Home | About us | Editorial board | Ahead of print | Current issue | Archives | Search | Submit article | Instructions | Subscribe | Advertise | Contact us |  Login 
National Journal of Maxillofacial Surgery
 
Print this page Email this page Small font sizeDefault font sizeIncrease font size
Users Online: 224
 


 
Table of Contents
CASE REPORT
Year : 2010  |  Volume : 1  |  Issue : 2  |  Page : 176-178  

Management of atrophic mandibular ridge with mini dental implant system


Department of Prosthodontics, Faculty of Dental Sciences, C.S.M. Medical University (upgraded K.G.M.C.), Lucknow, Uttar Pradesh, India

Date of Web Publication9-Apr-2011

Correspondence Address:
Raghuwar Dayal Singh
Type 4, Flat no. - 9, Butler Palace Colony, Lucknow - 226 001, UP
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-5950.79225

Rights and Permissions
   Abstract 

Mini dental implants (MDI) are ultra-small diameter (l.8 mm width), biocompatible titanium alloy implant screws, conceived and designed over 20 years ago by a board-certified Manhattan dentist, Sendax Victor. Dr. R. A. Bulard added a single-piece "O-ball" design to Dr. Sendax Victor concept. These implants can be used in atrophic ridges, flabby ridges, or in other cases where there is denture instability or lack of retention due to poor availability of residual bone. In this article, a case report of 55-year-old female patient is presented, with a severely atrophic mandibular ridge that was managed by the MDI system with an overdenture.

Keywords: Immediate loading implants, mini dental implants, overdenture


How to cite this article:
Singh RD, Ramashanker, Chand P. Management of atrophic mandibular ridge with mini dental implant system. Natl J Maxillofac Surg 2010;1:176-8

How to cite this URL:
Singh RD, Ramashanker, Chand P. Management of atrophic mandibular ridge with mini dental implant system. Natl J Maxillofac Surg [serial online] 2010 [cited 2020 Jun 2];1:176-8. Available from: http://www.njms.in/text.asp?2010/1/2/176/79225


   Introduction Top


Every dentist has experienced the problem of dealing with patients with atrophic ridges. The patients always return with complaints of instability of dentures. This problem is more pronounced in the mandibular arch. [1] Due to less available tissue surface, denture adhesives have limited use in the mandibular arch. Traditional dental implants require a period of healing and tissue integration in a nonleaded capacity for optimum predictability. [2] The mini dental implant (MDI) system can be immediately loaded and provides ongoing stabilization. [3],[4],[5],[6]

This article discusses a case report of a 55-year-old female patient with severely resorbed mandibular ridge by placement of 4 MDI with overdenture.


   Case Report Top


A 55-year-old female patient reported to the clinic with the complaint of a loose mandibular denture. The patient was unable to chew or speak properly as the denture kept coming out. The patient had a history of complete teeth loss 20 years earlier due to periodontal disease. She has been using her current set of dentures for the past 1 month and has had no previous dentures.

Clinical examination revealed that the patient has completely edentulous upper and lower arches. No bony spicules or root pieces were seen and there was severely atrophic knife-edge mandibular ridge [Figure 1]. However, the maxillary ridge was favorable for denture construction. The patient has an Angles Class III ridge relation.
Figure 1: Knife-edged mandibular residual ridge

Click here to view


Treatment plan

After radiologic examination of the patient, it was observed that the patient had dense compact bone in the mandibular anterior region without any pathology. The blood reports of the patient also did not show any pathology to rule out surgery. Hence it was decided to place MDI on the mandibular arch and an overdenture over it.

Procedure

A new set of complete denture was fabricated for the patient [Figure 2]. The anatomy of the jaw was evaluated to determine the angulations of the implant.

A Brasseler-type latch drill was used to open denser bone layers to facilitate the self-tapping and self-cutting features of the MDI system. (The speed of the drill should not exceed l600 RPMs with adequate torque and irrigation.) [7] Drills were only used to establish access angulation and pilot starting point for placement of the implant. The drilling technique typically involves no surgical incision or flaps. The drilling entry procedure was completed with a few pumping motions, resulting in light penetration past the dense cortex into softer, more trabeculated medullary bone. Sterile irrigation was utilized throughout the drilling procedure. (The desired site depth should not exceed one third to one-half the threaded length of the MDI itself.) A gentle up and down pumping motion was performed to prevent the drill tip from overheating and/or becoming bound and embedded into the patient's bone. Each sterile, double-pouched implant is suspended in a transparent vial for easy access and transmission to the implant site.
Figure 2: Old denture of the patient

Click here to view


A small thumb carrier-wrench or finger driver was used to retrieve, convey and introduce the MDI into the target site after the initial pilot drilling process has been completed. The implant was carefully screwed clockwise into the site using rotation of the thumb and index finger on the knurled handle of the wrench until it became difficult to turn. The thumb wrench was then removed from the implant abutment head. The thumb wrench was replaced with a winged thumb wrench for more mechanical advantage and leverage. The implant was again turned gradually into the patient's bone until once again it bound to a point where it became difficult to turn. Then the winged wrench was removed from the implant abutment head.

A ratchet wrench was then used to slowly insert the implant into its final position. The neck of the MDI was fully inserted into the soft tissue (attached gingiva) so that only the abutment head is protruded into the oral cavity [Figure 3]. The tissue side of the patient's prosthesis was relieved so that it could be seated passively over the top of the seated implants. A soft blockout MDI shim was then placed on each inserted mini implant's square base portion of abutment head, leaving the O-Ball top half exposed for attachment placement. Keeper caps with IMTEC (3M Imtec Corp, Ardmore, Oklahoma, US) MDI O-Rings were then snapped onto the O-ball heads [Figure 4].
Figure 3: Patient's ridge with 4 mini dental implants in place

Click here to view
Figure 4: Keeper cap fitted on each mini implant

Click here to view


The patient's prosthesis was carefully examined to ensure a passive fit. A standard chair side self-cure acrylic mix was then prepared and placed into the denture, then seated with a functional bite into the patient's mouth over the top of the mini implants with the keeper caps attached. After an appropriate hardening time, the prosthesis was removed from the patient's mouth, the blockout shims discarded and excess acrylic material trimmed. The finished prosthesis, containing the keeper caps, was then replaced into the patient's mouth for occlusal equilibration and border adjustment [Figure 5].
Figure 5: Insertion of the denture into the patient's mouth

Click here to view



   Discussion Top


In our clinical practice we regularly come across patients in whom we find it difficult to achieve optimum denture performance due to problems associated with reduced denture retention and stability. This can be due to a number of factors, such as reduced vestibular depth, flabby ridges, atrophic ridges and so on. MDI system can also be used for stabilization of a complete denture where bone quality is inadequate for standard implants. [8],[9],[10] The system can be used for Type I and Type II bones. [11] In Type I bone the standard propriety thread design can be used and in Type II bone the MDI MAX thread design is used. [12] The advantages of using the MDI system in such cases are as follows [13],[14] :

  • Immediate loading,
  • Can be inserted in minimal tissues without relying on grafting techniques,
  • Minimally invasive procedure,
  • One-stage denture stabilization,
  • Does not require osteotomy,
  • Cost-effective,
  • Can be placed in patients with ridge to narrow for conventional implants and
  • A simple 5 steps technique.

   Conclusion Top


MDI are an excellent and profitable addition to every dental practice. This system provides an immediate and ongoing stabilization for the patient in an economical and efficient manner. It is an extremely simple and safe procedure and can be done in cases with poor bone quality as well. It opens many treatment modalities to the dentist and the patient.

 
   References Top

1.Nishioka RS, Garcia-Junior IR, Souza FA, Luvizuto ER. Treating the edentulous mandible: Immediately loaded implants. Dent Toda 2008;27:70, 72-3.  Back to cited text no. 1
    
2.Branemark PI. Osseointegration and its experimental background. J Prosthet Dent 1983;50:399-400.  Back to cited text no. 2
    
3.Sendax VI. Mini implants as adjunt for transitional prostheses. Dental Implantol Update. 1996;7(2):12-5. .  Back to cited text no. 3
    
4.Misch K, Neiva R. Small-diameter implants for optimal stabilization of implant-supported overdentures. Pract Proced Aesthet Dent 2007;19:428-31.  Back to cited text no. 4
[PUBMED]    
5.Assad AS, Hassan SA, Shawky YM, Badawy MM. Clinical and radiographic evaluation of implant-retained mandibular overdentures with immediate loading. Implant Dent 2007;16:212-23.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Nazarian A. Mini dental implants: Immediate gratification for patient and provider. Dent Today 2005;24:110, 112.  Back to cited text no. 6
[PUBMED]    
7.Gibney JW. Minimally invasive implant surgery. J Oral Implantol 2001;27:73-6.  Back to cited text no. 7
[PUBMED]    
8.Christensen G. The Mini Implant for General Practitioners, Simplified Implant Surgery Techniques. Dent Town Mag 2001;132:231-3. .  Back to cited text no. 8
    
9.Bulard R. Mini implants a solution for loose dentures. J Okla Dent Asso 2002;93:42-6.   Back to cited text no. 9
    
10.Balkan BE, Steflik BE, Naval F. MDI implant insertion with auto advancing technique for ongoing applications. J Oral Implantol 2001;27:32-8.  Back to cited text no. 10
    
11.Sussman HI, Goodridge OF. Use of SIG device to accurately place permanent miniature dental implants to retain mandibular overdenture. A case report. N Y State Dent J 2006;72:34-8.  Back to cited text no. 11
[PUBMED]    
12.Jefferies SR, Boston DW, Damrow MP, Galbraith CT. Comparison of detachment forces of two implant overdenture attachment types: Effect of detachment speed. Am J Dent 2008;21:244-50.  Back to cited text no. 12
[PUBMED]    
13.Sadowsky SJ. Mandibular implant-retained overdentures: A literature review. J Prosthet Dent 2001;86:468-73.  Back to cited text no. 13
[PUBMED]  [FULLTEXT]  
14.Dene L. Implant supported overdenture for the atrophic mandible. N Y State Dent J 2010;76:26-9.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


This article has been cited by
1 Mandibular Overdentures Retained by Two Mini-Implants: A Seven-Year Retention and Satisfaction Study
Alfonso Catalán,Alejandra Martínez,Francisco Marchesani,Urcesino González
Journal of Prosthodontics. 2015; : n/a
[Pubmed] | [DOI]



 

Top
   
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
    Introduction
    Case Report
    Discussion
    Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed3341    
    Printed182    
    Emailed1    
    PDF Downloaded586    
    Comments [Add]    
    Cited by others 1    

Recommend this journal