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Ask UsA Flap for Mini Dental Implants?
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Maria, a dental implant patient from Canada, asks us:
I was thinking of getting mini dental implants, but I was informed that I would need to get a flap done in order to do the implants. Previously, I had 5 dental implants, and had them removed. Basically, I made some bad choices, and am (of course) reaping the results of this.
I am left with very little ridge in the jaw and poor bone (some pain) on the left side. I may need some bone grafting on the left side.
Would a flap indicate what the bone is like? Would a flap reveal any possible bone and/or tissue problems? Would this be a good choice for me under the current circumstances? Would it be better to go with two regular dental implants (and dentures) rather that four mini dental implants? Any replies and/or information would be greatly appreciated. I am hoping there is some hope left for me. Thank you.
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9 Responses to “ A Flap for Mini Dental Implants? ”
Flap is not necessary especially if CT technology is employed
Before even thinking about placing new implants, thinking that bone might be limited, a CT scan is mandatory.
That would allow to “see” the bone before any surgery.
Then, the operator will decide safely of a flap is needed to place the implants.
Since you have very little ridge left in the lower jaw, mini implants may provide a suitable solution for you. In general, I would recommend four mini implants over two standard implants as the retention of the denture and the distribution of the biting forces should be better. In your case I feel that a CT scan would be of limited value. A CT scan will give your dentist accurate information concerning the dimensions of the bone. However, the overlying soft tissue often makes it difficult to accurately “center” the implant in the crest of the ridge. In your case it may be very important for your dentist to make use of every bit of available bone to secure the implants. I agree with your dentist. Save the money on the CT scan and flap the tissue. This does not involve a lot of extra surgery or recovery and the implant placement will be more accurate. In addition, the flap will give your dentist an opportunity to place the gum margin accurately around the implant platforms and to insure that the gum margin around your implants is strong and not loose. This is very important for the long-term survival of your implants.
Get a cat scan done. Our office does them for $390USD and then you truly know what your treatment options are. if a dentist places your implants with a flapless approach and does not have a cat scan fabricated guide stint (jig), that is similar to driving a car with your eyes closed. plus go to a provider that offers BOTH full size implants and minis if you want a real consult. If the dentist does not offer real implants, that should be a “red flag” to you. A really, really big red flag. good luck.
I would recomend a double CT scan, and with this you might be elegible to get a nobel guide technique also called teeth in an hour, that of course would remain to be confirmed by the scans.
if not possible, the novum technique may also be a choice for you.
good luck
Nice plug for teeth in an hour do you work for nobel. What a waist of time. Do not let some dentist who is on the latest nobel biocare band wagon talk you into teeth in an hour. Or what ever other gimmick they are selling this week. Find a dentist who is trained and let him treatment plan what is best for your mouth and your situation. No two cases are the same, most edentulous mandibles will need an alveoloplasty to level off the ridge which will definitely require that a flap be raised. Let the surgeon decide and under no circumstances are temporary (mini) implants indicated for long-term prosthodontic success.
Why CT scan? this patient wants to place mini dental implant which is 1.8mm diameter to secure her denture. 1st The ridge can be measured with bone caliper,perio probe if you don’t have a caliper, palpation, and pan. If dentist not sure then the flap will be the best thing to do in order to see anatomy of the bone. Before you write about CT scan answer how many implants have placed, and what do you know about this procedure.
This is exactly the type of case that is very difficult for guided surgery. CT scans are helpful if the dentist utilizes them properly. I have done hundreds of MDIs and planned hundreds of MDI cases for dentists all over the country. I have never flapped an MDI case, ever…and I can’t imagine I will ever need to. My objection to flapping an MDI case is that your abutment position related to the gingival position is very important. Remember, when you place a mini implant you are placing an implant and abutment at the same time. You’re doing the surgery and prosthetic portion together.
I tell all of my students and colleagues that a surgical guide template is not a substitute for a brain. A CT scan is also only a piece of puzzle. Combine everything and you have your best chance of success.
MDIs may be perfect for you but a dentist that you trust should make that determination. After having problems with implants, unfortunately, the chances of having further implant problems are also higher. This might indicate a minimally invasive procedure is preferred (read Mini Dental Implants). Ask Questions and Good Luck.
Good comments, Ben. In my experience the CT scan REALLY helps. Initial penetration can be in the right place, angulation is easy to visualize, and length can be determined exactly. I have tried to place 13 or 15 mm MDIs in places that looked fine on digital pano, but the later CT scan (when threads stripped during placement) showed that a 10 or 11.5mm implant placed vertically would avoid the lingual plate while the 13 or 15, if not angled severely buccally, would impact the plate and strip threads or worse perforate lingually. If you have access to the CT scan, use it - it takes a lot of the worry out of the procedure and makes the denture fit better. Obviously not necessary all the time, but why not have the help if you can get it?
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