Missing Teeth? Mini Dental Implants Can Help

Before web It is estimated that over 50% of Americans are missing at least one tooth (not including wisdom teeth or third molars). 

Some of these missing teeth can be in the smile area.  This picture shows a patient of mine that lost two of her teeth due to fractures in the root.  She did not like showing the large gap between her molar and her canine tooth.



For this case I selected a OCO Biomedical two piece 3.25mm dental implant.  The picture to the right shows the OCO ERI 3.25 implant being placed.  The bone was very soft and the two piece implant was allowed to heal without fear that it would get moved around by biting forces. 






OCO Biomedical ERI 3.25mm dental implant in place right below the gum.  The gold color you see is the collar of the implant.  I think it is a nice touch to mask the grey color of the implant.







The OCO Biomedical Implants with a solid abutment screwed in place.  The abutment is the part that is placed into the implant and comes up out of the gum for the crown to cement to.  This does add an additional expense but in some cases it is necessary. 





X-ray of the crowns made to fit over the OCO Biomedical dental implants.







Paresh B Patel

Mini Dental Implants

Dental Implants Charlotte NC

Dental Implants Hickory Lenoir Asheville Boone NC 


Mini Dental Implant Upper Denture Tooth Bridge

Part II of the fixed hybrid bridge post.  You can scroll down 1/2 into the web page to see the complete case…

This is the finished product for our patient that came in just gagging on her upper denture.  She wanted to have a solution that would allow her to have the roof of mouth not covered with plastic. Cost was certainly a factor.  We offered the solution of 4 to 6 locator's implants and a removable over-denture without a palate.  I like to place 6 on the upper arch to withstand the lateral stress if we plan to remove the palate in the denture.  This certainly would have been the most elegant solution (easy to keep clean and offers a tremendous amount of retention)but was declined. 

I put in 8 mini dental implants to support a metal frame (not a tissue supported upper denture).  This metal frame would hold and support her new set of teeth made out of acrylic and denture teeth (a fixed hybrid solution).  Since there are no two piece mini dental implants (a diameter of less than 3.0mm) we can either cement the teeth over the mini dental implants or we can incorporate a teflon keeper that is processed into the metal acrylic base.  Shatkin First has this option if you need further information. 

Mini Dental Implant Fixed Hybrid

 Mini Dental Implants in place

Cast metal frame with Preat E-Fiber underMetal Frame acrylic

 connecting both sides together.  I would have preferred to continue that cast framework from one side to the other…but to accommodate the patients bite and other request it did not work out.  So the solution to use the e-fiber was decided upon with patient approval.  For technical data on the e-fiber you can go to their website.  It is 10x more fatigue resistant than fibrekore and 2x as strong in flexural strength.  Occlusion is only on the posterior teeth with only light occlusal stops on the lingual of the anterior teeth.  This is done to provide the artificial dentition patientt anterior incisal clearance during all posterior masticatory function.  All four anterior teeth do touch the lower teeth during incising and protrusive function. 

No Palate

View of Fixed hybrid denture in place with no palate


Smile view of fixed hybrid denture in place


There is about a 1/2mm to 1mm of space to allow for floss and water pick to keep the fixed hybrid denture clean.  Lingual side has a tight fit against tissue. 

Paresh B Patel Dentist Mooresville NC

mini dental implants

Mini Dental Implants – Small Diameter Implants Training Seminar & Education Lecture

Todd E. Shatkin DDS & Paresh B Patel DDS will teach in Dr. Shatkin's 1 and 2 day seminars on Nov 5th 2010 in Baltimore, MD and Dec 3rd in Pittsburg, PA: Mdbaltharbor

mini-implant placement and case selection

treatment planning and case selection

one stage denture stabilization; immediate implants and crowns

full arch reconstruction with mini implants

handling bruxism; handling thin and atrophic ridges.

Mini dental implants, with their minimally invasive nature, provide less risk to patients. The lower cost of mini dental implants are readily accepted by patients. Mini dental implants are easily placed by general dentists and are a true service to your patients.

Register today at 1-888-4-SHATKIN, ext 121 (1-888-474-2854).  7 hours of AGD approved Dental CE (Continuing Education) Credits will be given. 

Todd E Shatkin DDS – President International Academy of Mini Dental Implants

Paresh B Patel DDS – Mastership in Academy of Mini Dental Implants Dentist Mooresville NC

Paresh B Patel is a General Dentist who places mini dental implants to replace dentures and missing teeth.

Mini Dental Implants to solve problems

I got a phone call last night from a Dentist friend of mine in Buffalo NY (one of the worlds best respected Mini Dental Implant clinicians).  He had a patient of his from years ago that had a Resin Bonded Bridge that had now failed. 

She was an interesting young lady in grad school at UNC-Chapel Hill….of course she was in tears that she had lost her front tooth.  IMG_7697

 What to do?  I got her numb and sounded the bone in the missing tooth area…very thin…hardly any bone left to work with in the Lip to roof of the mouth direction.  IMG_7698

Knowing full well that this patient would end up back in the office of the guy who has restored the most mini implants in the US I felt a bit of pressure to get it as correct as possible.

The patient agreed to let me put a mini dental implant in to hold her resin bonded bridge in place until she could get back home and then have the permanent crown made over the mini implant.

So I put in a 2.0 x 15mm Intra Lock mini implant to hold the bridge.  It was fairly easy to grind out a hole in the pontic and fit it over the mini…whew!IMG_7701
I filled in the one wing that was not broken and the hole I created in the pontic with resin cement.  She left so happy and excited.  She had a tooth until a new one could be made for her.

Now for me to see how I did….

The assistant put my mentors patient in the iCAT CT chair and a few nail biting moments later I could see if I had threaded the bone and kept the mini in between the bone and not in air or soft tissue.

IMP^PAN^R^Lisa_Raymond^20100316^000 The Pan x-ray looked good, plenty of bone between the implant and the adjacent roots.

Now for the CT slices…

MPR^EXP^R^Lisa_Raymond^20100316^000 MPR^EXP^R^Lisa_Raymond^20100316^001
We had kept the 2.0mm implant within the 2.5mm of available bone…man was I glad.  




Mini Dental Implants vs Traditional Implants

The next story is about a patient of mine named Storie….how bizarre.  Well actually the patient is the wife of a patient of mine who had placed mini dental implants on to replace his existing partial denture. 

She had broken her tooth.Before Ext

X ray of broken premolar #13

I gave her the option of a root canal, post and a crown.  I thought it was a good option but she had it in her mind to take the tooth out and have implants.  We talked about traditional implants but she wanted what her husband had been offered – mini dental implants and crowns.   

I took the tooth out with some peritomes to preserve the facial bone as much as possible .

After Ext & Bone Preservation X ray of the tooth removed and the socket preservation with De-mineralized  & Mineralized Freeze Dried Bone (6 months later)

The area had healed in quite well and I was pleased with the amount of bone that was preserved in both the Facial/Lingual dimension as well as height.IMG_7513 

3 Intra Lock Mini Dental Implants were placed to act as the roots for the missing premolar and molar (#13 and #14)IMG_7514

As you can see the procedure was very atraumatic to the tissue as no flap was made.  Notice hardly any blood in the sites where the mini implants were placed. 

I standard impression was taken and the case was sent to Valdi and Shatkin FIRST Lab for 2 PFM Crowns.  The thing I like about FIRST Labs is that you don't get charged for the lab analogs for the master model or the 2nd pour for contacts.IMG_7658 IMG_7659 

Not to mention that the crowns look good and more importantly fit well on the mini implants.

IMG_7660 IMG_7661

I dry fitted the mini dental implant crowns in the patients mouth…let her approve the color and aesthetics.  She approved them and we cemented them.  Overall it was a slam dunk case.

IMG_7662 IMG_7666 13 14 Mini Final Xray




Mini Dental Implant Bridge – Part II

Ok..after a few weeks of procrastination I have finally got the pictures off the digital camera and am ready to share the initial results of the Ken Clifford Fixed Mini Implant Bridge.

To read Part I scroll down in the main blog to the Ken Clifford Bridge Post.

To clarify, the acrylic bridge is totally mini implant supported; it is not tissue supported.  Every effort has been made to keep the bridge at least 1mm off the tissue to allow my patient to use a water pick to flush out any food that gets under the pink acrylic. 

IMG_7463 Mini Implant BridgeIMG_7465 Lingual view Mini Implant BridgeIMG_7468 Space under Acrylic Ken Clifford BridgeIMG_7462
IMG_7472 Underside of Acrylic Fixed Hybrid Clifford Bridge

The acrylic bridge cemented in place. 2 week post op picture.  The patient has been keeping the acrylic mini implant bridge clean with a water pick and a electric toothbrush.  I will continue to take clinical photos at the 6 month recare appointments and will share how the bridge functions, looks, gum health, and implant stability. 

IMG_7482 IMG_7488 2 weeks post insertion

Mini Dental Implant Upper and Lower Dentures made by First Impressions Dental Lab.  Mini Dental Implant Lab

Mini Implant Crowns for Missing Back Teeth

I had a hard time figuring out how to start this case blog.  Its an interesting story.  A patient of mine, who was one of the first multiple crowns over the top of mini implants that I did, referred to me a friend of his.  DP pre panThe patient of mine was a boxer and was missing teeth on each opposing side. 


I knew I was in for a challenge, but to my surprise the case turned out well.  Lots of help from Jon at First Impression Dental Lab and getting his bite as correct as possible made the difference in this case.  I do not envy anyone who has to get someones bite established that has no frame of reference and has teeth on the opposite sides! 

Mini Patient 020

Although we did not do as many crowns and mini implants as planned, the case worked out well for the patient.   Most important to him is that he no longer has to wear partial dentures.  Pitts


The case has been in function over just over a year (9-25-09) and hopefully I can track the case for several years.  One year post op pan is shown.  I told him if he did not return for the follow up exams every year…I would find him and knock out the rest of his teeth!  Somehow I don't think I would win that boxing match, but he seems like a nice enough guy and will return without threat of bodily harm. 

The Main Event

Now to the real case.  Our new patient, intrigued with implants to replace his missing back upper teeth, saw a prominent and well qualified dentist in his home town of Asheville NC. 

A CT scan (3D – xray) was taken and a very impressive treatment plan was created for our patient.  Bi lateral sinus lifts, bone grafting, PRP(Platelet Rich Plasma), implants, custom zirconium abutments, and zirconium crowns.  The treatment plan could not have been any better.  The one thing that stopped this case dead in its tracks was that it was not affordable to the patient.  As I tell my patients there is only one treatment plan in the end that is right….its the one the patient understands the pros and cons of and can afford.  Apparently he noticed my boxer buddy's new teeth and they got to talking about mini implants…one thing led to another and he ended up coming to my office for a alternative treatment plan. 

Why minis?  Both mini implants and conventional implants are constructed from medical grade titanium alloy.  Mini implants have been researched and used widely now for over 10 years all over the world. Conventional dental implants now have more than 30 years of data, and many dentists will only use these larger implants. I believe that now is the time for a paradigm shift as I have been working with this alternative.   I have no quarrel with others who are uncomfortable with mini implants, but I am ready for a change in thinking and treatment planning for patients that otherwise could not have implant supported teeth. 

After studying his CT scan I told Tim that I though he had enough bone on the palatal slope of his upper jaw to place mini implants and skirt around the sinus pneumatization (dropping down of the sinus balloon to where the bone used to be).TB post pan The mini implants could support a set of fixed crowns.  Tim was not ready to get rid of the existing bridgework he had on his remaining upper teeth just yet.  We did discuss that when that time comes we ccould extract the remaining upper teeth, place additional mini implants and fabricate a full arch bridge.  This wwould also give us the benefit of cross arch stabilization.   Another challenge to the case was the hyper eruption of the last molar on the lower right side.  The space between the arches had gotten so small I cautioned Tim that we may not be able to get porcelain on the top of the last tooth.

The mini implants were placed, impression made and on this case I tried a modified ridge lap design where there will be a 1mm space from the lingual so Tim can use a electric toothbrush to keep the implants clean.  I know that most dentists who place crowns over mini implants like having the ridge lap design tight to the tissue on both the cheek side as well as the roof of the mouth or tongue side.  I think with having a 1mm space I know the implants can be kept clean.  IMG_7383 Minis in placeIMG_7438 1mm gap being show from lingual  IMG_7434 Occlusion being established…the bridge will be sent back to the lab to final polish the metal. 

 Tom Buttermore crown panPan x-ray with crowns in place.  I will have the patient come back in 1 month, 3 months and then 1 year to see how the soft tissue reacts to the 1mm space and how he is keeping thing clean.  The post will get updated with new pictures at those times. 

Paresh B Patel DDS  Mini Dental Implant Dentist

General Dentist Mooresville NC

Mini Implants ~ Do They Hurt Dr Patel?

I get asked this question quite often.  Of course there is going to be some discomfort you would think having a titanium screw inserted into the jaw bone…..but believe it or not most if not all of my patients claim it was less painful than having an extraction.

Not ever having an implant placed or a tooth removed from my own mouth I always think when I see the condition of most of the mouths that need implants…how is this not hurting to begin with?TT pre mini condtion

But as with most things in life the older I get the more I figure out I don't understand. 

So without further adieu…our patient in her early 60's is now ready to introduce her broken down teeth to Dr. Good (as in good by to the broken and unrestorable roots she has left).  They have been in this sort of condition for the last decade or so. 

The teeth are atraumatically extracted (how an extraction is autraumatic I am not quite certain).  But we try and preserve as much bone as possible I guess is the point. 

The sockets are packed with our freezed dried mixture of mineralized and de-mineralized bone and closed up tight so we hopefully will have some bone to place our mini implants in a few months.

Tick tock…tick tock…tick tock…

Wow…its now been 4 months all in the space of a few lines.  TT mini implants placed


The patient has mini implants placed in the healed areas and we will splint the minis together with some composite while the integrate into the bone. X00483_1 Mini Dental Implant in upper jaw

On the patients left side the mini ended up having to be placed a bit closer to her natural tooth as there lack of good bone where I wanted to place the mini implant. 

She is coming back to see us in 6 weeks and I will continue the post at that time.  To keep costs down for her she has elected to have resin crowns made by First Impression Dental Lab to fit over the mini dental implants. 

Paresh B Patel DDS  Mini Dental Implants

General Dentist Mooresville NC

Mini Dental Implant Crown ~ Mini Implant Cost

News flash of the week…we had our first 'drive by'.  No not a drive by shooting but a patient that said, he saw our sign on his morning drive to work each day.  Intrigued by what a mini implant was he did, 'a bit of searching on the inter-web.'  Pleased with what he learned he decided to make a visit to our office.

So Danny's now in the chair and as he is talking to me he has a curious habit of flipping his one tooth partial round and round in his mouth.  DM Partial He tells me its DM Missing toothbeen years since he lost his front tooth, thought about getting a 'real implant' but he did not see the value in around $1500 for the implant, $500 for the screw that goes into the screw, and $1500 for the cap (all his words). 

I assured him that I was not going to put a 'fake' implant in his mouth…it would be made of a similar titanium alloy and should integrate into his upper jaw just like those 'real' implants. 

We decided to place a DM Mini ImplantIntra-Lock MILO 3.0 x 15mm mini implant to support a single front tooth crown. No flap, no stitches, two small drill holes and then the implant was seated in the bone.  The entire process to place the mini implant was a surprise to Danny in terms of time and lack of discomfort. 

I was able to take one of my acrylic burs and make a hole in the back of his partial.  DM Partial w Hole He was able to use that to cover the mini implant until the lab fabricated crown come back to the office. 

The post will be updated with his final crown photo in a few weeks.

  DM Mini Implant xray He did ask if I could cut off the front tooth on his partial when he gets his crown.  Why, I asked puzzled?  He said, ' so I can flip that darn thing round and round.' 

Mini Dental Implant Bridge (Ken Clifford DDS Fixed Hybrid Denture Bridge is Here!)

Do you have a denture?  Would you like to get rid of it for good?  Well now thanks to mini dental implants and my good friend Ken Clifford you have that option.  Ken

A patient of mine came to me and said, 'Dr. Patel I am so glad that I had mini implants placed to keep my lower denture from coming out every time I tried to eat or talk….but can you give me some teeth that I don't have to take out?'Vicki Mathis 011 Vicki Mathis

After pondering the thoughts of how to make a bridge that most people could afford I saw my friend Ken at the Annual Academy of Mini Implant Dentists in Orlando.  He had a great idea; why not take high quality, 4 layer denture teethPortrait_colortooth (in my opinion they look better than some porcelain teeth I have seen) and make a fixed bridge for our patients who suffer with dentures?  The more I thought about it the more it made sense.

Why should we tell patients that if I take some really accurate impressions and then make a tracing of how your chewing motions are that I will be able to create a set of dentures that will work?  Its just not true…they might work…but I think most just make do with what they have.  Dentures resting on gum tissue and chewing muscles will always create some sort of problem.  Soreness in the gums, irritations when chewing foods that get under the denture, the list can go on and on and most denture wearers will attest to that.

So with mini implants in hand, and soon in our office, a Cone Beam 3D X-ray its 'time to get to work,' as Ken would say.  After some careful planning we decided to upgrade Vicki's ability to chew by adding 7 additional mini implants on the lower arch.  One Intra Lock 2.0 x 18mm was placed in between the four she had.  3 additional Intra Lock 2.0 x 11mm were placed on each side for a total of 11 mini dental implants. Vicki Mathis Clifford Bridge Pan These will be used to hold a molar to molar (Roundhouse) Fixed Hybrid Denture Tooth Bridge; also know in my office as the Ken Clifford Bridge.  This bridge will be cemented over the top of the mini implants and will not be removed by the patient.

IMG_7413 IMG_7420

The existing denture was modified to allow it to seat over the additional mini implants.IMG_7419   IMG_7418   She will comfortably wear her denture until the fixed set of teeth are made.


It will be designed in the same fashion as a traditional fixed hybrid bridge over regular diameter implants.   

I will continue the post as I get the model work back from First Impression's Dental Lab. 

Here is an example of a Fixed Hybrid Mini Implant Bridge.     Photo courtesy of Ken Clifford DDS. IMG_7524 IMG_7525  

Visit my dental office on the web at or if you are in Lenoir NC

Visit Dr. Ken Clifford on the web at or if you are in Chico, CA.