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Ask UsSmall Diameter Implants to Support Full Arch Fixed Partial Denture?
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Dr. AJ asks:
I have a case at the moment that has placed me in a difficult position. The patient wants a full arch fixed partial denture in his maxillary jaw. But because of the poor bone quality and poor bone volume, he needs a hip graft to augment his ridge. He will not accept this. The only other option is for me to place small diameter dental implants in the maxilla. This is something I have never done. Can someone please advise me on this. Will small diameter implants be adequate to support a full arch fixed partial denture in Type IV bone?
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8 Responses to “ Small Diameter Implants to Support Full Arch Fixed Partial Denture? ”
I routinely place 10-12 mini implants for a full arch restoration like you are referring to. I am presently using the MDL implants distributed by my father’s company Samuel Shatkin FIRST, LLC. This is a supplier of mini implants and crown and bridge laboratory work to go on the minis.
Thanks,
Todd
I would never reccommend the minis. Eventhough they have gotten FDA approval…I still always hear from offices placing them they are still losing 1-2 implants over 2-5 years due to overloading. READ THIS ARTICLE - THE FDA NEEDS TO RETHINK WHAT THEY HAVE DONE!!!
Measurement of the Fatigue Life of Mini Dental Implants: A Pilot Study
Authors: Flanagan, Dennis, Ilies, Horea, McCullough, Paul, McQuoid, Scott
DOI:10.1563/1548-1336(2008)34[7:MOTFLO]2.0.CO;2
Journal: Journal of Oral Implantology Issn: 1548-1336 Volume: 34 Issue: 1 Pages: 7-11
The full abstract of this article is available for free:
Abstract
The fatigue life of mini or small-diameter dental implants is of particular interest because these implants are used to retain and support fixed and removable dental prostheses. The fatigue life of an implant depends on both the implant itself as well as on the physical properties of the bone. However, the capability to predict the fatigue life of a newly placed implant is currently inexistent. This pilot study represents the first step in developing such a methodology and focuses on the design of a cost-effective device to measure the fatigue life of a dental implant. In our measurements, the implant has been mounted in an essentially rigid support, but test specimens can also be bone mounted in vitro. Furthermore, we developed a finite element-based computer model capable of predicting the corresponding fatigue life. The finite element analysis was performed in ABAQUS, and the results predicted by the model correlated fairly well with our initial experimental results. Most of the 2-mm diameter implants fractured after more than a million cycles.
Dear Dr. AJ: There is another option for you, the Cigomatic arch implants, There is a technique with 2 cigo and two anterior implants (7 and 10) or a 4 cigo implants to support a full arch restoration with great success.
If you still want to use the mini dental implant technique I would recomend the Arrow Press Changeable implants from Alpha Bio that are 3.3 in Diameter self tapping ,suitable for inmediate loading and have the option of straight or angulated abutments in titanium or a castable similar to a UCLA. This system works actually really well with 8 or more for a full arch.
I also Concur With Dr. JB , smaller diameter implants like the 2mm or so are not to my liking eventhough I have never had a problem with one but still…..
Cheers
Have you consider possibly expanding with BTI kit or the Messinger Kit. Type 4 osseous support is easily compressed and expanded which may allow the placement of traditional sized fixtures. You may consider Nobelactive fixtures. Have not tries although, they claim to expand rather then remove ossous support. Additionally, I have found with several patients with type 4 osseous support that the bone quality significantly improves following the placement of impant fixtures. Disuse atrophy reversal. If you do not feel comfortable with a fixed appliance and do not think you can expand the ridge you may advise your patient that you will only do the case as an implant supported overdenture. If patient balks, let them go somewhere else. They tend to forget how hard we try to please them when something does not work as planned despite our best intentions. Remeber, do know harm and protect yourself. Good Luck
Hi,
I have placed at least 70 full arch fixed restorations on mini implants. Usually 10-12 minis splinted together. I have not had any of the mini implants under full arch roundhouses fail! 100% success over the past 7 years. We also have many dentists who use our MDL mini implants for full arch restorations with similar success rates. The problem of overloading can be an issue if you try to place 12 units on 6 minis but if you use 10-12 there should not be any issues.
Thanks,
Todd
I would agree with Dr. Berg and recomend the use of Alpha bio’s Arrow press system. 3mm or 3.3mm.
If possible combine it with regular implants if possible in some areas.
Immediate loading is recomene with this system in order to provide cross arch stability.
The system provides good results. (3 years of experiene with the system). More preditable and much more easy than bone grafts. Still, the patients must be aware of the long term risks and lower success rates than the regular systems.
I only use the minis in the anterior mandible. I consider minis in the upper as transitional. I wouldn’t do the case if the patient will not let you do it right.
I used 3 MDI implants as transitional implants in the anterior mandible after bone grafting. Went to replace them after 9 months with the thought that I’d have a rough time removing them. Nothing could have been further from the truth. Removed easily - no osseointegration. No wonder you need 12-14 to support a denture.
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