Mini Implants with PFM Cemented: Follow-Up and Long-Term Success?

Dr. C. asks:
I have a new patient in the practice who has a mini implant (IMTEC), one-piece design, in his mandibular first premolar site, with a PFM cemented on it. I have never seen in practice a situation like this and want to get some advice on follow-up. I cannot find anything in the literature. What is the long-term success of this kind of implant and restoration? Is it any less than for a conventional implant? One periodontist has lectured on how these mini implants restored with single crowns are more subject to failure. Is there anything I should mention to the patient?

17 thoughts on “Mini Implants with PFM Cemented: Follow-Up and Long-Term Success?

  1. Hi Dr.C.,
    I cannot help, because I’ve never seen such a solution. It looks not to be the best solution for the patient, because those thin implants look a bit underdimensioned for the loads applied to teeth in that position of the dental arch. May be you should anticipate to the patient the possibility of a fatigue failure of the restoration, and try to monitor the “health” of the metal structure checking the surrounding bone condition: if there is no bone loss around the implant neck, it could means that no excessive forces are discharged on that tooth, and it coould survive yet a little bit.
    Best regards

  2. Imtec makes a couple of diameters, but less than 3 mm is not ‘generally’ accepted for single unit crowns. That being said, doctors are doing it. Like you, Bicuspid forces would give me pause.
    Added to Dr. Bozzi’s recommendations, keep an eye on the occlusion w/bite wax & paper (T-Scan if you have one!) and keep the lateral forces under control.

  3. Dr. Todd Shatkin has placed thousands of mini implant supported crowns and bridges and his results have been published in the Compendium with very high success rates of over 90%. I have placed about 30 mini implant supported individual crowns and bridges over the past 3 years with no (knock on wood) failures yet. The surrounding bone resorption is slightly greater than with the conventionals I have placed but as long as you do not place any excessive occlusal or lateral stresses on the fixtures I believe they will match the success of the conventionals.

  4. I would very much like to contact Dr. Walker so that I could become a patient of his. He stated that he has placed several mini implant supported crowns, and I am interested in having mini implants instead of traditional implants for my two top front teeth. If you could give him my e-mail address, I would truly appreciate your help. npetrous1@twmi.rr.com

  5. I have had some experience with MDI from IMTEC and the success rate is almost as high as any conventional implant if you select specific and indicated cases, not for all cases and it offers to your patients a simple easy and cheaper solution. DR. Alvaro ordonez from Miami has a very long experience about and he has given many lectures about for last years, also as Dr, Suzman from New York.

  6. I too was surprised to see a case where 6 Mini implants were placed in Anterior maxilla for loading. Even with a 10 year experience, I felt short of experience to handle this situation. I am definately looking for some more responses on the stability & long term prognosis of such a case scenario

  7. i use frequently these mini implant from ditta tramonte in Italy, 2,5 mm. diameter but in such locations: from 42 to 32 in premolar region and in 12 and 22 region.

    my experience is very good in most than fifteen years without failure or breaking of implant.

  8. I have had the experience of using mini transitional implants, by Dentatus, which originally were made from surgical grade pure titanium……which gave the benefit of being able to bend them to correct an unfavorable path of insertion.

    I have loaded these implants, which do osseointegrate and can support PFM crowns.

    The problems are that the neck of the crown as it appears coming through the soft tissue is very narrow and unnatural, and that over time, the softer non alloyed metal can fracture….but if there is not room for a conventional size implant, and othodontics is not possible, it is a good alternative for however long they may last.

    The fractured portion can be easily trephined out when necessary.

    Gerald Rudick dds Montreal, Canada

  9. mini implant is not that inferiors i believe, if you put the minis by its indication its sure go well, its like for asian patients which only had 4mm of width, most case is in lower front tooth, its worked splendid

    also they have the hybrid implants 2.9mm, i like this stuff. at least for patient with insufficient width and afraid of the augmentation procedures

    sure you cant put the minis in molar region, male patient with big bite force, bruxism, free end etc etc

    and if its fractured like dr Gerald said you can trephine it out….

    and also my advice for denture support. its just not like they will stay forever there and you don’t care for the maintenance. you should know about the denture adaptation in the gum if you put loose denture with… lets say 4 – 6 implants… it will fail !!!
    if you dont put it in the proper way all the lateral force will force them. just keep it in mind this minis are the denture support not the denture base….

    Marik Guizot jakarta indonesia

  10. Learn to manipulate bone (expand, split etc.) and graft. You will have results superior to that of using minis. Learn to place plateforms. They require better hands and they work very well in thin bone but remember either submerge or splint as soon as possable.

  11. dear dr.

    check occlusion and lateral forces. I have placed close to 1000 of the imtec MDI implants and have the same experience of Dr. Shaklin. The bone loss issue is only seen if the occlusion is overloaded. Bicuspids are a fantastic area for these implants. Hopefully its a 2.4 Max (wider spades). If all of the above factors are good and hygiene is good, it is not a problem.

  12. Hi,Dr.C,
    Glad there are Drs like Tod Shatkins,Walker and Juan .
    Have experience of close to 8yrs with the minis or the reduced diameters of 1.8,2and the 2.4 or 2.5 and closed to 1000 implants.Success in the early yrs were lower than now which has reached close to 90over%.
    Worked in almost every position and all types of bone.
    Cement your pfms or resin crowns with tempory cements during the bone training phase and when the implants are well integrated with the bone which normaly takes about 3to 6 mths you can replace the temp.cement when the crowns gets losen or debonded with resin cement or gics.
    glad to be of service.

  13. Dr. C…there is a study by JH Diaz of 2081 Mini in Human Long-Term Fixed Prosthetic Function as well as Todd Shatkin’s study of over 5,000. Both show a survial rate similar to traditional size implants. As far as I have been able to find there are several articles on the success of mini implants for fixed work and no articles with the conclusion that mini that are properly placed with implant protected occlusion do not survive.

    In regards to what you should tell the patient is that you will follow the same guidelines as if it were a traditional implant for followup and continued care. Best of luck..

  14. I would record periotest measurements over time to look for any early signs of a shift in occlusion which may put undue stress on the implant.

  15. thanky for all the information. my question: has anybody experience to use mini implants to support chairside made or labe made fibre reinforced composite bridges like everstick or dentapreg?

  16. Dr Scholtz – This seems like a good new topic to get its own discussion board. I do bridges using denture teeth and denture acrylic, which could be done in-house or at a lab within a matter of hours. I know of other dentists using composite resin, and I have done a few myself with good results, – although not enough to have a statistical database. I would suggest to the administrators of this forum that a new thread on this topic would be in order.

  17. The use of mini (less than 3.0mm diameter) implants is on the rise, no doubt about it. Dr. Gerald Rudick correctly pointed to a very serious problem – establishing a proper emergence profile. There are currently two types of mini implants – one-piece and two-piece design. Two-piece design allows a greater flexibility, but requires abutment to be cemented and prepared in the mouth. Cement contamination of an implant, inability to take accurate implant level impression and the need for more instruments are issues to consider. Selection of the abutment is also limited. I developed a KAT (Key Assisted Transfer) Implant System that allows the use of a single platform, locking taper screwless and cementless connection and one surgical/restorative kit for placement and restoration of implants ranging in size from 2.5 to 5.0mm (3.0, 3.5 and 4.3 in between). Standard abutments, healing abutments (4.2, 4.7, 5.5 and 6.5mm) and accurate implant level impression technique can now be used with mini implants. You can even make a chair-side temporary screw retained restorations without the need to remove healing abutments! If you do mini implants, do it in a way you work with standard size implants. You do not have to compromise on esthetics, function and flexibility.

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