Mini Implants for Long-Term Use?

They do work. Be sure to screw them in slowly (1/4 turn and wait 5 seconds) and most of all, be sure you have excellent occlusion! My preference would be to place 2 root form implants in the canine areas and retain with Locators after 2-3 months, using minis to stabilize in the interim. Some people are stretched for the mini fee and can't go for the root form, but, with care, the minis are still in there functioning well. If your patient is edentulous now and is going "up" to minis, he'll think your a genius!

That still doesn't answer the question directly, if root form implants are used as the main pillars of support, then the minis are there as extras. What are the LONG TERM happenings when these minis alone are used to support long span removable or fixed bridges? I don't indicate often but have seen quite a number of complications like loosening and fractures, the patients came after having lost confidence in the previous operator.

I have been placing the Imtec mini implants for about 5 years. I have no qualms placing or recommending four mini implant in the mandible. The Maxilla is a little more problematic, but with good bone they work well.

Dear Dr C I have been using narrow diameter Implants(previously named mini or transitional) for more than 10 years.Recently there was an FDA approval for using them for long term use.My longest experience is with the Dentatus system and I have patients with narrow diameter Implants(1.8,2.2,2.4mm)for up to 9 years with complete function and no radiographic bone loss.Narrow Diameter Implants are a perfect solution for narrow interdental spaces and narrow ridges eliminating the need for major grafting procedures.As a rule try always placing as much narrow implants as you can . Another treatment modality is denture retaining support.I have been using the Atlas system from Dentatus for more than 4 years now with great success.Implants can be placed flapless(Knowing exactly beforehand where the bone is with a CT)therefore minimizing patient's morbidity.I think that for that part of the population that can't afford doing major grafting or Implant reconstruction it is a great solution.

I have been using Mini Dental Implants (MDI's) for fixed applications for the past five years. They work well for crown and bridge when the bone is dense (DI-DIII).Use a hard cement, place a punched rubber dam (10 mm in circumference) around the MDI base when cementing your crown to avoid cement running subgigival. I also place lubricating jelly on the outside of the crown to prevent cement setting on the crown. See Inside Dentistry September 2007 Volume 3 Special Issue 2 'Applications of the Small Diameter Implant in Dentistry' (pages 1-7)

If you are a golfer you would not think of going out to play without a sand wedge. If you do dental implants and do not have the mini in your bag you are missing the boat. Mini implants (I use the MDL from Intra-lock because of its superior break threshold) are the duct tape of implant dentistry. They are also long term when when used in the right situtations. I have been using mini's since 2001 first for denture retention. But have expanded their use to single units and fixation for free end partial dentures. All my referrals now will not do a free end partial without at least one mini. The placement of the mini in this situtation has eliminated partial adjustments after delivery. You need to have the surgical ability to reflect a flap and all that goes with that if you want to expand their use beyond denture retention in the big flat ridge with lots of bone. The slam dunk cases. In many cases flaps have to be reflected to ensure proper placement especially when a knife edge ridge has to be flatten prior to insertion. In the hands of someone with implant experience the mini is the answer no bone, no space and no money.

The minis is great if they dont break.And to make sure they dont break u got to place a lot (4-5) for the mandible.Its known to be a great long term solution for denture stabilization. For crowns and bridges u could find a paper published by some guy Shatckik i think in Compend Edu which i still cant find!

The name is Dr. Todd Shatkin. His work has been very helpful to those of us who use small diameter implants on a regular basis. You can find many posts he has made in other areas of this website. I have attended his two day seminar along with several other seminars on mini implants, and I believe minis are the wave of the future. Minimal or no grafting. Minimal or no flaps layed. Great for denture retention. In my opinion better than single traditional implants in the molar area for tooth replacement because by using three implants at the same angles as the original roots of the tooth you achieve the same force vectors while occluding that nature intended. After 28 years of practice, it seems wierd to call "standard sized" implants traditional, but they are. Minis will replace them for many if not most applications in my opinion - but then again I've been wrong before!

What is the definition of long term as related to the permenents that most full size implants are approved for. Why put in four minis when you can put in two full size premenents? I see a use but it is a mini useage scope.

The reason you use mini's vs standard is because an 70-80y/o lady/man who just wants to enjoy the rest of his/her life eating good foods cannot afford standard implants living on social security and medicare. Seems like a good reason to me! :)

Ask a patient if he/she would prefer two standard implants with 6 months healing before loading, a flap to visualize the bone, and possibly a graft to achieve enough bone to stabilize the implant, at a cost of at least $4000, or would you prefer 4 mini implants, 30 minute surgury with local anesthesia, no flap, no grafting, immediate loading (enjoy using them the next day), at a cost of $3300? Tough choice for the doctor maybe, but not for the patient.

Mini-implants have the advantages of low cost, simple surgical placement and high versatility, have moderate success rates and are easy to insert when anatomic measurements are carefully considered. When failures are noted, retrieving the loosened one and/then inserting another mini-implant has little discomfort and is usually well accepted by patients. A vast majority of clinicians believe that implants not requiring surgical preparation have higher failure rates, while implants with better stability require flap surgeries for insertion and removal. Whereas conventional or modified oral implants have been shown to successfully serve as anchorage for orthodontic appliances, mini-implants failed to reach these high success rates. When the high failure rates of mini-implants are under evaluation two main factors have to be considered. The biomechanical loading of peri-implant bone as well as the time schedule of loading have been shown to have a major impact on the peri-implant bone healing and can be assumed to determine the clinical fate of mini-implants. Therefore, mini-implants can serve as anchorage for orthodontic force systems when loads do not exceed a tolerable strain level. It is important to note that the amount of stresses and strains are dependent on the geometry of the screw as well as on the mechanical properties of the implant and bone. The clinical view that loaded mini-implants showed no movement through the bone is confirmed. The risk ratio of failure is enhanced when mini-implants are inserted into the nonkeratinized (nonattached) gingiva. A decrease in diameter is associated with a decrease in the cumulative survival rate, whereas the length of implants has no statistical significant effect on implant failure. Microimplants (1 mm in diameter) have been able to sustain an intrusive force of 150 g for 12–18 weeks in beagle dogs, and, it has been shown that immediate loading can be performed successfully when peak loads do not exceed an upper limit of stress at the implant neck.

If you are already using the mini implants as transitionals, try placing two of Sterngold's 2.2mm ERA Implants, then around those place some of the 3.25mm ERA implants which have been approved for permanent use by the FDA. Load the 2.2mm implants and allow the 3.25mm implants to integrate. At the end of the healing period, tell the patient that you want to remove the 2.2mm implants which have been approved for long term, transitional, temporary or however you want to word it. What do you think the patient is going to say? I will guarantee you they will not want to remove them. The fact of the matter is that although these implants can only be marketed as temporary or transitional, the FDA has not put a specific time frame on this transitional period. They leave it to the discretion of the clinician. Life is temporary, is it not?

Sorry, I hit the send button accidentally before I finished my thought. As far as complications go, the only problems we are seeing with mini implants is when they are immediately loaded under inadequate conditions. If you do not have dense bone, let the implants integrate. The majority of these patients are coming to you with their dentures in their pockets, what is wrong if they wait two months before you load the attachments. Other complications are the same as traditional implants. Patients who smoke or have uncontrolled diabetes, inadequate bone density are all going to experience higher failure rates. I have not seen any studies or cases where there were specific problems with mini dental implants integrating.

Let me start by saying I have never used a "Mini-implant system". My concern was the likely success rate of loading a smaller diameter, shorter implant immediately while providing what seemed to be a minimal savings to the patient. Having recently attended a lecture by Dr. Misch, my concerns have been confirmed. Also, a recent article (Clin Impl Dent Rel Res 2007;9 (June): 65-70.) from Norway showed a 20% failure rate of NobelDirect 3.0 mm implants that were immediately loaded. What is the comparative diameter and length of Mini-Implants? The 3-4 month healing time and slightly increased expense of standard implants in my mind is more than justified by the increased success rate and predicability of standard implants.

I first saw the mini transitional implants presented at an AAID meeting about 13 years ago. The only manufacturer at the time was Dentatus. My first case was that of a 65 year old man who recently had his natural tooth abutments all fail due to periodontal and caries problems. He was a busy executive, and refused to wear the flipper his dentist had made for him to replace the maxiallary teeth 1-6. I inserted the MTI's into the pontic spaces where there was adequate bone and built a fixed temporary bridge. He was thrilled, and so was I....it allowed us the time to do bone grafting, sinus augmentations,etc. and the patient had full function at all time. When the conventional implants were ready to load, I simply reversed the MTI's with a little torquing action,...because they did tend to almost integrate after a year in the bone. The problem with the early Dentatus MTI's were that they were made from surgical grade pure titanium, which allowed them to be bent to achieve parallelism, but on occasion they could break. The broken parts are easily removable with a trephine drill. I have a number of the original MTI's still in the mouth, and they are fully integrated. The newer Dentatus mini implants are titanium alloy, and are very strong....great results Dr. Keith Rosein gives courses on this subject and is very knowledgible.... a worthwhile technique. Dr. Gerald Rudick, Montreal

Small diameter implants are here and here to stay. IMTEC, MDL work very well. The quality of bone is so important and that will allow them to work. Slowly, Type one bone, going to the inferior border of the mandible and OCCLUSION, OCCLUSION and one more time OCCLUSION. Case selection is always the key.

LOAD, LOAD AND LOAD! Interigate and question how your patient lost their natural teeth.Study and observe facial form. Note the size of the masseter muscles. If there are some remaining teeth left note the wear or relative tooth substance loss and how that loss may have occurred. Consider the pattern of tooth wear. Does it appear to be a para-functional factor? When I think of occlusion I think of how the teeth come together or the study of occluding. As dentists our depth of knowledge needs to be vast. In a sense we are cival engineers of the oral cavity. Where ever possible attempt to understand the relationship between ETIOLOGY AND PROGNOSIS. Thus, Load (magnitude and direction),rate or frequency, function, bio-mechanics, chemical factors (acidity or pH) and other factors that we can not always understand will play a powerful role in outcome assesment. Most of all know your host. What is the status of your patients ability to withstand your planned treatment. Know their expectations of your proposed treatment. Last, their ability to afford that treatment balanced against the risk/benefit ratio and are you really saving them money. Long term predictable success is achieveable when we consider biomechanics, and periodontal physiology and how to maintain bone, and to consider the systemic health of the patient. That also relates to their emotional health as well! Good Luck

LONGEVITY, LONGEVITY, LONGEVITY! Everyone talks about small diameter implants as if they are some revolution in implant dentistry. "Those who forget the past are condemned to repeat it". One needs only to look at the Linkow studies in the '60s when looking at small diameter implants in compromised ridges. Several things have changed, however, since these original studies. First, these implants are TiAlV alloy rather than CP titanium. This increases the strength and degree of cyclical loading before failure. Second is the introduction of rough surfaces. The early implants were all machined titanium which resulted in a lower percentage of bone to implant contact. Third, they now tend to be used in wider ridges with more medullary bone. It is bone with a HIGH cellular contact that results in better integration. The fallacy is that cortical/D1 bone gives better results. This may be true for initial stability, but NOT long term integration. This is why the early cases in thin ridges had a high failure rate (primarily cortical bone). What we have not seen yet, as mentioned in the previous post, is the longer term failures of these cases as a result of occlusal overload. For those of you who believe that small diameter implants will replace standard sizes, your expectations will be tempered by a new rash of failed cases. Small diameter implants have a place in oral implantology. But to suggest that we violate basic biologic/prosthodontic principles for short term gain is intellectually dishonest.

I had orthognatic surgery 10 years ago, where titanium screws were used. I had no problems. Then I had implants installed 11 months ago and I have chronic facial swelling, facial redness, tinnitus, facial burning sensation, burning eyes and have developed severe food allergies. I have also lost facial fat, a slight workout makes me look gaunt. I think the implants are titanium alloys where the screws for jaw surgery are pure titanium. I also think there is galvanic current running through me. When I shave, with just aloe vera, my face swells. It seems the metal blade is what creates the swelling. I am going to have these implants removed. has anyone heard of a similar situation? I would really appreciate any comments. Thanks.

I have seen the recent comments by Dr Willardsen re mini implants and the replies by Dr Clifford. In my experience mini implants in the mandibular arch have never failed and are often life changing for the patient (and dentist- fewer adjustments). The success in the maxillary arch in not as great and I feel they are unpredictable. I have placed numerous in the maxillary arch and the prosthodontist has constructed open palate cast framework dentures. I have seen older ladies do fine long term and even huge weightlifter types do well. I have had a number of failures even when the initial placement showed great initial fixation in a variety of patients with great arch form and apparently rather dense bone. Two root form implants with Zest attachments, I think have much better predictability.

I have used mini implants since 1999 when the MDI system was launched by imtec. (it is the only mini implant system I have used and I am very pleased to this day). I have done now hundreds of cases, usually an average of 4 per patient (I have used a maximum of up to 8 per arch in a few cases for specific reasons), so that means placing a good number that goes beyond the thousand MDI'S. My practice is a TMD center, so heavy forces are always there (of course not every implant case we do is a TMD patient. Very often we have denture patients with infra and suprahyoid pain due to the inability to hold the denture in place and to the common lack of vertical dimension that denture- TMD patients have. We have use MDI in some of these patients for initial support of the dentures so we can use splints on top of the dentures. We have been able to follow the cases now for 8 years and I am surprised; I wasnt expecting those lower overdenture MDI to last so long. The experience in the maxillae has been different, we have notice an increased loss of MDI whenever the MDI invades the nasal fossa area and secondarily whenever it invades the sinuses area. off course, no implant is supposed to invade these areas, so it is my mistake, but we have cases lasting now up to 5 years in the maxilla and usually loses of MDI have been early losses, all we do is remove them and replace them with another one. In the maxillary area, if your primary retention is not beyond 40 Nw (and that is quite often), I suggest you let them integrate just as you would do with any regular implant(dont use the soft tissue reline technique, let them integrate, it is more predictable); all you have to do is to hollow the area in the denture around the mini so it is never in contact with the denture. The secret to long term stability of MDI is related to: 1. Your ability to make the desition wheter to immediate load or not (primary retention of 40 Nw ideally) 2. Your ability to make a denture conection that will seat on the soft tissues and not on the MDI, so the MDI'S will always be passively seating and only acting if distraction forces are applied to the denture. Beware of cantilibers! 3. Your ability to design a denture with flanks (flanks are the ones that should resist and be the barrier for the lateral displacement forces. 4. An excellent occlusal design, BALANCED OCCLUSION. since the closure forces will be applied in the posterior areas (away from the MDI's) and the excentric forces again will be placed in the posterior areas. We have used them as transicional devices while standard implants integrate, but we dont do that anymore in denture patients, we leave them there, since it is additional retention for the denture. Mini implants are an alternative, they work if you use them right, they integrate since it is titanium with a surface that has been treated with a technology similar to sla. They are very resistant to fracture since the alloy is stronger than the strongest titanium available comercially; it has a very interesting alloy that among other components has vanadium. Wheter one system is better than another? it is a tough question to answer, I would have to think that the sterngold mini is a nice alternative but my concern is related to the attachment design that would create a very nice increased connection mini- denture but at the same time would demand more from the mini since more forces would be applied to the mini. In reference to the ultralock mini, I understand they are made in brasil not in the USA and that to me is a concern; their design is very similar to the imtec design so I would assume that it should work well. It is a relatively new company so long term use is unknown. Dr Linkow sent me some interesting pictures of cases done in the sixties with the ancestors of the actual mini implants and the cases were stable up to the last follow up done to the patient in the nineties; longer term than that? it speaks by itself, and they were not made in titanium, so what we have today available in the market should be better, no matter what company you consider using. Another interesting long term user of minis is Dr Ziv Mazor who is also participating in this blog, he has a nice article published on lippincot with Dr steigmann, on fixed cases; last week I met with Dr Mazor in Frankfurt and he told me that the molar cases of his article still stable and that the cases are from 1997, Those are H&H mini implants. The point is: 1 they should work long term but this will depend on your case selection, technique,care and follow up. 2. Hopefully, you dont become a mini implantologist only and keep yourself evolving in the world of implant dentistry since Minis are just another tool you have to treat your patients. Keep this in mind. 3. The desition to use minis should be also related to patients expectations, budget etc, since again, they are an alternative, not the only way to do the job. 4. Yes, they are less invasive, but that is not your choice, it is the choice of the patient who decides if he wants an specific type of dentistry that is more detailed, cosmetic, functional and complete so beware of expectations. and for these, minis have limitations. 5. Get very familiar with socket preservation techniques so you always have more available bone. and implant dentistry becomes easier. Alvaro Ordonez

Alvaro Thank you for posting such an informative reply. John

I have been placing small diameter implants for at least eight years. Their success rate is higher in the lower than the upper. I have placed over thirty Small Diameter implants in the Maxilla and all but two are still in the mouth. I would tell the patient that the upper is more of a temporary implant and the lower more long term. I find taht the small diameter implants help stabilize the lower dentures of edutulous seniors. There are a lot of elderly patients with limited funds and a need to improve their diet so that they can have a better and healthier quality of life in their last years. I have helped many paitients with this implant modality. Believe me it is not my first choice since I have a higher success rate with conventional implants, but it does help your patient. I charge 1/3 of a conventional implant but tell the patient if it fails they will have to pay me again if they want it replaced (even if it lasts a month). This usually helps them find the money for a conventional or it gives me peace at giving the patient options. I have had the small diameter implants last eight years so far. I use MDL's since there mode of transfer from the vial to the mouth is seemless. Their impression coping is more secure to the ball. They have a cement on abutment that a implant crown can be made. The Metal housing and O rings fit both MDI and MDL. The MDL has a slightly thicker body or surface area to the bone than MDI. I use a stent when I place them. This is to assure myself that I do not hit the Mental foramen. I could go on but it seems that the doctors above have said so much that probably only a few will scroll down to read this.

I guess nobody answered the real question if the mini implants actually osseointegrate. I had used them for the last several years and have taken all of them out by simply removing them with my hand. They screw out with around 10Ncm easily (what I can apply with my hand).

there are some studies saying that minis do osteointegrate with the bone by simply trying to remove or unscrew the minis at 72 months and some other study that they found histologically that osteointegration of minis and the bone compared to traditional implants. but I think those studies are funded by IMTEC. There is another source that you can try to find out if they have any independent studies( try Jackson Hospital in Miami). I have placed minis for about 3 years and I don't think that I would continue placing them any more as a standerd of care to my patients.I would rather do 2 regular implants with locators for lower dentur wearers than 4 minis.. beleive me it is not about saving your patients money it is about doing the right thing.

It is very interesting to note the differences in comments. There are many supporters for the mini's or reduced diameter implants as there are those against. May I suggest that if these implants work well in your hands continue to use it. For those that have not experience such results please try investigating why there are many out there that seem to be singing praises for this mini's. Well for me the standard diameter if there is such works as well as the mini's. I use both and I rather called them the larger diameter and the smaller diameter implants. My experience dated back to slightly more than 7 years for denture retention as well for crown and bridges. I just taken an order for 125 mini's this month. I hope this will help those colleagues using the mini's to encourage us to keep going on The key to successful implant practice is to make sure that you follow sound tested principles to ensure osseointegration. It takes more than 80 newtons of torque to fracture a 1.8mm Imtec mini. All the best to you Dr.C

I read with interest Dr Oppenhiemers post about never flapping for mini implant placement. I think there are definite reasons to do so. 1. Knife edge ridges can be smoothed, but do not penetrate the cortical plate. If you use a split flap and position it correctly you will wind up with more attached gingiva. The implants can be positioned (depth) by placing the housing and checking; then adjusting. Healing time is longer but the existing denture can be used temporarily by drilling for the housings and using viscogel as temporary retention. 2. I have flapped when there is no attached gingiva--split flap--and taken a graft from the palate and used the minis to help secure the graft (also suture the edges to the flap). If the periosteum is thin then use a bone bur to freshen the site so adequate bleeding occurs so the graft will survive. Placing a graft gives an excellent result. For those of you who don't know American dental implant (www.americandentalimplant.com) has a 2.4 mm diameter implant with a standard 3.5 internal hex so Zest attachments and others can be placed..two with Zests will anchor very well.

I just read the Compendium Feb 2007 article. Would be grateful if one of the article's authors can clarify the below. 1)Was it a protocol that all fixed prosthesis wer splinted (either to adjacent natural teeth as a bridge, or to another mini-implant)? Thank you.

Dr B I am not the author of the article you refer to but i am a presenter for Imtec Mini and Endure standard diameter implants The protocol laid out by Imtec has been for single teeth ..bicuspids and anterior A common mistake is to over use mini implants for fixed cases i do not recommend joining to an adjacent tooth,as this in unneccasary and destructive and biomechanically incorrect Here are some guidlines for the FIXED cases 1) Do not go further distal than bicuspids unless you are placing for support rather than function 2) Splint all implants where possible 3)Avoid lateral excursions on the implant crown 4)Premolarise all teeth and keep cuspal inclination effectivly flat 5)These are not prettty cases unless you do lower incisors and upper laterals 6) Create internal tripodisation where possible 7) Create external tripodisaton where possible 8) As a rule I prefer to leave the crown in a tempory and take final impressions after a couple of months 9) Place a little deeper to allow for the emergence profile YES they do intergrate Why wouldnt they ? It is titanium and bone this point does not require explanation anymore in 2008 There are quite a few more points that need covering but the lecture would be exhaustive for this thread come and join us in Barbados early April for a full day of lectures and of demos and golf and beach of coarse! good luck

hi. im interested in replacing 1 tooth with an implant (upper right Lateral incissor). i understand that they stay for a good while. but how long will it really stay based on your experience? how many years? is there some kind of license that the dentist should have before they perform the procedure? im from the philippines and there are dentists who are using them already. what are the questions to ask a dentist to make sure that they are really trained for it? can a general dentist do it? thank you so much. anna

mdi very nice but very expensive. hope i can reach the very high cost.

Question: When placing implants in an elderly patient (65 years and older) to support denture (lower), what saftey precautions do you take to protect the airway of the patient? (rubber dams etc) Thank you!

Is there any research for MDI's longevity?

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