Connecting IMTEC Implants and Natural Teeth?

Interesting case. I had a patient with a full arch fixed maxillary bridge supported by 5 IMTEC (or similar) mini implants and one molar tooth (UL7). Needless to say the bridge kept falling out and was being retained intermittantly on highly mobile implant units. The patient had paid a considerble amount of money for this work. I am now having to undertake a more 'conventional approach' with implant retained bar overdnture solutions after a full clearance of teeth and implants. In fairness to IMTEC, I have never seen any of their literature recommend such treatment so it is the surgeon who is entirely to blame for the failure in this case. Is legal action warranted against the dentist in question? A matter for the patient and her lawyers I think but certainly a lesson to us all. Dr B

The above case might have a chance of working in the lower arch where an abundance of Type 1 bone exists, but in the maxilla it would only succeed on a miracle basis.

The chances of 5 mini implants retaining a full arch of fixed is slim to none. These implants were never designed, or capable of doing that. I am starting to see more and more fixed catastrophies on mini implants coming into my office. I blame practitioners who are looking for a quick buck and minimal surgery time. It is a shame!

I have been a very loyal mini implants user whenever indicated for a case. We have done a very high number of cases, I mean probably thousands of minis now. We started using minis as soon as the MDI system was introduced in Orlando at the end of the nineties. We have done removable and fixed cases, and our removable cases go back to 1999, some of them very stable today. Our fixed cases go back to 2002, also stable since we have been able to keep in touch with the patients and recall them periodically. Of course we have had some failures just like anybody else. Now, the case in question is related to connecting natural teeth and minis permanently, which I have never done, I have done it as a temporary solution but not permanently. I know people that have done it, probably the world record doing this is Dr Enrique Rojas in Dominican Republic, I have been given some of his cases on a power point during a course we had in miami. My personal opinion about this is that it is gambling! it is gambling with the outcome of a treatment, with the longevity and with the patient. Minis are very special, they are good friends of what we do in our everyday dentistry, yet we get them in abusive situations every day of our life. It is hard to comment or advise on a case or case related situations without specifics, but this is one of those situations where I would reccomend caution. Beware of what you loose in the especific application that you are considering on doing. My concern is related to what you dont get, think about it! you loose the apropriate emergence profile, which you only obtain with minis in narrow interdental spaces, remember, the emergence profile is paramount for periodontal health and cosmetics. You loose biomechanic advantages (read jarvis article on WDI compendium 1997 and read jae hoon lee and val frias, journal of prost dent 2005)remember that lateral forces will confront a thinner ar wider implants again a "wall" of bone, think logically the difference between the edge of a knife against the edge of baseball bat. If you were asking about using minis for a round house situation, I would give you a different answer, since you could use an increased ammount of minis and it would be easy to compensate mechanics, emergence and cosmetics. it doesnt work the same way when having to integrate natural teeth and minis. Dr Linkow used in the past minis conected to natural teeth with success, so historically it has been done, I have the slides he very nicely and kindly sent me and the case lasted a few decades, so he had succesful cases. The issue is, the implatologists were very limited in resources at that time and had to use the alternatives they had available. Talking to Ziv Mazor during my lecture on fixed applications of mini implants at the DGOI in frankfurt in september this year, he agreed with me that some molar cases done with minis in the nineties had to do with the limitations we had at the time in bone regeneration, today a good number of those cases, if he was in the same situation, would likely be grafted with cortical blocks or some other technique. you can ask Ziv an open question about it, you most likely would get an answer since is an avid osseonews reader, and he and steigmann would be the right and most reliable guys to answer due to their long term experience (way beyond ten years)and the fact that they dont specifically profit prom mini implants sales. The constant statement that minis are better because they are less invasive is not acceptable, we are using that as an excuse to get away with the easy way out and that is not right, we should as drs look for options and I agree, minis are an option but usually not the only one. My advise to you, is that you carefully review the reason why you are considering doing such approach, lack of bone? graft or get better at grafting (in the mean time get some help, find a good and given mentor). Lack of budget? well, think of options minis are one, no question about it, but in the maxillae you loose predictability (believe me when I tell you that the success rate in the maxillae is lower, in the mandible the success rate is excellent). Another reason could be to keep it simple? yes, it is simple, fast, easy and minimally invasive, but it may not work, Dr, it is a long span, with bone of a quality that might not be the best, with anatomical structures in your way (sinuses and nasal fossaes) so you might end up giving a lot of explanations; it is not worth it, you might want to save those agravations creating a comprehensive implant treatment plan that will be more solid and predictable. That plan, might scare the patient away usually because finances, so what? do the right thing, believe me, it is better. Humane behaviors are such that when things work, we all love each other, when they dont, we (human beings)become very picky, greety, and we forget everything that was said and told at the time of first visit. If the patient is pushing you to do something you dont feel confortable doing, DONT DO IT! If you have a new toy and want to try it, BE CAREFUL! If a Dr Is pushing a product or technique that seems fishy! DONT BUY IT! And if you see a Dr making profit (commissions over sales) during a course from what you buy, an from your account everytime you order, believe me, that dr will push the product, and will push you and invite you to use it as much as possible. I wouldnt do it, I would not connect natural teeth to mini implants as a permanent treatment for a patient, but anyone else is welcome to try and welcome to do it!

It's a dicey plan at bset. It depends a lot on the patient and the bone type. Can it survive. Possible. Is it the standard of care? Hard to argue yes. Most studies (and experts) will argue there needs to be a nminimum amount of surface area on imp,ants to support a full arch restoration. That being sad, I have a patient that has a full upper overdenture supported by 3 4.0 (dell bona attachment)and 3 imptecs which were supposed to be temporary. It's been 6 years and the system is going strong with no signs of prolems....

Mini implant fixed case protocol use 2nd bicuspids and forward in occlusion Narrow occlusal tables Low cusp form Always splinted To natural teeth is OK if immidiatly adjacent and in good health ..ie a bridge salvage Treatment of choice for lower incisors and laterals ! All are immidiate load with tempories leave in place for 3 months before final loading/prosthesis This is not pretty work It works its effective and very cost effective for you and patient Pts with less money are the greater portion of most offices Great system for the right applications SS

My rule of thumb is to use 1 MDI for each tooth missing on larger cases. I recommend 2-3 for individual molars and always splint together when possible. I have never had any problems splinting to natural teeth when absolutely necessary, but I would rather extract any questionable tooth and add another MDI. I wouldn’t cantilever MDIs either anteriorly or posteriorly. Hope this helps. Ben

Well after placing well over 5000 mini implants for fixed single, multiple units and roundhouse bridges I can comment on the questions. I am the developer of the F.I.R.S.T. Technique and patent holder of this procedure. This allows a dentist to place the Mini Implant and a permanent restoration in one visit, usually in less then 30 minutes for s single tooth and less then an hour for 4 units. We suggest 2 mini's for each molar and 1 for each anterior tooth. Using the surgical stent and drilling a pilot hole with the pilot drill guide instrument (F.I.R.S.T. Pilot drill guide) then place the mini through the guide and cement the crown(s) made by Samuel Shatkin FIRST, LLC Laboratory in advance from the impressions and xrays and bite sent to the lab by the treating dentist. We have over 98% success with this technique over the past 4 years. There is no need to temporize these mini's in my opinion. Placing the implant and final restoration with permanent cement is the best choice for long term success. Thanks and Happy Holidays to everyone!

To Todd What is your opinion on splinting to natural teeth? SS

This is regarding Dr DCsmiles cases above. Why wouldn't the case he reported be stable? He mentions that the patient has 3 implants of 4mm width (quite wide) The width of Imtec Implants he put arent mentioned they could have been wide though labelled as mini (some mini implants are 3.7 mm wide!!!) . If the mechanics of the case was well planned, and the patient had weak musculature and bone of good quality and the implants went in perfectly parallel. The patient kept good oral hygeine and changed 'O 'rings on time, I can't see why the case should fail. Of course that would be too many co incidences put together, but life has coincidences doesn't it?

similar case to above but in mandible with great bone quality, 1. question of splinting to natural teeth? Using 4 teeth with endo and post and cores{13 mm roots} and 4 x 2.4 mm by 13 mm imtec implants. 2.need to be rigidly cemented 3.need for occlusal table to be narrow . 4. need for occlusal forces to be in an axial pattern , round cusp design, and free of lateral malfunction. Cost factor, time factor, pt resists all other options of treatment...no ext. fast and non-invasive... Full explanation of alternatives from overdentures to full extraction and standard implant with splint... comments please.....