Mini Dental Implants: Extensive Debate

Mini implants has major desing problems first it is a terrible idea to place an implant without incision it is agood marketing tool but in the short term dr s will see the problem. it is like doing surgery with your eyes closed. the problem with that you can not always predict where the buccal bone is. your mini implant might be too buccal or lingual the second probleb is their size and immediate loading to put full denture immediatly will create problems in short immediatly. and patients will loose more bone.

I have used the mini-dental implant system now for about 3.5 years. It has been a great addition to my practice and to my patients. Many times I have had very mature patients present to me frustrated and dissatisfied with what their previous dentist has recommended for them as far as major costs, procedures, and surgery. The mini-implant system is mainly used in my practice for three different groups of patients. These are patients who are financially, medically, or anatomically compromised. My success with these implants has been great! Patients who have experienced this system have referred their friends and family for similar procedures. With proper diagnosis, case selection, and proper insertion the mini dental implants has proven to be a great asset to practioners and patients. 98% of my cases has been for loose dentures in the mand. region.

SHOW ME ONE STUDY with long term (greater than 5 years) results that supports DR. Shitkin's results of placing "thousands"(his words) of "permanent" (his words) crowns, bridges, or overdentures....... Sorry.....publish, or perish.... Sorry, also....Dr. Joe Gillespie, Mt. Pleasant, SC, hasn't yet placed THOUSANDS of IMTEC's......and until I see ONE reliable study placed in a reliable journal, I WON'T believe it.......

Dear Readers, Please take some of these comments with a grain of salt. We are currently doing a statistical anaylisis of close to 5,000 MDI's. Our preliminary findings are 95%-98% success with crowns and denture stabilization. We will be publishing this within 6 months. Thanks, Todd Shatkin, DDS

I have never seen an FDA 510k for the permanent use of a temporary mini implant. Why would a licensed doctor use a procedure that uses a product in a way that it was not designed or approved to be used?

I think that the most interesting thing about the IMTEC is how I started using them as a transitional implant to allow my dentist patients to "function" immediately while their other implants intergrated. Easily, 9 out of 10 times the mini could not be removed without breaking them. They were intergrated. The published reports I know are coming. To speak to the FDA issue...I was wondering how many dentist were cementing abutments well before the 510K said you could on implants?

For everyones information, the FDA has actually approved the MDI for use with LONG TERM, not transitional, not temporary but LONG TERM USE for denture stabilization, single crowns, multiple crowns splinted or unsplinted. If anyone would like a copy please contact Steve Hadwin at IMTEC Corporation. This approval was granted over 2 years ago based on 25 years of studies including those of Dr. Sendax, myself and others. Please check your information before making bold negative statements. Thanks

i dont believe because no sufficent evidence.we need proper reference and stusies on it.

Dr,may i know the diffrence between the 1.8mm and the 2.3 and the appropriate use for each one. as well the diffrence between the oball and the square head.

can we be a little more friendly please....... It is tough world out there. We should stick together ........

Dr. Shatkin or others: Can someone please comment on the long-term viability and durability in using a mini-implant on my top front incisor? My periodontist has recommended a mini-implant to repair a single missing tooth instead of a traditional, single-tooth implant. My dentist is not so sure. The literature is simply not clear on whether I should be concerned about using a mini-implant or not.

Dear Patient, The mini implant can be successfully used to replace a single incisor. The main reason to use the MDI is because the surgery is simple, it is non invasive with little to know discomfort, It is cost effective, and the results are nearly immediate. In fact, if your dentist using F.I.R.S.T. Laboratory and our technique, the implant and crown can be completed the same visit within 1 hour. Thanks for posting your question here and feel free to ask any other questions you may have. Thanks, Todd Shatkin, DDS

Dear William, Thamks for the comment. I agree, this is a tough world and we dentists should support each other as much as we can. As for the question on the diameter of the MDI's. The 1.8mm is used in more dense bone and the 2.3 is used for softer bone like in the Maxilla or posterior mandible. I use the 1.8 for lower anterior cases 95% of the time. I use the 2.3 very often for fixed cases or for upper denture stabilization. Thanks, Todd

Having placed both mini and standard size(over 3.0mm wide) implants in an "immediate load" protocol, I have found that success of any size implant is most dependent on the amount of torque (n/cm) that is applied during the final turns of seating. If, generally speaking, I can see more than 30 n/cm with mini's and 45 n/cm with standards, I am very confident there will be no problems short term or long term. If I have a thin ridge and don't feel comfortable using a larger (wider) implant, then I'll consider a mini. However using the widest implant possible, mini or standard, has been, and continues to be, I feel, the smartest course to take. Quite frankly, this little battle that seems to be waging in the profession today, between the traditional stantard implantologists, and the mini implant advocates, is all really quite silly. Bone physiology is not a sentient being, and therefor incapable of discrimation. Most doctors feel a well placed 3.5 mm wide/12mm long implant will last a long time and call it a PERMANENT Implant. And many of those same Doctors will scoff at the idea that a mini in the same place could ever last as long and would never call it permanent. But if the "Mini" were 2.5mm wide and 18mm long would it not have the same "holding power"? To think that healthy bone will osseointegrate around a 3.5 but not a 2.5 is ludicrous. I've talked to many Doctors over the last few years I've been doing my own implants, and no other issue seems to stir emotions like mini implants vs standard. But in this humble writer's opinion the whole issue will simply fade away, as the differention between mini and standard is already becoming very cloudy with the introduction of 2.5 and 3.0 and 3.2 immediate load implants. More sizes will be available as more manufacturers get in the game. Soon it will simply be a matter of asking guestions. How much height and how much width does the patient have. More height less width, use a longer, narrower implant. more width less height use a wider shorter implant. Period! Of course a multitude of other factors must be considered when choosing an implant. General health, bruxisum, # of teeth left, presence of deep overbite etc. so no one can diagnose "over the phone" so to speak. If you have enough bone height so that the longer mini implants could be used, it may be an option for you. A consultation with an experienced Mini Implant Doctor such as Dr. Shatkin would be your best bet. Now would be a good time, as I hear it's beautiful up there, this time of the year!

I have placed about 8-9 lower overdenture cases and one upper lateral crown using minis. What I like best about the technique is it's forgiving quality. When a mini snapped upon insertion, I simply placed another nearby without any negative effect. When two of them pulled out due to soft bone, I again replaced them into stronger, denser bone. I won't compare them in strength or quality to regular implants but I will say that my patients upon receiving an affordable, reversible and easy way to retain their dentures or replace a missing tooth have always shown joyous enthusiasm and long-term studies or guidelines won't change my mind.

i use these stricktly transitionally.. even though permanent use is approved, i find 1/3 fall out prematurely, and therefore i dont feel confident for long term use. iti implants have been in my hands greater than 99% successful, si if im defidient in bone i graft, widen , displace to create ideal bony anatomy and place implants with long term proven results.

I have been placing regular and wide diameter implants since 1993 and mini implants since 1999. It is interesting to see so much controversy on this topic, mini implants are to regular diameter implants what regular diameter implants could be to wide diameter implants (5's and 6's), I believe each option in the field of implant dentistry have indications and plays a role. Mini implants are an excellent player and are here to stay; they work excellent in overdentures (stick to the protocol) and they are showing very nice results as an option for fix cases in which space, bone and health is a problem, not every patient for different reasons will want or can have orthodontics, or bone regeneration and in those patients single mini implants play an important role. If we stick to the concept of surface area, the longer mini implants will have a very decent surface area which in addition to a good management of occlusion will make an impact in the longevity of the restauration. Do they work? yes they do! do they work well? yes they do! the questions is related to the ability of the practicioner and the selection of the case. We have been using them for 6 years now and when I look back, there are cases that I did with regular implants that would have been better managed with mini's if I had the experience I have today. We have never lost a mini implants, we keep strict follow up procedures in these patients and I am impressed of the results, I have not place thousands like Dr Shatkin but a very decent number for a decent number of years, also I have the advantage of having placed regular and wide diameter implants so I can compare. As I said, they have indications, protocols that have to be followed and no question abou they are safe! I personally believe mini implants are the way for drs to get in to implant dentistry! Dr Ordonez

I have restored over 50 mini dental implants over the past 10 months in various edentulous situations. Dr. Tedesco has the best response so far. You can't be "narrow minded" when treating your patients. Mini's do work in certain circumstances and when placed correctly.

The beauty of mini implant is that you don't remove so much of precious bone that is left.

I believe as a doctor we must be open minded to be able to work on new ideas with scientific basis. First bone healing will be the same around both standard & mini implant,and it could be betteraround mini imp.types because of preservation of good blood supply as result of minor invasive surgery and less bone destruction. The second point is more mechanical,which include load distribution over bone implant interface,and also retention of the implant. From my point of view, the implant diameter plays an important role (especially up 1/3)in load distribution,while the implant length is important for implant retention. I think the point is load distribution(bone implant interface). So my point of concern is: How is the crestal bone resorption around mini implants after 2 years of loading?

I truly agree and believe Sendax MDI’s are a good way to have docs get started in placing implants. I also think that it gives us an edge, as today's hot topic for many speakers in the main podium is “ Immediate Load this , Immediate teeth that, Teeth in a minute ,etc... Aren't we already doing "Immediate Loading" using this protocol ? Could the same criterias be used for “Regular Implants” in the placement for immediate load? I certainly think so. The advantage of MDI's is the ease of placement in thin ridge rather than bone grating or filing , making of large incisions overly exposing bone which we all know affect in delayed wound healing, bone loss, period. I think we as dentists can learn from each other, success or experience, rather than criticize. Guys please remember, not all mini’s are created equal…

I really appreciate all the comments re the mini dental implants. I am considering them, and have found a really negative attitude from the dental profession in general - especially in Edmonton, Alberta. In fact, no one here even does them. It would be great to hear from a few patients who have had them done, and their comments for or against. As they say: "The proof is in the pudding."

Also, I appreciate the comments by Dr. Ordonez.

Do they actually osseointegrate? I have placed many, but present them to patients as non-traditional implants, and a second place alternative to traditional ones. Mini's have huge advantages to the patients and docs alike as mentioned above but they simply don't have the documentation that "traditional" ones have. I personally don't think that means they are less likely to work long term or that makes them bad it just means they come with a little less documented predictability (risk). I think good research is now slowly coming in in favor of the mini's but at the time of my IMTECH training they had no data on osseointegration success. They had great data on case success (high number of cases but from few providers) but overtly avoided the issue of true osseointegration. Hey, I'm a keep it simple kind of guy, if it stays in and preforms its function then it works. My point is that you can't extrapolate data from traditional implants to mini's because some of the magic that makes oseointegration work is because of the CP titanium. Since the mini's are smaller they are alloyed to increase strength and therefore reduce the likelihood of fracture. They are probably just as likely to truly integrate but a good non-biased scientific mind has to respect the fact that although I believe they will work just as well they do not enjoy the same scientific backing yet as the traditional ones. That by definition adds a little more risk to using the procedures and materials. It shouldn't prevent you from using it but it should be considered in presenting options to the patient. does this make sense, your thoughts?

Dr Christenson said at the meeting last weekend that studies show, the average horz. bone loss for implants is .1 mm per year. So even standard sizes loose stability over time. He also loves mini's. He says they allow us to be very imaginative in our treatment plans, but have limitations. Mini's were designed for full denture stablization. Using them for fixed crowns is possible if you don't mind pontic type crowns, but certain rules must be followed, to maximize success rates. In the anterior segments use the longest implant possible. Molars need 2 implants each, in fact I've used 3 mini's in a tri-pod arrangement for the #30 of a bruxer, after we attained 12mm of ridge width, 8 months after Bone Augmentation surgery. Now that molar is stable! He loves it, says it's the strongest tooth in his mouth. I placed 3 - 2.5mm mini's, 15 mm in length. That's 7.5mm x 15mm in surface area. Is their a stability advantage here over say, a single, 6mm wide - 15mm long, standard implant? Think about a table with one large leg in the center, vs. the same table with 3 legs out from the center. Which one will resist the LATERIAL forces of chewing the best? Which will stress the bone /implant interface the least?. (This should stir some debate with everyone.) Before anyone gets on me about this, my patient is a 30 year friend of mine, we discussed all his non-implant options and he wasn't interested. He had many evaluations with Oral Surgeons and Prosthodontists,and received many quotes in the $5000.00 Range. After reviewing an appropriate informed consent sheet he was excited that I could help him for less than half the fee of everyone else. I was able to place the implants and permanent crown in 3 hours. I'm excited and you can bet my Patient was excited with the result. In the same vein, if you do say 2 molars as a "Bridge" place the mini's in a stagered line. This gives you a ton of stability that you don't get by placing them in a straight line. More resistance to lateral chewing forces. I learned that the hard way, had to bone aug. and replace 10 months later, on my dime. But the patient was thrilled to have a much stronger segment to chew on. Even the failures end up being opportunities for success and patient satisfaction. You just have to inform properly before surgery, and manage your cases gracefully and mini implant dentistry, as well as standard size immediate load dentistry, can be supremely satisfying for everyone. (Well....maybe not the Oral Surgeons.) And...here's another thing. My patient's don't drive Lexus's and BMW's. My people drive Ford, GM, and now they too, can benefit from Implant Dentistry! That's what it's supposed to be all about, isn't it? Helping all our patients chew again - not just the rich ones.

I place mini implants to give more stability to a transitional denture. I typically remove them when I can after several months when the traditional endosseous implants are ready for uncovering or abutment placement. I know from experience some of them must integrate as they don't back out and in some cases I've simply cut them off at the bone rather than damage adjacent bone getting them out. So in some cases, I've observed integration, but in the majority of situations, they do back out without much difficulty. I haven't run across a patient I couldn't prepare their bone for a traditional implant yet, but I could see using these products more long term for denture stability in patients who were informed about their traditional use. Regarding "off label uses", there are many examples of using hardware and medicines off label prior to FDA clearance. A few examples. Minoxidil or Rogaine, is a potent vasodilator and used in ICU's to control blood pressure long before it was a hair growth product. It was noticed to grow hair under transdermal patches and clinicians began using it for just that. Botox, initially approved for the treatment of blepharospasm, was then used "off label" for the reduction of dynamic wrinkles for years (until 2002) without having FDA clearance. I used lactosorb screws for the securing of traction sutures in the cranium for browlifts well before it was specifically approved for that particular use as well as using lactosorb plates in the mandible when it was only "approved" for midface uses. Platelet gel's first application was for sealing dural leaks in spinal surgery. We know have found a tremendous amount of uses for the product which I have no idea what is approved and what isn't. There are some clinicians who use a piezosurgical unit to perform some osteotomies (mectron.com). This is mainstream in Europe and in Canada, but has no FDA approval period here. It used radiofrequency waves at a particular wavelength to cut bone and spare soft tissues like vessels and nerves and membranes. It is a wonderful product and who knows when the FDA will ever approve it as we use piezosurgery for apical preps and other dental applications. Therefore, "off label" uses are commonplace in the practice of medicine and dentistry.

Wade, If you had a choice of not using the minis for those 50 implants you've restored, what would have been your optimal treatment plan if the patient did have sufficient bone and money? Or do you think the minis are as good as 40 year tested root form implants?

Dear colleagues, I wonder some missing information about those MDI. Bite force analysis is an important parameter in functional loading. Are there any results about these? What about the physical properties of a thin implant? Can it resist the diagonal forces aplied during lateral and protrusive jaw movements as standart sized implants? Does this cause any change or loss in osseointegration in the long term? Does the patients use their MDI implants effectively? What are the indications? Can MDIs substitute standart sized implants in any way? Those questions should be answered before saying "This is a safe procedure". I am a scientist as well as being a surgeon. Scientific researches are the definitive guide for us. As Dr. Oyster said "publish, or perish". H.Aykut Ozyigit,DDS

By the way, FDA approval is not our criteria for confident usage. Here is an example for what I mean: Year 1999: FDA approved vioxx as a COX-2 selective non-steroidal anti-inflammatory drug. Consider the current day. Year 2004:Merck announced a worldwide withdrawal of Vioxx So I'm looking forward to Dr. Shatkin's journal article. H.Aykut Ozyigit,DDS

Does anyone have any experience using two MDI's to support a lower 4-unit anterior bridge (ie: in a situation where there is very little space- and it is anticipated that very small (M-D) restorations will be placed)- in a "little old frail female?

I had never seen so many questions and hot arguments about a topic like I have seen with this mini implants; it seems to really affect some people. Remember, they are an alternative, thanks god we have alternatives! they require additional training even if you are an experience clinician, they are easy to place but technique sensitive. I run a TMJ center in miami, a graduate fellow of the TMJ center of Tufts university in boston and a professor for different educational institutions in and out the USA. I have a population of patients conformed by heavy clenchers and grinders, In 1994 was one of the main researchers for the development of the T- Scan II and wrote the foundations for what is today the Tscan III which combines EMG and computerized occlusal analisis(have a recognition letter from the company. We have TMJ edentoulous patients on mini implant overdenture, we have done bite force analisys to these patients and EMG, the results are no different than any other patients since the main component of forces is been directed to the tissues in vertical forces and to the flanks of the denture in horizontal forces, no regular diameter implant or mini implant is supposed to absorved the main component of forces in an overdenture situation, the implant or mini implant role is mainly to resist vertical dislodgement of the overdenture component. Dentures and overdentures are supposed to have an occlusal design functioning in balanced occlusion, which is a very stable occlusion design created by engineers (not by dentists) for improved stability. In a fixed mini implant condition, I have had to asses cases, and my very personal impression is that forces need to have a pattern of distribution and dispersion in which the different components of the occlusal set up share the applied loads, at no time should a single component including mini and regular implants act as a fence that obstruct mandibular motion. In a patological case of a clencher or grinder where forces are abnormally applied or abnormally directed, it doesnt really matter if regular implants or mini implants or natural teeth will be affected, the forces will have to be dispersed and the occlusal set up better be right or the effects will be felt. Diagonal forces will always affect any type of structure under the effect of the forces, as clinicians, our duty is to diagnose them on time and protect the structures redirecting the forces in function and parafunction. A normal human being will be in rest position most of the time and applied forces will be of minimal duration. So yes, forces will affect integration of anything over a long or not so long period of time if left undiagnosed and untreated, PLAN FOR IT! Patients use their MDI efectively, we have cases with 6 year follow up to prove it (TMJ patients with overdentures) can they substitute regular implants? it depends on what you want as a clinician and what you want to do with it,and what you need them for but mainly, it depends on the expectations of your patient. Alvaro Ordonez

You may be right on some subjects but as I told before the answers of these questions should be answered depending on scientific records. There are no stress strain analysis about MDIs (no published). This technique is so new and hasn't proved its reliability yet. Functional diagonal forces doesn't affect either osseointegration in standart implants or natural PDL structure. Even those are stimulating forces. But the physical properties of MDIs are very different including perhaps the most important of all, its radius. I used the word substitute since many of our colleagues tend to use MDIs in every indication of implant placement. Todays implant concept is immitating the natural root structure. MDI is not an innovation in my opinion. It's just a way of thinking commercial. I'd rather wait for maturation of this MDI concept before applying it to my patient. H.Aykut Ozyigit,DDS

me interesa la relacion que existe entre la superficie del implamte , y el hueso .

In reply to Dr. Shatkin's FDA approval, this is not consisent with the information I had received from the company last year. I had a lateral incisor case with inadequate spacing for a tradition fixture, when I called the company and asked customer support about the use of the mini-implant for single tooth, I was told the implant was not approved for single tooth, but many surgeons are using it in that application. I then proceeded to call my state department of professional regulation and they informed me that if anything went wrong then the surgeon placing the implant would be liable. Fellow surgeons be careful you are treating your patients to the standard of care.

to:geoge joseph mitoraj Si ud. quiere saber mas del huseo y el implante, comprate un libro y a leer.

Dear Dr Ozyigit In the most respectful manner (I dont mean to be or sound disrespectful at any time or step on anybodies toes), I would like to remind you that scientific evidence of clinical issues can only go so far, and that even the best evidence can be subject of manipulation, so even those "scientific papers" if produced, will not necesarily be right. in the mean time, you and many respectful clinicians will be loosing the chance of using this technology as an alternative, listen carefully, AN ALTERNATIVE for treatment. The stress strain analisis can be conducted by yourself if you have access to an instrom machine, all you have to do is to place the device or material to be tested on the machine and apply different types of forces in any direction you want. you can also do it with finite element modeling. I would assume the companies that produce mini implants would have this information so the best option is for you or any other dr interested in this field to contact any reputable company that produces minis and ask for the results of their tests, which I am sure they already have. The technique is not new at all, these type of implants have been around for a very long time, with different names and brands, made in different countries, in fact, the first time I ever saw a mini implant was in brazil in 1994 or 95, and they already had long term cases, so make your numbers.in the states, I know of cases made in the 80's. I would also like to refer you to the work of the tramonte family in Italy. I also have to disagree with your statement that "Functional diagonal forces dont affect either osseointegration in standard implants or natural PDL structures", that is a misleading statement and completely untrue, to make it simple, I would like to refer you to "contemporary implant dentistry" the book of Dr Mish, which is probably the best book in implant biomechanics (but not the only source) for the part related to standard implants of your statement, for the part of the "natural PDL structure" just look at Dr Glickman periodontology book, which has a very nice chapter related to this topic of forces and effects on the bone and teeth. For forces to be stimulating, they have to be within a normal range not at a parafunctional level, parafunctional forces are always destructive, remember, there is a big difference between function and parafunction, patients are also different and respond different. in a patient with parafunctional habits you need to assume that whatever material you place will be subject of harrasment by the habit, no matter how well you plan it. my advise is that the clinician should protect the dental structures and restorative work with splints, but that is another topic since you as a clinician will need to select the right type and design for the splint. I HAVE TO AGREE WITH YOU AND I WAS CLEAR ABOUT IT THAT MINI IMPLANTS ARE JUST ANOTHER TOOL IN OUR ARMAMENTARIUM AND ARE NOT THE INDICATION OF EVERY IMPLANT PLACEMENT. I also agree with you in the fact that physical properties and radius are different and will be an issue when planning for a case; "radius" which I prefer to call diameter, will afect the cosmetic result of a restoration since it has a direct effect on the emergence profile of a restoration, this is important specially in patients with high smile line. Mini implants have been comercial for many drs, I disapprove anything that is treated that way (but it is the fault of the dr not the fault of the product), drs should be able to explain to a patient all the possible options and the good and bad of every option. I like your position as a devil advocate since this brings controversy and controversy is good as long as it is done respectfully and with the purpose of advancing the field and knowledge on behalf of our patients.> sincerely Alvaro Ordonez

Dear Dr.Alvarez, Thanks a lot for your patience and attitude you assumed. But I wonder if I've said something irrespectful. If so I'm so sorry. But again I can say that I'm not satisfied. You've implied my words about diagonal forces, but I think you ignored the word "functional" at the beginning of the statement. I agree with you with what you said about parafunctional forces. It's true. But functional forces is the key of immediate loading for example (of course not that simple). One more thing is the analysis. It's not so simple to perform such a detailed analysis. And also you should appreciate that we have other interests and scientific works to be done. This type of work will be so expensive and time consuming(just for us). There are a lot of scientists who can perform this and of course one of them is you. May be you can do it for us and report it. Of course report the success of your cases. These data are very important for me. I can't say I'm completely against this method. But the only way to satisfy me and many of my colleagues thinking like me is scientific results (and not the manuplated ones of course, as you told). I've always liked those kind of discussions about scientific matters. This is the only way to broaden our horizons. Yours faithfully, H.Aykut Ozyigit,DDS

Dear Dr, I had a good deal of exposure and time to play with instrom machines while a resident at Tufts in the early nineties, they had a nice machine at the cosmetic department and the lady engineer in charge was a good friend, I dont do that any more but I am very familiar with the process and it doesnt take that much time. My line of research is different now, last year we developed some expanders that were presented at the annual academy meeting in orlando, the abstract was published in their meeting book. this year we are continuing the same line of research, our work at this time is the development of a collagen membrane with some very specific shape and functions to fix perforations in the sinuses in "atraumatic or minimally invasive sinus elevations" (sinus elevation techniques performed from the alveolar ridge instead of lateral window), I will try to contact one MDI company and ask them to post here the results of their tests of mini implants, I would assume they have it, if they dont, I will ask them to produce it. It would be nice to have a company independently evaluate all of them in laboratory conditions and post some results. One of the reasons we were able to produce the expanders we did (independent research), surprisingly enough, was thanks to the initial result we had with the expansion and self threading\ tapping component performed at the mini implant placement many years ago. Expansion is a regular practice done in implant dentistry this days, but it is another "VERY HOT TOPIC" and not the main topic here. To finish my participation here for good, I just want to say that occlusal set up is in the hands of the clinician, Dr W Askinas, one of the best and most respected and experience prosthodontists I have ever known said once to me "It is not the occlusal design you choose, it is how well you use it", we as dentists have so many choices to work with but we only learn to work with one set up, or we only "dare" to work with one set up, in special situations, a good management of occlusion will make all the difference in the clinical result, specially in mini implant cases were forces will make all the difference in the world. The same way we have different products, shapes, diameter, lenghts, internal, external hexes, particla size, mixtures, alloys, materials ETC. We have KNOWLEDGE to make the choices,CHOICES that thanks god we can make since we can choose from a variety of products and brands, and WISDOM that thanks god we have to make our choices. Alvaro Ordonez

Just again.....publish or perish. I've read ALL the comments, and an underlying theme is: Yes they work is selected cases. Yes they HAVE worked in UNUSUAL cases.... And YES I use them, but only as they were approved by FDA, that is lower denture stabilization for "long-term" whatever that means. I still tell patients they are a "low-cost" alternative, but have NO long term studies to show how long they will last....UNLIKE 30+ years of 2 Branemarks.....and let them make the choice. Its still amazes me the number that want the REAL THING...i.e 2 REAL implants on the floor!! And Yes, Just because the FDA "approves" it, doesn't mean it works......(Vioxx, and silicone breast implants??) NO ONE has yet to tell me what REPUTABLE JOURNAL has published a good study (please, not case reports or just anecdotal...) i.e Academy of Osseointegration (JOMI), IAID, JPerio, OMFS Journals, that SHOW long term success rates...... All due respect to Dr. Shatkin, et al, and their BLOG reports of success, and articles in trade journals that STATE success, I have yet to read properly presented data in PEER reviewed journals.... An article in Dentistry Today, ADA News, or General Dentistry, or even CRA means little to those who pursue SCIENCE over SHOW. I AWAIT WITH ANTICIPATION the Dr. Shatkin, etc's PEER REVIEWED DATA IN PUBLISHED ARTICLES IN REPUTABLE JOURNALS. Sincerely, DK Oyster, DMD, MS Diplomate, AMER. BD. of Perio

try one on your dog to see if it works! buy my book and my buddy Garg aka "gargamel"

I read with interest the discussion between Dr. Shatkin and the many users of mini implants vs those that are for the standard and large diameters. I share the same passion as Dr. Shatkin for the minis,in fact I prefer the term "reduced diameter" to that of "mini". Try replacing a missing lower central incisor and the term "reduced" will be appreciated. I have been using the Imtec implants in Malaysia since 2000 and have conducted several seminars since then. These implants work wonders and many of my patients not only sing praises about them but also refer their friends and love ones. Thanks Joe Gillespie for introducing these wonderful implants to me in the year 2000 at the Putra World Trade Center in Malaysia.

Does anybody know the URL or the phone number for the F.I.R.S.T. Laboratory? Thanks!

mmmm....so the dentist is being paid to lecture and train by the makers of the implant? is someone else doning the study? seems like it would be a conflict of interest,....but anyway. i am a patient, about to get endure implants. thought i had found a great dentist.....thought the $1800 per implant to hold dentures was for the standard implants, not minis. but he wrote dowm "endure" implants, and from internet and imtec site have found these actually are minis, and the day of extractions i get two on top and two on bottom, to hold dentures, yet dr. shatkin even says not a good idea on day of extraction? am i being overcharged for something destined to not work?

Dear all, I have not posted any comments in a while. I want to inform everyone that the article is completed and is being submitted for publication as we speak. I think once it is out you will be pleasantly surprised by the statistical analysis. Yes I am a paid lecturer for IMTEC, and yes I am an owner of FIRST Laboratory, LLC. But the only reason I was asked to lecture for them is because I had placed so many of the MDIs with great success. And the only reason I accepted the invitation to teach for them is because I was and am so excited about the procedure. Hundreds of my patients have benefited from the use of the MDI to stabilize loose dentures, replace individual and multiple missing teeth in one visit and even for full arch reconstruction. This has been a truely amazing procedure for my patients and my practice. We are having a 2 day advanced MDI Training program in Las Vegas on Feb. 24 and 25 at the Mandalay Bay Hotel Resort and Casino. Anyone interested in attending can contact me by email or phone at 716-839-2959. " Do not go where the path may lead, go instead where there is no path and leave a trail " Ralph Waldo Emerson

Thanks Dr Shatkins for the coming publication and I look eagerly to review it. The Imtec MDIs are gathering momentum in the Asian regions. It is great feeling to know that there are dentists that are trail blazings and passionate about what they are doing. My colleague and I will be conducting courses on the MDIs in Yangun and Mandalay in Myanmar in March coming. Hope that we can be of help and also enjoy helping our patients too.

I've just pulled this off PUBMED. Long-term, multi-centre study looking at 1,029 MDIs over an 8 year period. Compend Contin Educ Dent. 2005 Dec;26(12):892-7. Related Articles, Links Multi-clinic evaluation using mini-dental implants for long-term denture stabilization: a preliminary biometric evaluation. Bulard RA, Vance JB. Department of Implantology/Department of Oral Maxillofacial Surgery University of Oklahoma College of Dentistry Oklahoma City, Oklahoma, USA. Mini-dental implants (approximately 1.8 mm to 2.4 mm in diameter) can provide immediate stabilization of a dental prosthetic appliance after a minimally invasive procedure. Furthermore, mini-implants can be used in cases where traditional implants are impractical, or when a different type of anchorage system is needed. Healing time required for mini-implant placement is typically shorter than that associated with conventional 2-stage implant placement and the accompanying aggressive surgical procedure. The design of mini-implants is such that insertion techniques minimize peri-implant tissue and bone damage. Because of their versatility and ease of insertion, mini-implants have proven useful as transitional stabilizers and as fixtures for long-term prosthesis function. This study of mini-implant successes/failures provides data for a thorough review of long-term mini-implant in vivo performance. A biometric analysis of 1,029 MDI mini-implants", 5 months to 8 years in vivo, representing 5 clinics, facilitated this study of the MDI as a fixture for long-term prosthesis stabilization. MDI failure rates for stabilization on average were 8.83%. These analyses establish that the MDI mini-implant system can be implemented for long-term prosthesis stabilization and deliver a consistent level of implant success.

Dear readers, Many of you have concerns about the use of the MDI for various reasons. Some think of them as temporary, some think they are too small to hold a crown and some just don't want to believe that they will work over the long term. That's fine, because while you are questioning these procedurs, thousands of dentists are accepting the MDI for long term success and are treating many patients with this amazing, simple and cost effective procedure. These work, and work well for both removable and fixed applications. If you still wonder, then ask Dr. Gordon Christensen. I recently had a meeting with him in Provo and he is also using these for both removable and fixed applications with "remarkable success". I encourage all the naysayers to consider trying this, but if you don't it's ok. The rest of us will take care of all your patients who choose not to have the conventional size implants placed. All the best! Todd

Wow, Published in Compendium. That is such a prestigious puplication. I need to see the M&M and stats on this.

Mini dental implants are at the same stage that reqular implants were in the 80's. Conventional implant and the clinicians who used them went through a period of baptism by fire before they finally became main stream and now the treatment of choice. Mini implants are at that same point now. I have been using mini implants to help my patients who are not a candidate or can not afford conventional implants. When a patient says NO to coventional implants what do you have to offer them to aid in denture and partial retention as well as single tooth replacement in a compromised area. If you don't use mini implants you have nothing. Unfortunately too many of us want 20 year studies and are not willing to try something new even though our patients will do what ever it takes to solve the problem. I have 5 year follow ups on a lot of my cases and they are still going strong. I use mini implants not only to retain dentures and stablize partial dentures but also for bridges and single units ONLY IN SELECTED CASES. Conventional implants are my first choice but you need a secondary treatment plan. Mini Dental Implants can also be the Duct Tape of implant dentistry. Check out my site to see what can be done and is being done successfully. www.minidentalimplants.net.

Thankyou Dr. J. Kacaba for the very interesting photos re mini dental implants. Your website is very well done, and I see that some of the patients have very little bone left on the lower, and are still able to have the dental implants. Thanks again. Keep up the good work!

Hello, I would like to know if there are any doctors who would give me mini implants to support an Upper denture or perhaps a small bridge. I have been in agony wearing these upper dinosaurs and need to find a doctor willing to perform this ( upper mini implants) on me. Money is no object, I just need to live in the real world again ( i havnt been to a restaurant in 5 years ) Am I asking for the impossible. will someone please help. thank you

is there any website the post pictures of mini implants that is used for briges and individual crown? We really need a site like this to help us who practices mini implants.

Dental Implants vs. Dentures - The top reasons why dental implants are better than dentures. Dental implants are very strong because of the method of placement. There is no problem with slippage, which means that you can eat and speak with comfort and confidence. Although modern plastics allow us to provide dentures that are a little more comfortable, many patients still complain from denture pain, especially those patients with a full set of lower dentures. Modern technology allows for an accurate fitting of dentures for each individual’s mouth. Even with such advances, there is still a problem of denture slippage and discomfort. Looking at a smile with dental implants is like looking at a smile with natural teeth. Once teeth are gone, the jaw bone will continue to erode away over time. After a number of years, the patient can be left with an alarmingly thin ridge. The ridge may be so thin that the patient cannot wear a denture and may be succeptible to jaw fracture. Dental implants have been shown to, like teeth, "hold the bone" so that this erosion over time does not take place. Since dental implants offer greater stability, the dentures can be made with less material thus leaving such structures as the hard palate open increasing the taste of food. Dental implants allow anchors for dentures to "snap" on to. In some senarios, these dentures can only be taken out by your dentist. In other situations, the dentures can be removed by the patient but only with some effort. Dentures cover large areas of the oral cavity containing many taste buds thus making eating less enjoyable and food less tasty.

how do you eat or what do you eat and for how long right after you get implants installed? Example: yogurt, jello, mashed potatoes,etc. for 3 mos.? or __________________ ___________________ thank you so much for this discussion.

I have litle experience with mini implants sice last december i am using Ace mini implantes with surface just like the standards. I have used them first for provisional treatment in adverse conditions (multiple extractions) and i put them between sites of teeth extraction, imediate function with tipe o´ring conection. 3 implants for each maxilar, and they are working greatly. since then i am using them also as definitive in the case of great bone loss in superior maxilar. and as a suport of parcial dentures. But i do not trust them (for now) as being a suport of ceramic crowns. I only use them in overdentures rhe other treatments i use standard 3,75 and 5 mm implants even with parcial flapness tecnic. I do hope they work.

After reviewing the extensive number of posts regarding mini-implants, it seems to me that you're for or against, that there is no middle ground. In regards to long term studies, let me remind the readers that unless you read Dr. Branemarks statistics carefully, failures were not counted if another implant was placed, failures were not counted if the prosthesis was successful. We are all here to help our patients. Those of you who have been around long enough have seen successful blade implants, ramus frame implants, various finned cylinder implants, mandibular staple implants and subperiostael implants change patients' lives. A screw is not a screw is not a screw and even with "traditional screw type implants" we can't extrapolate data regarding success from one to another. Same regarding abutment connections and crestal bone loss. If all we have in our practices are "ideal" patients, that is: healthy, young, financially able and ideal surgical candidates for dental implants and the prosthetics, then to restore a lower arch with 4 on the floor, hader bar implant supported overdentures at maybe 10-15 thousand dollars and treatment time of 4-6 months may be the way to go. But doctors, are you making any gaurantee with this Cadillac of options that you promote. Of course not. I have seen first hand at one of Dr. Todd Shatkins courses the placement of 4 implants, yes, one even broke and another was placed along side, in a minimally invasive surgical approach with only a little local anesthetic in a fully conscious patient and adapt a lower denture in a little over an hour. We also viewed the placement of 8 mini implants supporting immediate posterior and anterior bridges. Although I may not use this immediate technique we are seeing manufacturers downsizing diameters of implants particularly for use in the lower incisor and upper lateral incisor positions. I have not to this point heard anyone claim 100% success for any implant system. We will have success and failure. Many factors are out of our control once the patient leaves the office. If you have an elderly patient in fragile health, anatomically compromised on a limited fixed income, distraught that she can't eat or function after being treated with relines, suction cup liners, soft liners and denture glues and you can offer the placement of 4 mini implants and even adapt her lower denture at a reasonable fee and with confidence that you can help her, what a rewarding experience for all involved. Inform the patient of all treatment options, fees, and yes even the fact that the long term studies may not match those of other more invasive and costly systems, show them models of the implant and prosthetic options and see what will happen when they remove that lower o-ring retained denture from the model. You don't have to sugar coat or be evasive. Let the patient decide. In regards to Dr. Shatkin having vested interests in the Imtec implants or F.I.R.S.T. technique, so what, he is perfectly honest about it. This has not always been the case with other courses I have taken. Thanks Todd for giving me another tool to offer to and help may patients.

I am considering implants to stablize both a full upper and lower denture using 4 implants in the lower jaw and 2 implants in the upper jaw. The surgery portion of the proceedure was what I thought was in my price range, but when it came to the cost of the dentures I started putting on the brakes. My questions are: 1) What is the major difference in the cost of a denture? (My current dentures of 10 years were $700 to $800 and now the cost is $5000 plus $500 for each implant snap-on for a total of $8000) 2) My research on the web tells me that the "mini" implant is designed to stablize my dentures. Is this correct? and 3) Are 2 implants in the upper jaw enough to stablize the upper denture?......Thank You

To the patient posting fee concerns. Fees for the prosthetics with implant supported removable dentures can vary widely based on the attachment type from the very simple round ball attachment with a soft liner placed in the denture to grip the ball on the implant, to a slightly more involved o-ring retained denture, to the vastly more complex and costly bar supported removable dentures. Understand that many of the implant procedures are costly to the dentist regarding material costs, laboratory fees, time involved and the complexity and possibility of fit problems requiring the added expense of remake. No dentist would attempt to diagnose or second guess your dentist based on a chat room post. Talk with your dentist, ask him or her the questions that you have regarding your treatment. If you have read the entire posts about mini implants you can see that there remains considerable controversy. Voice your concerns. It is your body, your health and your money. If you go to a dentist who places only "conventional implants" or a dentist who places only mini implants you may get only one viewpoint but you may also get satisfaction in regards to your questions and concerns. seek out a second opinion if you are unsure. To answer your question regarding mini implants, in either jaw a minimum of 4 is usually recommended, but a nice option to consider if it is possible, is the placement of 6 mini implants in the upper jaw with an open palate denture. Less bulk and food will taste better. I hope this helps you.

Thanks, Dave for the info, I guess my shock was over the cost of the dentures without any of the implant hardware installed ($5000 for both upper and lower). I feel the cost of putting in the implants was fair and in line with what i expected, but when I visited the dentist and was told the cost of the dentures I was floored. In fact this has become a "show stopper". That is why I am investigating the mini implant as a solution. In closing I have just one more question. What is the difference in the dentures costing $700 - $800 for both uppers and lowers and the ones that cost $5000 for the pair? (I am refering to just the plan denture without any implant hardware).

I would like to comment on Dr. Tedesco's comparison of the surface areas of 3 of the 2.5 mm wide by 15 mm height implants to that of a 7.5 mm by 15 mm implant. They are not the same. Assuming that the implants are parallel walled cylinders with the sides and the bottom surface integrated to bone, the surface area is π rr + 2 π r h. Three of the smaller implants have 368 mm square of surface area vs 397 mm for the 7.5 mm implant. Of course, I am in no way implying the comparison of the two types of implants is a simple comparison of surface areas. A 7 mm wide implant would have the same surface area as 3 of the 2.5 mm implants

Dear Colleagues: I have read with great enthusiasm all your current commentary on Mini Dental Implants. As the originator in 1976 of the MDI device and patented insertion protocol (that is the core "secret" behind an MDI's immediate bony integration and functionality), I am clearly impressed with the high level of clinical success evidenced in ongoing reports and studies relating to the IMTEC/Sendax MDI System. As to the inevitable opinion controversies that arise, no professional modality should be immune to scientific scrutiny. In sizing up the competing marketed products it is often said that imitation is the sincerest form of flattery, and I rely on my colleagues' respect for the concept that the "original" has the best track record for credibility & long-term reliability! P.S. The FDA & Dr.Gordon Christensen do concur!

Hi I keep having trouble with Nobel Biocare Direct implants, they seem to work fine during the first months bau after 5 or 6 months movility appears ,, what could be going wrong??

Does anyone know about studies correlating the primary stabilization strength to the bone compression around the implant, with success rates for different strengths/compressions? My doubt is wether there is possibility of applying too much strengh on a MDI thus over-compressing the peri-implantar bone, leading to the colapse of small vessels and cellular death, resulting in bone loss. Thanks for your time.

Branemark generally copied the size and the shape of the tooth in designing his first implant which is logical and made sense at the time. Everyone copied him after that without too much thought about the validity of his assumptions because it works. The question today is how much osseointegration is required to support a tooth say, the premolar in the mouth. The answer to this question will determine how big an implant should be and therefore will determine whether we should continue to make root sized implant fixtures or reduce and minimise its size optimally. How much osseointegration in terms of surface area and quality of bone attachment is required to support a premolar satisfactorily in a functioning dentition needs to be examined closely anew. Lets assume the quality of osseointegration is uniform for most interfaces between the bone and titanium surface. Therefore looking at just the surface area required per se, it follows that if osseointegration aka ankylosis is say, twice as tough as the normal periodontal ligament, then my friends, it seems that the minimised diameter implant is going to triumph over the conventional sized implant as the main workhorse in dental implantology! To say it simply, if it is true as we all know that ankylosis is tougher than the periodontal ligament sq mm for sq mm, then the minimised diameter implant is sufficient to hold a normal tooth! Has anyone done a comparative study between a normal periodontally held tooth and an ankylosised titanium implant? Its beginning to make more and more sense to me that a small diameter implant is actually sufficient to hold a tooth and if true , its good news for everyone because implantology is going to be cheaper , easier and more versatile than it is now.

dear drs i believe most of the doctors posting messages here are very senior and experienced i too have placed many minidental implants in mostly denture pattients and i feel good the patients are satisfied. regarding the durability and viability of these implants i would say if the MDIs are of good quality, and of titanium for sure and u have good surgical and anatomical skill i should not fail u at all since many box frames when used on skin for fixations of a fracture, bone gets a very good healing around them. in the end i would say correct surgical technique with good surgical hands and with proper proper protocol of this surgery the MDIs are still the best its the matter of affordability now both in terms of finances and time duration required for placing regular two or three stage implants. with regard to many of u there is no harm in using a product if it is scientifically proven and giving u result.

Dear Drs My mother is having severe problems caused by ill fitting lower dentures, she basically has very little ridge to support them, mini implants to secure a denture may be an option but surely the denture needs to be pretty right before securing it in place, the last thing she needs is more problems am I right?

Dear NikkiB, Your mum sounds like one of my patients. 4 mini implants were place on his lower ridge and his loose lower denture was fastened reversibly to the implants. Reversibly means that the denture can be fastened and removed at will for cleaning purposes. Generally, the existing dentures is used so that the patient need not have to get used to a new set of dentures. Once the patient is used to the implants, a new denture can be made if necessary. This particular patient was 82 years old. He was able to eat much better that very night. Hope your mum's problem is solved soon. Mini implants are very forgiving in the sense that its easier to place than the conventional sized implants and if one fails, it can be removed easily and a new one placed immediately if necessary. warmest regards. Dr. kfchow

I have a patient with poor fitting upper complete denture. I m thinking about putting 6 mini implants on her thin resorped ridge. I like to know what s the success of upper mini supporting overdenture?

placed then palatal .longest one 18mm, open a flap to see the bone or have CT scan place more than 4 like 6 is OK.Just in case they fall off you'll have some left.

can some one tell me what is the diffrence btw.sendax MDI,Intermezzo and Noblebiocare ipi.I am using sendax MDI,works well for lower over dentures but single tooth replacement?.So recently i discovered Intermezzo(Korean,Megagen)and used for upper lateral incisors,it looks good.But it is new.I am looking for some coments on this product from users around the world.I am in Malaysia.

I am seriously considering using dental implants to replace a series of missing teeth in my lower central jaw. From reading all these posts I gather an experienced skilled dentist can do a good job inserting these MDIs and there is a good chance they will last quite some time. My question is how does a patient find a dentist who is skilled and experienced at installing these MDIs? I want only the best to do the work. I live in Portland Oregon.

the other blog on mini implants is interesting. FDA requires an implant to be 3.0mm or more. Intermezzo is 3.1mm but not many are familiar with it. MDI the market leader, will never use the word implant on its own. Dr. Shatkin stated in June 2005 that a study would be published in 6 months. It is now 6+9 months. Has anyone seen anything? The marketing can really confuse you. Be careful.

Can somebody show me the link to the stated FDA requirement of an implant that isn't one if less than 3mm diameter. I can't get the search result on the FDA website, thanks

Try calling them for the link. That is what I did and they did give the criteria for an implant.

Here's a guideline. See section 12. http://www.fda.gov/cdrh/ode/guidance/1389.html

Thank you Bruce for your help, really appreciate it. It shows how useful such a blog or forum can be.

Drs. Sendax and Shatkin. Will you comment on the subject of lateral force and fracture at the neck of the MDI 1.8?

I have been placing Minis for quite sometime with great success for overdentures. Minis give great stability and functionality. I have lots of satisfied patients with overdentures on these. I use 2.5mm (Max) and only one of them have come out so far but patient using denture with three implants without any problems. I offer this service to my patients at a very affordable price of $500 each. I place these after 2-3 months of extraction of teeth, I place metal o rings after 2 months of placement of implants. I use soft liner in the denture while integration is taking place. This is a revolutionary treatment and I am very excited to offer this to our patients and I am available to answer any questions on this. Please email me at sharmadental@yahoo.com

I have been using mini implants since 2001 for single units, denture retention, distal extension partial denture retention and as transitional implants which are removed once the conventional implants have intregated. But the biggest use for these implants is that they enable many "bail outs" from difficult or impossible situtations. Unfortunate they are currently experiencing the same rep that conventional implants did back in the early 1980's. You know only hertics used implants what was wrong with conventional dentistry. With respect to the tools of the trade mini implants are virtually indispensable and as versatile as "duct tape". For those of you who want to know more about how they can be used I give a course: The Unique Versatility of Mini Dental Implants: Opportunities for the Creative and Resourceful Dentist. I do not represent any one company and tell it the way it is. Man only sees what Man knows. The important thing is not which mini to use but being able to recognize the numerous applications.

Another article just published Compendium February 2007 Vol.28, No.2: Mini Dental Implants for Long-Term Fixed and Removable Prothetics by Drs. Shatkin and Drs. Oppenheimer. They study 2514 MDI's over a 5 year period. Success rates mirror Branemarks.

I use mini implants in my practice for four years now.The key to success with these implants is 1- case selection, I only use the 2.8mm Maxi-thread implant ( because of the diameter size ). 2- the ideal patient is one with an atrophic mandible or maxilla in both a vertical height descrepancy and a buccal lingual or palatal deficiency. They work well in elderly patients ( median age for my patients is 80 years old or over, I placed two on a 94 year old man , who lived to 97) the important factor is the prosthes should oppose some type of acryclic restoration. This will dissipate occlusal forces. These implants are very technique sensitive, if you deviate from the directions you can sheer the head off ( not good)

I had inserted 4 mdi in the anterior region of mandible 2 week later.this system has many differences in regard to conventional implant system. 1-you have no primary stability in area 2-you confront with a up &down motion that made impossible the adjustment of housing in the acrilic denture,and if you want to have a stability by increasing the rotation of fixture you could not finally adjust the housing to the fixture. the problem of mobility is because when you drill the area in depth of half to two third of the estimated length you simply had lost the stability in huge area located in the coronal section.after a time you have aloose connective tissue that adher your implant to the bone that should last maximum in the ideal situation 5 years.

now,it is about 4 years i have been using MDI and osteocare systems for loose dentures and a single tooth replacement.faild cases not more than 3 percent and rate of paitent satisfaction not less than 100 percent.no sutures no echimosis,no knife,specially for elderly persons and the stress of surgery.Ihave even used maxi osteocare implants to fabricate the posterior mandibular bridges with high sucsess.

My husband is considering mdi's for his lower dentures. He currently does not have a denture plate...he still has 8 of his own down there. He is 45 years old and has had a top denture plate since he was 22. It seems that the majority of posts deal with the elderly...Is someone of this age a good candidate for mdi's? Also, can he be fitted with a lower plate and mdi's at the same time. Thank you, Delinda W.

Delinda - absolutely your husband is a good candidate for an implant retained lower denture if the remaining teeth are beyond salvage. Depending on the position of the lower teeth an experienced mini implant dentist may be able to extract the teeth, place at least 2 or 3 or 4 minis with the intention of adding the rest (4 will be needed long term) and probably deliver the immediate denture with retention by the implants at the same appointment. I have done this several times now, and it makes an amazingly comfortable immediate appliance. I always build a new denture after the final implants are in place and stabilized, and add the housings to the denture in our own lab prior to delivery. Patients love the immediate snap fit, greatly reduces sore spots due to denture movement as with conventional dentures. Good luck to you and your husband.

To all Doctors debating this issue; THANK YOU. As someone with only 8 remaining teeth on my lower jaw (all centered in the front), I am faced with many options, none very inexpensive. I have no insurance & have taken a loan from a friend. I would love to have the standard implants for both upper & lower jaw. My Dentist has recommended the standard implants for the lower jaw at an approximate cost of 6,000 for just the implants alone. I am faced with costs upwards around 10,000 to fix my teeth in the best way possible. The one thing I don't understand is why the cost of standard implants is still so expensive. It is a proceedure that has been practiced for decades & performed by thousands of dentists around the country. The cost can't be in the implant itself as it is so small & becomes much cheaper to produce over time. It's hard to believe that the proceedure is so time consuming or difficult for a good dentist to perform. I have been plagued with dental problems for years & am at a point (out of frustration) that I want my mouth FIXED NOW. It has been a source of health problems for years now, not to mention the limitation of foods that I can eat & the self-esteem issues I face daily. Debate is good & will eventually help the entire dental community to improve their services to the public by leaps & bounds. But I must say that right now I just want sound answers on the subject from someone who truly knows something about MDI's since it appears that this is the most affordable solution for permanently addressing my dental needs. From a logical stand-point, it seems that the MDI's are possibly an alternative to costly standard implants, & if done correctly, can afford a patient a permanent, affordable solution. On a final note, many of you may not be aware of just how many people need real, reliable dental help. So many don't have insurance or simply can't afford proceedures not covered under insurance. There are clinics all over the country that provide services for those who cannot afford regular doctor or dental visits. Please consider volunteering your services to these local clinics that are understaffed & almost always under funded. Not only could these clinics benefit from your services but the patients would most definitely benefit. Thank you all for your efforts in making the lives of people who suffer much better, & for giving many of us back our smiles & ability to eat. By the way, I drive a '93 Buick LaSabre. (To the Dr. that mentioned patients who drive Fords & GM's not Mercedes-Benz)

I had the mini implants on my bottom denture 4 years ago and have not had any problems with them at all. It is almost like having my own teeth. I have had problems with my upper full pallet denture in getting them to stay in with out denture cream. Then its a pain in the butt to get them out. I am considering getting my uppers done and going with a partial pallet. Any one have any thoughts on this.

Response to Larry K - glad to hear about your great experience with the lower mini implants. The good news is that if you still have enough bone on the upper, you can probably get a terrific improvement on the upper as well. It takes six implants to hold the upper properly in most cases, so be prepared to spend a little more. I have only done 3 upper denture cases at this time, but all have been very successful, and the patients love them. The best thing about the upper is it allows the dentist to remove the palatal covering - in other words, your denture will now be U-shaped just like your lower. Much more comfortable, you can taste food better with the palate uncovered, and it feels way more natural than a full coverage denture. Enjoy!

I was just told that I don't have enough bone left to do implants, not even with grafting. I have 9 teeth left on the bottom, 8 in the front and one on the very back right side. My top back teeth (which are crowns) have dropped on the left side where there are no teeth and I also have a slight overbite. My dentist told me that my crowns would have to be replaced since they have dropped so much. My oral surgeon now wants me to see an orthodontist to see about moving my teeth before proceeding with anything. One of the options he presented, was to remove the bottom front teeth and put implants there since there is sufficient bone left, and then have a full set of teeth on the bottom. My bottom front teeth are in good condition. My top teeth are ok except for the crowns that are dropping. What to do?? I just read about the mini implants and was wondering if I could be a candidate. I also checked and there isn't an office in the state I live in. I'm getting pretty discouraged because I think this is going to cost more than I can afford but my face is really getting the hollow look from bone loss and no teeth in the back. I've had two partials that were so uncomfortable. The reason was that it wobbled because there wasn't a tooth in the back on the left side to hold it down. I just can't wear it.I know there is a nerve that runs along the jaw line that determines whether one qaulifies for implants; apparently that is the issue with me. Do you mini implants go down as far as regular implants?

I have an elderly female patient in excellent health that has worn dentures most of her adult life and consequently has no ridge. Her mand. symphysis is 15-18 mm in height. Her existing dentures are slightly worn but otherwise in good condition. She wanted new dentures, but I feel the best thing I can do for her is to place 4 minis in the mand. ant. and use her existing dentures. Money is an issue. I am concerned about the lateral forces on the minis due to the fact there is little if any ridge to help resist these forces. I would appreciate any feedback from doctors with experience with similar clinical situations.

Hi everyone, I am researching mdi's for my 65 yr. old mother. She has very little bone on upper and lower, thus cannot wear dentures. We have received several quotes for traditional implants upwards of 30k here in the states (which we cannot afford), we have even been considering going over seas for this procedure. She needs tooth extractions and a sinus lift in order to place implants. She is plagued with infections and this ordeal is wearing her down physically and mentally. She is disabled and on a fixed income, there is no insurance available for implants and she does not qualify for a loan. MDI's seem like a more affordable option for her, but would she be a candidate for both upper and lower? And would the lack of bone be an issue for her? Where can we find a Dentist that will do this procedure. Please help! Any feedback would be very much appreciated. Thank you, Kate from Minnesota

Hello- I am a patient - reader. I pretty much read all the posts from the start of the discussions, and appreciate the professional candor. I am investigating parallel periodontry, due to severe boneloss and aggrevating bone infection, and holistic medicine, which links oral infections to other imbalances in the body. My demise - and that of many older people (baby-boomers and up) - is that osteoporosis of the jaw is still not recognized as cause for perio desease. Everybody must become informed about the larger calcium issue, namely that lack of magnesium cause calcium - and bone loss, no matter how many units calcium we consume. AND: lack of magnesium cause muscle restriction (cramps). For years I knew I had very tight gum tissue, biting my cheeks.... Since I take magnesium. my mouth area has relaxed. Of course other people have different manifestations of magnesium deficiency, but mine has definitly contributed on two front to bone loss in jaw. Closing: Many healers believe that desease - even heart desease has its origin in the oral cavity. The chicken and egg question does not stop there however, and bone and tooth decline must be addressed in the context of total body health. I hope the "mini" technolgy is being perfected by those applying it skill-fully. Regarding skills to use dental / perio technology: More and more young people lack "fine-motor" skills, inventiveness, skills with hand tools and careful observation. We need more hands-on crafts and art experience for children, to be skilled later on in the fine arts of tooth and jaw mechanics and restoration.

Frank asks I am a patient possibly interested in a single tooth MDI replacement (upper left first premolar). I have several very successful traditional 13 mm implants in the upper and lower jaws (about 7 years in place), but after the upper implants had an uncomfortable sinus condition for about 3 years that I attribute (maybe wrongly) to a sinus lift. My dentist says I have about 11 mm availble. I do not want another sinus lift, so wanted to go with a 9 mm screw, but the dentist strongly recommends against this. He recommends a minimum of 11 mm with sinus lift, if necessary. My question: Is it likely that a MDI would work, and do MDIs also require sinus lifts if insufficient space is available? Thanks.

to ken clifford....if i presented to you for full lower, immediate loading, mini implants but with five weeks healing after extractions, could it jeopardize the procedure due to immature cell growth? thanks in ad....

Deb - Not sure if you are planning an implant retained denture with 4 minis or a full "roundhouse" fixed bridge. Also not sure how many teeth you had extracted 5 weeks ago. Often I can find good bone between recent extracion sites, and I have occasionally placed only two minis as a temporary measure while waiting for healing for an implant retained denture, then place the other two implants six months later. Also, did your dentist place any bone graft material? Recently I have been using a product called "Foundation" by J.Morita which allegedly greatly speeds up the process of bone formation, allowing mini implants to be placed in as little as 2 to 3 months. One other factor is the length of the roots of the extracted teeth, because sometimes I can place a mini in a fairly recent extration site if the site is only 9 or 10 mm deep and I have enough bone to place a mini which is 15 to 18 mm long. Then bone will continue to heal around the mini in the area of the extraction while the good bone below supports the implant. If you give me a little more information I will be happy to give you my "educated guess" as the whether or not I would try to place mini implants in only 5 weeks.

thanks dr ken... had 19 extractions...all remaining top arch... and seven lower anterior with 1 lower wisdom... all in one hit so i am totally toothless!!!! looking at retaining bottom denture asap followed by top implants in another month or so..... My Dentist? bone graft material? would ya be tryin' to kid me then?... ah....the less said about My Dentist the better....but.... before surgery, i spoke with My Dentist re. implants ....he said it was something we would talk about after my teeth were removed and immediate dentures placed.....he does not do implants himself and deemed me somewhat overboard i now feel, to even think of having them....can i add here that i am a marriage celebrant....and my overall appearance and voice are/WERE very important!!!!this was also explained to My Dentist!!!! { i also have a distinct feeling of a badly misplaced sense of financial judgment.... and was accordingly sentenced!!!!!!!} he has also given me terrible dentures....two independent dental opinions....i cannot bite or chew and they are oversized...poor jaws!!!so must now have new set made.... have found dds who will do both new dentures and mini implants now if opg okay, where another dr...traditional implanting.... still wants me to wait for several months.... i am keen to have all of this behind me and be able to work/EAT/and smile freely again, so i am very tempted to go with dds but have had such a terrible run i don't want to rush and make matters worse....although i doubt that would be possible...... thanks for listening/reading, dr ken...

If minis are used say 4 in the upper jaw to stabalize a denture and they fail, break whatever;can they safely be placed again in another 5 years?Can they be place over and over in this manner?If they can be place again safely and fairly consistently then I don't see what the big deal would be.Seems like as earlier poster have stated this could be an alternative for people that can't afford the immediate cost of full implants.The initial outlay of so much cash at once makes full implants out of the reach of many.I'm a patient who might benifit from this proceedure and am contemplating going this way;but for now I am confused.Thanks,Henry

I have had quite a bit of experience with Imtec minis and some with MDI. They are great in the mandibular anterior-perhaps first bicuspid to first bicuspid given enough height of bone. An envelope incision with the flap reflected somewhat allows smoothing of a knife edge ridge-don't remove all the cortical bone however. The implants can then be placed, the flap sutured and then the implants adjusted for height-check height with the housing-you want the housing flush with the ridge but not impinging. Use the denture as a temporary by drilling holes to fit the implants and use Viscogel to secure. After healing the holes can be enlarged to fit the housings and they can be secured with cold cure acrylic. Use the shims trimmed to size to avoid acrylic flash. I have also placed a graft at the site when there is little attached tissue,you need a bleeding surface for the graft, so create this with a bone bur, then place the implants to secure the graft and suture the edges. Allow healing as above securing the denture with Viscogel. Minis in the maxilla have variable success-not predictable. They can be replaced after healing but will most like be lost again. I advise conventional implants in the maxilla with Zest attachments-much more predictable.

I am 60 years old and currently have a full set of immediate dentures. I am looking forward to this winter, when I will have my permanent dentures made and will be evaluated for mini implants. Hopefully, I will be a good candidate. The cost of conventional implants is simply beyond the reach of most people, whose dental insurance provides a maximum yearly benefit of only $1500.

I just received a full set of dentures in the past month. I am not doing too bad but I would like to get mini implants to secure both lower and upper. I was told $4,000 for the lower and don't know if that is high, low or middle of the road. Also for my upper I was shown an xray of my mouth and my sinus's have gone up and my dentist said I would need a sinus surgery that would cost $6,000. What I want to know is if I would need this surgery if I only have mini implants put in to secure my upper denture.

I had a mini implant done to my lower denture in August2006 and regret having it done. It cost over $3000. The bottom plate fits good but it made me have trouble with my top plate. It has given be trouble for the last year. I have gone back to my dentist but it has only gotten worse. I am at the point of not knowing what to do about it, but sometimes I think I might have the implants removed. I have trouble speaking and have pain all the time.

Dorothy - Why would you remove the implants on the lower if it fits and functions well? It is pretty clear that you need a reline on the upper or perhaps a new denture. It is not uncommon for sore spots to develop on the upper after implants are placed on the lower because now you can put biting pressure on the upper. Before, with a floating lower, the upper had no ability to get a good bite. At this point I don't think it would do you any good to remove the lower implants in an attempt to fix your upper denture. Just get the upper stable.

Lisa - $4000 to secure the lower is fair depending on where you live. Prices vary widely in different parts of the country for most dental services. A sinus lift for implant retained upper denture is not usually needed because the six mini implants needed can be placed forward of the sinus in most cases. I have seen cases, however, and you may be one of them, where a sinus lift is necessary even for mini implant retention. Good luck.

Ken, Excellent comments and answers to these interesting questions! I agree with everything you said. I am happy to help answer any questions that any patients have about the Mini Implant Systems or procedures. Best, Todd

Todd - thanks for the kind words. Hope you're doing well. I too have switched to the MDL implants for the most part. Spent this past weekend in Tulsa discussing techniques and procedures with a dentist who has some interesting variations on the fixed mini implant denture replacement theme. I love where this whole scene is heading right now. Keep the faith! Ken

Is a rebase for a top denture better than a reline after having a mini implant done on my bottom denture? This is what my dentist wants to do to stablize my top denture. He does not do relines only rebase.

Dorothy - A rebase IS better than a reline. It completely replaces all the pink acrylic in your old denture with all new acrylic, leaving only the teeth unchanged. Some research now shows that within 5 years your old denture acrylic has so many microbes and "stuff" imbedded in the acrylic that complete cleaning is impossible. Also, the old acrylic becomes more brittle and prone to breakage with time. Your dentist probably charges more for a rebase because it costs more than a reline, but I completely agree with his decision to quit doing relines unless it is on a nearly new denture which needs modification to achieve perfect fit. Go with the rebase asap. Good luck and happy eating!

It came to my knowledge that a new mini dental implant is in the market from Intra-Lock (MDL). I want to know if it is FDA approved for long term use like the IMTEC. Thanks

The MDL is FDA approved and Inta-Lock will be one of the major players in the implant world in the next few years. Their mini implant has been on the market for several years and has several geometries that address bone density/quality.

I would like to know what % (of course estimate)the mini implants can replace the normal size implants for single-tooth replacement. I know this is a case by case basis, but I hope that the more experienced practioners would have the best estimates. As for full overdenture, I think it is more common to replace the normal size implant anchors with mini-implants, am I correct?

Hello Dr. I have been reading your comment and live in LA area. I would like to go to see you for consultation for the "Mini Implant" upper & lower. Please e-mail me your office information. My current doctor won't discuss yet about my alternatives. He said that bone has to heal first. But I heard and want to have it now to reduce the plastic palate on upper and it is possible ( I read many web...) Also when I do lower, I want mini on same day. Please contact me. Thank you, May

I have a question and just hoping someone can help. I was going to get a tooth extracted due to the pain and replace it with a implant. However, I do not have money for the implant now, so would it possible to get an implant, say 2 or 3 months after the tooth is extracted? Thank you for your time and help. DC

dear DC the info you give us in inadequate for anyone to give u a responsible answer.1)what exactly is the reason ur tooth will be extracted?(pain is too vague)2)does the area show any sign of inflamation?(swelling,puss,bleeding)still,to give u a first,vague idea,yes u can wait about 2-3 months after the extraction to place the implant,if the area is "clean" u could have it done at the same time.In signs of infection waiting is a MUST.u need to give the bone some time to regenerate and clean completely after the extraction of an infected tooth.i would be intersted on any feedback from u,take care

I have been reading about "mini implants" on many different sites. Most seem to only recommend them for lower dentures. I am interested in them for my upper dentures. I currently have lower teeth. I am 50 and have had uppers for 28 years, I am concerned about bone loss on the upper jaw and want to know if the mini's would be a good option. The surgury looks less extensive and the healing time appears to be much shorter. Thank you for any help.

Peggie - Assuming you still have some decent bone, upper implant retained dentures work great in my experience. You will need six of them, approximate cost in the neighborhood of $5000, may need a new denture as well if your existing one is very old. After implants, the denture will be palateless, u-shaped like your lower. Food tastes better! Another option available from a few dentists at this point would be to place 10 to 12 implants and completely replace your denture with a one piece fixed bridge. Not removable, you clean it with Hydrofloss and a toothbrush. Looks and feels much like real teeth. See other comments on this site by Dr. Shatkin and others. This is sometimes called a "roundhouse" case. Much more expensive, but a terrific solution.

Please consider the angulation of the maxilla before suggesting and inadequate prosthesis for a complex situation. Maxillary reconstruction is not solved with individual attachments on the implants. You can get away with it on the lower, however it is a maintainace nightmare because you are replacing the o-rings or the locators often and I'm sure you like your dentists but you do not want to see him every 3 months. And if you recommend locators or individual attachments which will not draw in the maxilla on six or even 4 implants, treatment planning the case is critical and quoting 5000 for your maxillary case is unethical without seeing your situation. I have seen more drs get themselves into situations that they cannot get out of because they do not have a prosthetic design in mind and just quote fees randomly. Remember every case is different and there is never and indication where you can place 6 implants in the maxilla for 5000 and get a prosthesis that is acceptable. A cast bar or milled bar or a fixed prosthesis on 8 implants is the way to go for a maxilla with sufficient bone and it does not cost 5000. It is much more than that. Dr Willardsen

Mini implants are not indicated for any situation. Place 2 to 4 permanent implants and be done with it. Mini implants are a temporary implant and should not be used for permanent implant treatment plans. Dr Willardsen

Dr Willardson- Interesting. I'm being unethical for telling a patient what I charge for six mini implants to retain an existing full upper denture. Did I suggest full prosthetic reconstruction? Do YOU know she needs it without without a full diagnosis? Have YOU ever placed a mini implant and retained a denture with it? Do YOU have to replace the o-rings every three months? How much do you charge for it? I find I seldom need to replace them in less than a year if the patient has decent oral hygiene, and I do if free as part of our service. Takes my assistant around five minutes, costs me a few bucks for the rings. Full implants, bars, long waits for healing, sounds like fun to me. I will continue to provide ETHICAL affordable solutions for my patients. I don't want to get into a fight with the prosthedontists to whom I do refer appropriate cases, so I don't see why you want to question my ethics and integrity. Good luck to you anyway. Dr. Ken Clifford

Dr Willardson - By the way, I use I-cat scans before placing maxillary implants, do you? If you do not believe mini implants for denture retention are for long-term use, take it up with the FDA and see if you can get them to change their recommendations, but don't take it out on those of us in the real world of dentistry who need to help those who need us.

Well, I'd certainly be willing to put myself in the hands of Dr. Clifford. It appears he is working in the best interests of his patients and NOT solely in the best interests of his stock portfolio. That's what I call ethical!

I use cat scans on every maxillary case I tx plan, I see two to three patients a day who have been treated with mini implants and are unsatisfied with the retention of the prosthesis or the implants have failed or fractured. I have used many mini implants for temporary retention since MTI Mini Transitional Implants where introduced in 1999, while my permanent implants are healing. If you needed and implant retained or supported prosthesis would you want mini implants in your mouth. Hanging your hat on mini implants is very dangerous and they are just a stepping stone for general dentists to ultimately realize that they can serve their patients better with implants that the parts and pieces can be changed and a prosthesis can be fabricated. A custom prosthesis that is specifically made for the patient. Keep up the good work, and I am glad you are having success. Dr John Willardsen, DDS

Actually I had two MDL implants in my own mouth two months ago to replace tooth #4. The dentist, who is very experienced with minis and uses the I-cat, placed two in this area at my request because I have a very heavy bite. There was plenty of room to "stagger" two 2.5mm by 15mm MDLs. We used composite resin around the implant heads to compensate for the non-parallel arrangement, then fabricated in the lab a composite resin crown and polished it prior to cementation with flowable composite. So yes, I do put my reputation where my mouth is - so far, so good. Two months out, no pain, no radiographic evidence of problems, stabile, I chew everything and forget the implant(s) are there. Of course, I have to wait 5 or 10 years before I can brag about the results, but it does seem to me to be OK for me to provide this service to my patients right now. If a mini fails, there is minimal bone loss and a standard implant is still very possible. If a standard implant fails, usually much bone is also lost and augmentation will be required before before replacement. Anyway Dr. Willardson, I am sorry I took offense at your comment on ethics. I have looked at your web site and I see that we both went to Loma Linda and have the best interest of our patients at heart. Good luck to you and your three practices. You are a better man than I to be able to handle that volume of work. Hope you have an associate!

Good Forum. I had a rear lower molar replaced three years ago (2 mini implants) and my regular dentist is amazed at the long term sucess potential. At 62 with many extractions I find these implants offer a much better solution to missing teeth IF a qualified implant Dentist determines that your bone thickness and density at the site are appropriate! Cost is certainly a factor but the non-invasive procedure and time factors are the major reasons to at least pay an implant specialist for an evaluation! NB: As a Canadian I really have to go to the USA for this treatment option.

Mr. Cressman - Really glad to hear of your successful treatment from a patient standpoint. Your good experience may help many other potential patients to at least check out the potential of minimally invasive small diameter implants before rejecting the option out of hand on the advice of dentists who haven't even studied the subject. Thanks for the input.

i tried osteocare system i used mini and maxiz types for many patients about 74 cases one of them is 70 male for 5 years till now it is amazing and perfect

I have had great success with IMTEC-Sendax MDI for both fixed and removable use. Yes, some implants do fail but there are so many other benefits that I would even choose an MDI in my mouth over a larger diameter conventional implant like Dr. Clifford has done. MDI's do work well and I find it strange that if there are so many reports and publications of their success that there are still so many objections by dentists. They have such a wide range of applications that in my opinion every dentist that places implants should add the MDI to their armamentarium.

I haven't seen an age for mini single tooth implant. My 11 yr old child recently had a front top tooth removed due to trauma. My dentist has him wearing a flipper and says he will have to wear it til his mid teens. Is a mini implant a good option for a young child

Sam, We place the mini implants (MDL System distributed by Samuel Shatkin FIRST, LLC) on children as young as 14 years of age. Prior to that you should use a temporary replacement in my opinion. Thanks for visiting this blog on mini implants and I welcome you to visit our websites for more information and to find a dentist near you who can help your daughter. Thanks!

I had one of my rear molars extracted approximately 2 years ago. Foolishly, because I work long hours (and because you cannot really see the tooth), I never had a bridge or implant installed in the area. I know that this board cannot give me empirically accuracte advice without examining me, but as a general rule, will bone grafting likely be necessary before I am a candidate for an implant? If it helps, I am a healthy 33 year old who has otherwise flawless teeth and other than this tooth, have not had a cavity or other dental issues in more than a decade. Also, can anyone recommend a good MDI Doctor in New York City? Thanks. -Dave

CLARIFICATION: IT IS A BOTTOM MOLAR.

more info on mini denture implants

I would like to inform all of you that we will be releasing a book at the end of february beggining of march that will cover a great deal of information on mini implants and socket preservation. The name is "Mini Dental Implants an Alternative, Socket Preservation a Necessity" The controversy read in this blog was considered and we tried to provide some answers to so many questions, of course, we are way far from having all the answers. The idea is to promote the safe and ethical practice of mini implants in dentistry and to cover each and every aspect related to socket preservation. The idea is to create awareness of the importance of preserving the sockets and the performance of atraumatic extractions to be able to perform better implant dentistry on a nicer ridge. That would create a nice trancision for a dr that only places minis and wants to place other implants. We mention different techniques for fixed and removable mini implant placement and different techniques for socket preservation. This book in full color and hard cover is a multinational effort with Drs from different countries, foreword by Dr Linkow and Dr Kenneth Judy; we are editting the english since i wrote it in spanish (spanish version will also be available in february).The money generated by this book (if any)has entirely been donated to a charity in my hometown in colombia to educate street kids so you will be making a contribution by adquiring it. It has been written in a very simple language and using simple terminology, it is an invitation to do things right if you decide using minis..

Hello everyone, I am a 21 year old college student and I am interested in mjni implants I think. Bare with me as =, I am no dentist so will probably explain things wrong. I have a small baby tooth on the right side of one of my two front teeth (the adult one is impacted in the roof of my mouth, but I'm told that, though it would be difficult, it could be extracted). My smile is great right now, but I'm told that the baby tooth has some decay around it - I brush regularly, use mouthwash and floss (not as often as I should but I do). I am going to get a filling (or a crown if needed) I think, but I was wondering if it would be smarter to have the tooth removed and to use a mini implant? I am very scared about doing too much too it, because, as I stated, it is in the very front of my mouth, and I do promo modeling- I can't have a big space like that. Any info or opinion given would be greatly appreciated. I can send a picture also.

Liyah, If you can save your natural tooth in good health and good aesthetics, that is the right choice. If you are losing the tooth for any reason, the implant is the best replacement for the tooth. I would not jump the gun on placing the implant unless you had to or the dentist recommended it.

I suppose but, I don't want it to cause problems later when it will be much more inconvenient to get it fixed. I will be in residency in about 2.5 years (when I finish my degree in BioPsych: Premed track), and I won't have time for it then

Phil Cressman, Male, aged 62 with dental problems most of my life due to enamel problems (identical twin) I recently lost a tooth that was supporting a bridge and my dentist, Ontario, Canada recommended an implant. Since mini-implants are not normally done in Canada for tooth replacements (only denture stabalization) I contacted Dr. Tood Shatkin in Buffalo, NY. Had a visit for evaluation & Dr Shatkin recommended two implants to support a two tooth crown. Without going into costs as every case is different I do believe my treatment was about 50% the price of having conventional implants placed in Ontario. The really big savings is in terms of pain & suffering. When I returned for the implants Dr Shatkin was working for only about 30 minutes (aside from freezing etc) and the results were great. (Crown had been fabricated from moulds taken at the time of my first consultation.) Actually ate dinner a few hours later & only minor soreness for a few days. It has been only one week & I have to return for a check up but HIGHLY RECOMMEND at least looking into mini-implants as a potential alternative to conventional dental implants with associated surgery. (In my case a sinus lift would have been performed if conventional implants were to be used)

Just wanted to let folks know I had mini's put in to hold a partial on,with minis under the right side and a clasp on the left side.I love the mini's they seem real tough.Before I had a clasp partial;it was useless it would not stay put and food constantly got under it.For all practical purposes the partial was useless.Now I have a partial that works and is almost like having teeth again.I also have an overbite.The minis(two) hold the partial well and there seems to be no occlusion problem.Best of all it was affordable for me.Best Wishes,Henry

So I would like some help from the doctors or even patients on this board and I will try to keep this as short as possible. I am a 48 yr old male with horrible teeth. I have been fighting to not have them all removed for 4 years now, but I now have only 9 left. I have partials up top and down below. I went to see a "prominent" well known female doctor here in the Atlanta area about a year or so ago. To get what I guess is the surgical screws done with the 6-9 month wait would have been the price of a high end BMW with her and the surgeon. Last week I went to see a dentist who is advertising doing the MDI IMPLANT system. For 6 upper and 4 lower, extracting the remaining and making new uppers and lowers is a WHOLE heck of alot less. My main questions are two fold. ONE with the uppers on the screw implants, there would have not been much if any "plastic" or whatever material you use for dentures for the top, and therefor the roof of my mouth would be, The roof of my mouth: not plastic as this partial is now. How much or little "material" is going to be on the top denture so that I taste my food a little more. And as far as food underneath, does food get under like it does my partials now if I do not use some type of paste or glue? Second, I have read all the success rates from 90%-95% but are there people out here on this board or doctors who can talk to me about patients they have had who have had more than 1 or a few done and had maybe there whole mouth done that can tell me if they are happy with this procedure. Sorry this is long but this is a mjor investment and I would rather do it right the first time and not pay twice, once for MDI and later for the screws Thanks to all who have read this.

I have full dentures and am in need of new ones. I have been approached by my new dentist to have MDI Implants in the new lower denture and my mouth. I am hearing different things about this and can not make up my mind. The cost is not an issue and can be worked out. Can any user tell me about the comfort level with these implants. Any pain? How about infections after insertion or down the road? Problems with these metal prongs sticking up in your mouth? Any long time users out there? Please help me if you can as I really need to to have all the facts first. Thank you!

The back molar on my left was pulled years and years ago. I am now 51 and I don’t remember when it was pulled. The missing tooth had been “replaced” by a bridge supported by the adjacent two teeth, but the bridge recently failed. My dentist recommends an implant on the back molar to support the molar on the top side. I have been told that the implant procedure will cost $7-9,000, for the surgery implant and the crown, very little of which is covered by my insurance or health plan. Also the procedure will take around a year to complete. I am not too excited about this procedure, and frankly, I would rather spend this money on my kids’ college education. But then again, I would rather not lose my upper back molar (no lower support). Would I be a candidate for a mini implant?

Dear Terry, Your upper left, referred to as the posterior Maxilla is no place for mini implants with diameters of 1.8-2.3 mm in diameter. As you can appreciate with these "very skinny" implants there can only be minimal thread depth and therefore some are the diameter of a "toothpick". Mini-implants in the posterior Maxilla will more than likely result in disaster at a future date (much sooner than later). Do not follow any blogs that promote the useage of same in what is referred to as D-4 (D=Density) bone commonly found to have the density of Styrofoam or Balsa wood. Take into account that the posterior Maxilla is closer to the TMJ/hinge and the loading or biting force in the posterior jaw is approx 7-9 times that of the anterior (front of the mouth and further away from the TMJ/hinge) aspect of the Maxilla. The mini implants came out as transitional implants that were originally designed to provide for support of a prosthesis during an interim stage, while the large and appropriate diameter implants were integrating/healing. The transitional implants would then be removed at approx 4-8 months depending upon the density of bone, etc. The only place for mini-implants with a diameter of 2.3 mm or greater is in the anterior mandible, D-1, D-2 bone with the density of oak or solid pine (reference for comprebable density) under a complete denture and I would think twice before letting anybody place mini-implants in the back of the mouth. Please don't let cost drive your decision. The once transitional implant has only recently received FDA approval for "long term use". However, the FDA did not define long term use, other than to state that it was for more than 6 months. However, if we apply the rule of common sense then there is no way that a 1.8 or 2.3 mm implant can have deep threads to increase the BIC,(bone to implant contact). They simply aren't big enough. Further, in implant dentistry the majority of the force is directed at the crest of the implant or for the first 7 mm from the top. Therefore, length is a minimal contributor to success. In very simple terms I believe that the good Lord gave us large roots in the back of the mouth due to the fact that the forces and bone density are much, much different then the front of the mouth. Also, please don't let case reports or some dentist persuade you into something that every one of us who teach at academic levels and are part of science on daily basis persuade you into a still, in my opinion, experimental device with the greatest failure rate of any implant diameter on the market. There is a place for everything. However, the back of the mouth with forces of 150-250 lb PSI for the average male (up to 1,000 psi in a bruxer/grinder) is no place for mini-implants unless you want them to fail. Case studies are considered the lowest form of science evidence in our "Evidence Based" tree. Be careful as you are only 51 year of age and a properly placed and adequate size implant with proper occlusion may last you the rest of your life as the insurance tables say you and I will make 79-84 depending upon our current health. Best of luck, The mini implant is being marketed to dentist who are simply not comfortable with extensive surgeries such as sinus augmentations, chin grafts and growing bone to restore areas to the proper dimension to accept the adequate and proper size and design from a biomechanical and structural position. Best of luck, Duke Aldridge DDS, MAGD, MICOI

Thank you so much for this information, Dr. Aldridge.

I would appreciate amy advice. I'm 55 y/o male, and already spent on dental around 40K in the past. It looks like I would have to redo most of my teeth. In short, after extraction of all remaining upper teeth, I would need 7-8 implants and 12 permanent crowns (bridge). I also need to redo crowns on lower jaw. My question is, can I have some of the implants done with mini implants? I had recently done 3 implants on the lower left at a cost of $1900.00 each, and after some internet research I now find a dentist office in New York City area (with five locations) that offers implants at $545.00 each. Can anyone explain the big difference? Is there a catch? I know you guys would not like your potential customers to go for treatment overseas, but since I was quoted 50K for the work needs to be done, I found dentists in Costa Rica, that would perform same for about 30% of the cost. Any advice regarding doing implants/crowns in Costa Rica? Thank you.

Dear everyone, I have been in the dental field for 30 years and have seen lots of implant surgeries. These mini implants are amazing!! There a small learning curve but once you got the concept of how to achieve the results you got it made. I've worked with one of these original doctors placing these mini implants when they first came out back 7-8 years ago. And let me tell you this. THEY are still in place and we put these little guys in some really compromised ridges to help these people. The doctor I worked with sold the practice to a new doctor and now this doctor is seeing these original patients in which these mini implants were placed. The bone is still good little to no resorption/breakdown at the crest of the implant as in some traditional impants. They are the happiest people and sooooo very appreciative. So as far as test results and data in some journal check out some of these docotrs and cases they have done. Some of these mini implant companies have these names and are willing to lshare for information purposes. We are all on the same side trying to do the best for people and helping one another learn and grow in the field of dentistry. BTW...If you consider each patient has at least 4 minis placed in the lower mandible for denture stabilization as suggested and you've seen at least 150 patients in a 5 year period with a placement value equalling approximately 600 impants. SO being that Dr. Shatkin is going on his 10th or more year and he places more than just mandibular implants he could be close to the thousands. Kudo's Dr. Shatkin!! and all you other doctors out there doing what you do best.!!!

Hi all. I'm currently 29 years old and had all my upper teeth pulled about 5 years ago. I also had all my bottoms pulled except for the front 6. I have a full upper denture and partial lower denture. I've gotten used to the upper pallete that covers the roof of my mouth although I would LOVE for it to be gone. I really hate the lower partial though as theres a huge piece of metal that rests behind my natural teeth. My question is--Is 5 years too long to hope to have enough bone on my upper jaw? My old dentist said the bone will degenerate but never said how fast this happens. I know theres not an exact science to this but just wondering in general. I had no gum disease and my dentist actually put AMA on my chart as he was against pulling my teeth. I just couldnt afford all the caps/crowns/bridges/etc that he wanted to do. I have an overbite so I was hoping the dentures would help fix this. He made the upper teeth curve out a bit which helped but I think the bottoms need to arch back a bit to really be able to clench my teeth. In any case, I was wondering if 5 years is considered a long time in terms of losing bone mass? Also if possible to have an estimate on what it would cost for a complete new set of upper and lower dentures with however many implants/mini implants that is normally used--also assuming I don't need any other bone graphs, sinus work, etc. Thank you in advance for your time-and thanks for the forum--very helpful!

hi, would really appreciate some advice here, as there seems to be conflicting ideas about the appropriate use of mini implants. I am a 40, and when i was 11 i had my two upper canines removed because they were growing up in to my soft palete. I kept my milk teeth until i was 36, then, i had them removed and two maryland bridges made and placed. They were rubbish and fell out within a few months and i have been wearing a small uncomforatable denture ever since. I would love to have implants, and have recently been quoted £5000 to have the two done with traditional implants. So i'm guessing that my bone density is quite good, if i am indeed a suitable candidate for the traditional ones. To me £5000 is a amazing amount of money, so a cheaper alternative and being able to have the mini implant procedure done in one visit has a major appeal. but is it appropriate? how long will it last? and is that £5000 a fair price for the trads? I see that no-one has posted a reply for the lady above me....and she posted her question 4 months ago.....er is anyone out there?.........Mr Shatkin? x

katie, No way will mini implants support canines.

oh....ok....well thanks for the advice

Katie ....I disagree IF properly treatment planned and executed Mini Implants will do fine in the canine regions I just dont understand why so many dentists have such a hang up with Mini Implants The only compromise that i face is an aesthetic one Mini implants will not have the same emergence profile as a traditional However in good hands it can look very good Find a dentist who has done a lot of minis its getting very popular now as they do work very well even in canine region In my office it is around half the price of traditional implants C

Katie, you should get a consult done by someone who dose both regular and mini implants. Now, there are couple of different uses for mini implants and find some one who has applied to all the situations. I would not listen to some one who only does regular or mini implant or worse yet, ones who had bad experiences with them and generalize mini implants( or regular imjplants on that matter.) Drs, if you haven't used minis to replace a single tooth including canine, try not to mislead patients because ultimately, you don't know what you are talking about. I ve never placed minis for single tooth replacement purpose but I ve seen plenty that do just well.

I have read extensively on the topic of Implants. After a good analytical assessment of the online postings, it became clear to me that, in this battle of “conventional” versus “Mini,” economics are the ruling and influential element. I am still struggling which direction to go. My question, seeking a honest answer, now is: Doctors, based on your experience, research, and client feedback, which is the best, the most effective and functional min-implant in the market for a Maxilla denture and/or implants? Is there a mini-implant that is suitable for Maxillas? I am grateful for an answer. Antonio

Hello, Can you please advise? Are minis appropriate to replace lower teeth X2 on the left & X3 on the right? I am so confused by all I have read on the subject. Thank you, Denise

Denise, I'd recommend going for full sized implants in your case. In my experience, mini implants are not suitable for you. Good luck with whatever you decide.

Hi I am a 40 year old who as a child had a lateral incisor removed due to overcrowding and peer pressure to not have braces. (Oh only if i could have made the right choice at that time. lol) Anyway becoming 40 inspired me to finaly straighten my teeth with invisalign, with a view to also creating a gap to have am implant placed in the lateral incisors position to give me a full smile. (mid life crisis?) I guess you know what im going to ask. My dentist said she would refer me to have an implant fitted when the time is right (end of treatment) I did some research and found out about Mini implants. I was told by my dentists that with the lateral incisor being a biting tooth mini would be no good but the sergeon would canvass this better. Is a single missing lateral incisor a good candidate for a mini implant? Anything else i need to know or ask? Any help would be greatly appreciated. Lee

a one piece narrow diameter implant may be just the right thing . the harder decision is how to find a competent dentist . good luck

Dear Mr Lee, 40 in Chinese is "say sap", and is the halfway mark to 80, which is "pad sap".....which means "sure to prosper". Thus, 40 is a very auspicious point to take stock and make significant changes to embark upon the second part of the journey of a prosperous life. Yap. Get your teeth straightened and harmonious. The missing lateral incisor can be satisfactorily replaced with a mini dental implant which in most cases will safe the patient from having to have a bone graft at the same time as the bone thickness there is usually insufficient for a regular sized implant. All the best for an exciting ride beyond 40.

Thankyou for your replies "which in most cases will safe the patient from having to have a bone graft at the same time as the bone thickness there is usually insufficient for a regular sized implant". A bone graft sounds like a not very nice proceedure and something to avoid if you can. This certainly points me more to find a good surgeon who will assess me with a view to fit a mini implant. Also thankyou for your wonderful chinese take on becoming 40. Your words are much food for thought and i will certainly look forward to my second 40. Kind regards Lee

Dear Mr Lee. You are most welcome. Hope that your second 40 will be accompanied by a full and becoming smile. Chow

The cost of Standard vs Mini Implants notwithstanding, The way I read these Q&A's is that "Mini" Implants in general get a strong approval as the best way to go..If, and only If, you are considering implants for "Lower Full Denture Stabilization" exclusively, and that Implants for any other application is a totally different proposition and that Standard Implants might be, and probably would be, the better choice. ......Would you agree with this statement ?

Hello all.. I am wearing a partial denture for 4 missing upper teeth.. I have asked my dentist about either mini implants to replace the missing teeth or a mini implant supported partial denture and he seems to be against the idea.. he says he dosen't do mini implants and that they don't work, but from what i have read on the internet, many patients have had success with them.. The main reason i would go for mini implants is an economic one, from what i can understand they are quite less expensive than traditional implants, i cannot afford the traditional implants. I live in new brunswick Canada and i would love to talk to a dentist in this area that has done mini implants..I would also like to know if they work because im a little confused on it right now... Sincerly Marc..

marc, mini implant or reg. implant, to be successful, there are factors to consider such as how much bone volume is avaible, what your medical history is like ( any systemic disease such as uncontrolled diabetes, any immuno compromising conditions? Do you smoke? etc..), Granted that implants in general fail more in maxillary posterior area( that is upper back area ), if all the above are considered with good surgical hands, both types of implants will work. Having said that, just like you said, that dentist who doesn't recommend minis doesn't place minis and he/she probably doesn't know much about minis. Go get some balanced advice from knowlegable dentist on both types of implants. Good luck.

I am a 53 yr. old female that has a upper partial with 4 teeth on it one of which is my front right tooth. When my dentist had the partial made and put in my mouth for fitting, I mentioned that the front tooth was lower then my left front tooth, which made it look longer and not aligned which was why I got it done in the first place.(My right crown had fallen and was a lot longer) I mentioned it to the dentist so he filed the front tooth on my plate down. A few weeks later after the swelling with down....now the tooth on my partial is too short. I would have thought the dentist would have know that and would have told me that at the time he placed the partial in my mouth. BUt never the less now I have a partial that I paid 50% for and my insurance paid 50%. And I am back to where I started before I even got the partial. The dentist stated that if he was to change the front tooth on the partial that I would have to pay 50% again. WHAT????? I have not done that because I was so frustrated with my dentist, But I find my self not wanting to smile again and hate it when people take close up pictures of me because that is all I can see is a short tooth and if I try to move the partial down for pics you can see the top of the partial....ugh!!! So after reading and finding out more about mini implants I was so excited. I can't afford the $25,000 to get implants but would just like to have my front tooth fixed so I can smile again, I love to laugh and smile and I find myself not doing either one because of my front tooth. Can I get just a front tooth mini implant that won't have a metal showing and look just like my other front tooth??? That is affordable?? What would it cost for just a front upper tooth mini implant?? I am going on a cruise the end of June and would love to be able to smile and have great pics with a nice front right tooth. Please help me. Do you know any good mini implant dentist in the Charlotte, NC area?? Thank you so much for any help you can give me!!!

Can we consider using the same ball + housing attachment used for lower denture stabilization, on a single tooth replacement? I feel that the hygiene achievable with daily removal of the tooth would be superior to a crown permanently cemented. Orings may need more frequent replacing. Or is the fit too sloppy, allowing more debris to gather around the join?

In my opinion, using the ball and housing arrangement on one tooth (or any system without cross arch stabilization) puts way too much stress on the implant from lateral movement and will lead to rapid failure in most cases. I have a mini implant single crown at #5 in my own mouth, cemented over three years ago. No issues with hygiene, and the current x-ray shows zero bone loss. Looks just as good or better than the adjacent teeth. No cratering, no sign of a. I have done many cemented cases from single tooth to full arch and have experienced only the expected number of implant failures. The only time I get in trouble is when the implant is subject to lateral forces and the patient has a very strong bite. Don't worry about cementation if the crown is well made by a lab experienced with mini implant crowns.

I have a patient with diminished space between 25 and 27(which is rotated). The patient was evaluated for orthodontic treatment, but will likely refuse. The space can accomodate a mimi implant but I haven't seen very much in the literature regarding single tooth replacement and the crown and bridge aspect of the restorations. Can you point me in the right direction so I can discuss the options with the restorative dentist.