentists who are now seeking to get dental implant education.  There are several great mini dental implant seminars and education as well as regular implant CE courses.  I encourage any dentist to get started and mini dental implants are a great way to move forward in helping our patients. 

Paresh B Patel Dentist Mooresville NC

Mini Dental Implants Charlotte NC

Broken Tooth ~ Extraction ~ OCO Dental Implant Procedure for Immediate Load Upper Tooth

My patient who alternates between our office and the periodontist office came in today.  She had been told a few months ago by the periodontist that her upper canine tooth crown was failing and would come out soon. But as most patients and people are we hate to go see our dentist until…..it breaks

Broken Canine

 

Broken upper canine tooth.  She had super glued the post and Porcelain fused to Metal crown to the root for the weekend.  Not a great solution as you can see from the gum tissue.  But I thought it was quite creative.

 

 

PFM and post broken

 

 

 

 

 

 

X-ray of the broken tooth with the crown and post missing.

 

 

 

 

 

To get the rest of the root out without damaging the delicate plate of bone on the cheek side I had ordered some SalvinPDL-elevators.  These are thin bladed instruments used by the dentist to remove the broken root without damaging the bone.  Thanks Chris Totty for sending them out.  I had another brand but needed another set and I quite like these.  Plus Salvin Implant Supply is here in Charlotte NC.Salvin pd-Elevators

 

 

 

Salvin PDElevtors

 

Canine root being removed and as much bone being preserved as possible for an OCO Biomedical ISI 4.0mm dental implant placement.  With this kind of implant we can predictably load the implant without a surgical flap and have a 99.9% documented success rate.  Patients no longer have to suffer with the healing of a invasive gum flap and a time intensive two state surgery. 

 

 

 

Canine out

 

 

Now with the canine root out I could check the quality of bone and pick what dental implant would make the most sense to place.  We could let the area heal and place a few mini dental implants or consider a one piece OCO Biomedical Immediate Stabilized Implant. 

 

OCO 4.0 x 14mm

 

Having a stock of OCO Biomedical Implants that Matt Baron and Chris Sanchez had sent me I quickly found a OCO ISI 4.0 x 14mm that would work great in a situation like this.

 

 

 

 

 

 

 

 

 

Pilot bit

 

 

Following the simple OCO dental implant placement protocol I used the pilot bit to ensure the correct angle was being followed and took an xray to confirm.

 

 

 

 

 

 

 

 

OCO 4.0 ISI in

 

OCO Biomedical ISI 4.0 x 14mm dental implant in the extraction site.  Notice the gold color Titanium Nitride finish.  This will give a good warm color to the implant and final crown under the gum tissue.

 

 

Final OCO ISI 4.0 x 14 in

 

Final x-ray showing the OCO Biomedical ISI dental implant in place spaced correctly between the two adjacent teeth and capturing 3mm of bone past the end of the extracted root for immediate stability.  I used her existing PFM crown as her temporary by grinding out the old post from the inside of the crown and cementing it over the OCO dental implant with temporary cement.

 

 

 

 

 

 

PFM temp

 

I used her old PFM crown as a temporary and fit it right over the OCO ISI dental implant.

 

 

 

 

 

OCO ISI 4.0 x 14mm Pan

 

Final Pan x-ray with the OCO ISI dental implant and PFM temporary crown in place.  The patient will come back in 6 weeks for a tissue and healing check.  If all looks good an impression will be taken for First Impressions Dental Lab to make the all porcelain crown to fit over the dental implant.  I will post the final crown picture at that time.

I think this case could have been solved either with a mini dental implant capturing the palatal slope of bone or a traditional implant as shown.  I have done both and they both will work well with the proper training.  I am encouraged by the number of dentists who are now seeking to get dental implant education.  There are several great mini dental implant seminars and education as well as regular implant CE courses.  I encourage any dentist to get started and mini dental implants are a great way to move forward in helping our patients. 

Paresh B Patel Dentist Mooresville NC

Mini Dental Implants Charlotte NC

One Piece Solid Regular Implant or 2 Mini Dental Implants to Replace a Missing Upper Molar

My next patient had an upper molar that he wanted to replace.Before oco 4.0 ISI

 

The upper molar had been extracted a few years ago.  The molar behind it had started to tip forward and he really missed it when chewing his favorite food….Prime Rib a J&W Cafeteria.

 

 

 

 

 

 

 

 

 

 

Before OCO ISI xray

 

On the x-ray of the area you can see how the molar behind was starting to tip forward.  You can also see the sinus cavity slowly coming down.  In a few more years I suspect there would be very little height of bone.  Then it would be very difficult to replace his missing molar with a mini dental implant or even a regular conventional implant.

 

 

 

 

 

 

 

One of my biggest objections to using a regular Regular Implant
implant is the two piece design.  Anything that is made of two pieces is never going to be as strong as something that is one solid piece.  Thus a 2.5mm mini dental implant is just as strong as a larger two piece 3.75mm implant. 

I was asked to try out a different kind of regular implant.  An OCO Biomedical solid one piece regular size implant.  To replace this missing molar I would have used 2 Intra Lock Mini Dental Implants from Shatkin FIRST

 OCO ISI

Since there was not 8mm of height available to place the regular implant I decided to do a sinus lift by tenting the membrane with some Foundation collagen material.  The concept is to carefully penetrate the bone and then widen it just enough to place some of the Foundation material in to push the sinus membrane up and then insert the implant.  Over time the body will fill bone in around the tip of the implant in the sinus cavity.

Pilot bit

Pilot bit in and ready to tent up sinus              Foundation

                                                     Foundation material

 

 

Parallel pin 2

 

OCO Biomedical 4.0mm parallel pin in place to check spacing for final implant placement.  Notice the lack of blood as the placement protocol is similar to that of placing a mini dental implant.  NO FLAP, one pilot bit.  There is one additional step…the final sizing bit. 

 

 

 

Xray OCO ISI half in

 

After the Foundation bone grafting material was packed into the socket the OCO Biomedical ISI 4.0mm implant was used to push to material up into the sinus under the sinus membrane.

 

 

 

 

OCO fully seated

OCO Biomedical ISI regular implant in place ready to replace the missing upper molar.  I will have the dental lab make a all porcelain crown to replace his missing molar.  Once again notice the lack of a surgical flap, lack of blood, bruising of the tissue, no stitches or suture.  Really very minimal surgery…very similar to the placement protocol of a mini dental implant.

 

 

In the end I think there is a place for either type of implant (regular or mini dental implant).  They both work and they both work well.  It really to me is what the dentist feels works best in his/her hands and what the patients desires are.  Cost certainly is an issue with the mini dental implant being more cost effective.  If I had to to this case over again I would have a hard time choosing the best option for my patient.  Its all on what you like to do and what you are good at.  My final thoughts are that there are so many patients that have missing teeth we should encourage dentists to get trained in placing implants…mini dental implant are a great way to start.

Paresh B Patel Dentist Mooresville NC

Mini Dental Implants

 

 

 

 

 

ACE Surgical Mini Dental Implant with a Zest Locator for the Upper Denture Plate

Does your upper denture gag you?  Does it feel like a big bulky piece of plastic?  Do you not taste your food anymore?  Do you talk funny or don't sound like yourself anymore? 

These are all the things my patient told me yes to.  That is a lot of yes answers to have on one patient.  Usually I don't get that many issues with the upper denture.  But when we do have someone that just simply can not wear the upper full denture plate its a huge problem; both for function and esthetics. 

Relined upper denture

 

Upper denture prior to placing 4 Mini Dental Implants with a Zest Locator attachment (different than a o-ball and ring snap typically used on mini dental implants).

 

 

Locator

 

 

 

 

Zest Locator attachment.  It has a flat surface to make inserting the snap easier on the patient than the o-ball and ring.  It also has different nylon rings that can be swapped out by the dentist to offer the patient levels of retention…..so if the denture is not tight enough a more retentive ring can be placed.  This feature is not available on the o-ball mini dental implant.

 

4 minis in place upper

 

4 ACE Surgical Secure Mini Dental Implants with Locator attachments.

 

 

Marked inside upper denture

 

Upper denture marked for location of the ACE Secure Mini Dental Implant.

 

 

 

 

 

 

Space for locator mini implant  Space created for the Zest Locator 'snaps' that will be fitted inside the existing upper denture.  In a few weeks I will make the upper denture into a horseshoe shape so he can: 'Talk better, taste his food better and gag much less'

Black housing in denture

 

Snaps picked up in the upper denture.  These rings will be replaced with more retentive rings after the implants heal into the bone.  But even today the denture is tight and my patient is impressed with how much hold he has now.

 

 

 

 

Robert ratner post

 

Final Pan X-ray of the ACE Surgical Mini Dental Implants with a Zest Locator Attachment. 

 

 

In the end I am impressed with the Locator attachment.  A bit more skill required to place these mini dental implants than a o-ball type.  This is mostly due to the protocol of using a 2.3mm in the front and having to place a 3.25mm in the back.  My preference would have been to just use 6 2.3mm minis and give the patient a few extra implants.  But as with any product it is up to the dentist to determine what he/she feels is best for the patient.  This case could have been done and been successful with any mini dental implant, IMTEC MDI, Intra-Lock, OCO Biomedical mini or micro. 

Paresh B Patel DDS  Dentist Mooresville NC

ACE Surgical Mini Dental Implant

No Bone for Dental Implants ~ Would Mini Dental Implants work?

One of the main reasons patients don't move forward with dental implant treatment is lack of bone.  This lack of adequate bone can be in the width or height dimensions. 

Thin ridge

Cone Beam CT scan showing a lower mandibular ridge with severe resorption in both the vertical and horizontal dimensions.  The ridge of bone is only 1.2mm wide at the top and stays that way for 9mm until you get to the wider bone near the chin. 

In this case we had no choice but to flatten the ridge to make room for the smallest mini dental implant we have (1.8mm wide).  Once that was done there was only 11mm of height left to place the mini implant in the lower jaw. 

Lower ridge 
 
The mouth has a very specialized kind of bone, its called alveolar bone.  This alveolar bone is not found anywhere else in the body.  Its purpose is to hold the roots of your tooth the the base of the jaws.  Once teeth are lost this bone just melts away or is resorbed by the body.  If you have a loose or ill fitting denture or partial the constant rubbing and moving will cause this bone loss to accelerate.  Even in areas of one missing tooth the alveolar bone melts away.  Without a tooth root over time the bone will be lost.  The good news is that any dental implant, mini or traditional conventional will help to keep this bone from melting away any further.  Bone loss for implants

This picture shows how substantial bone loss can be from missing lower jaw tooth molars.  The ridge of bone is thin and is vertically deficient.  Options could be to do a block onlay graft of bone or to consider using mini dental implants.  One of the benefits of mini dental implants is that we can sometimes avoid this additional surgical procedure. 

Large bone defect Area where a tremendous amount of bone has been lost in the lower jaw.  A large defect that would require bone grafting to place traditional size dental implants. 

So what should you do if there is no bone left for a dental implant?  The most elegant solution is to repair the missing bone and gum to gain the height and width that was once there.  This requires the experience and high degree of surgical skill of an experienced Oral Surgeon, Periodontist or a well trained General Dentist who does this kind of surgery on a daily basis.  We refer this kind of treatment to a highly skilled dentist in our area. 

But with every procedure there are some drawbacks.  For this kind of bone grafting or repair the potential hazards are:  prolonged healing time, additional surgery, additional temporary dentures to fit over the repaired bone while it heals, potential morbidity and expense.  There could be additional pain and discomfort or injury to the nerve.  Mini Dental Implants are an alternative to consider to bone grafting or bone augmentation.  The patient not only saves on the cost of the bone grafting (anywhere from $3000 to $6000) but we can use the mini dental implant almost immediately.

Thin ridge that needs grafting

This picture shows how thin a ridge can get.  It would be very difficult to place a traditional implant here without doing a surgical bone grafting procedure. 

 

 

Mini implant placed

 

Here we have placed a mini dental implant without any bone augmentation procedures.

 

 

 

Mini implants thin bone Mini implants thin bone 2

 

Intra Lock Mini Dental Implants in thin bone.  Here I used a 2.0mm Intra Lock mini; however just about any mini dental implant would work….other minis I use include OCO Biomedical mini or OCO Biomedical micro, IMTEC MDI, ACE Surgical Secure Mini Prep or Hiossen.

 

 

 

Crowns on minis

 

Porcelain Crowns on the top of the mini dental implants cemented in place.

 

 

 

Thin bone and nerve

 

This x-ray shows a 2.0mm wide mini dental implant.  Notice how thin the bone is…it is at most 4mm wide.  A traditional regular implant would not fit without bone augmentation(repair) surgery. The pink shows where the nerve bundle exits out of the jaw into the gum tissue.