Mini Implants Beyond Mandibular Dentures: Q&A with Dr. Oppenheimer
OsseoNews.com recently hosted a webinar on with Benjamin Oppenheimer, DDS. Dr. Oppenheimer was kind enough to put together this short Q&A based on questions asked during the webinar, but which he could not get to. Additional questions/comments about this Mini Implant Webinar can be posted below.
Question (Q): Can the integrated mini be unscrewed as simply as it was screwed in?
Answer from Dr. Oppenheimer (Dr. Oppenheimer): Sometimes it can… in the maxilla even after integration it can be removed with the same instrumentation as placement. It may fracture upon removal if it is in dense bone. Mini Dental Implants (MDIs) that become loose may even be removed with the finger driver and no anesthetic. I commonly do this if i have an implant failure.
Q: Is hygiene a problem with your fixed applications? Not all emergence profiles are ideal.
Dr. Oppenheimer: Hygiene is sometimes a problem. The emergence is a different topic though. Request that the lab make the pontics bullet-shaped and make sure you can clean between the mdis with floss threaders or waterpick.
Q: How did you get the implants to stay in the extraction sites?
Dr. Oppenheimer: Enter palatal wall of the socket and angle toward the palate.
Q: What is the best way to relieve excessive tissue that has migrated around the implant. Placed 4 on the mand. about 2 months ago. Implants are stable but two of them have some irritation around head of implant. Laser, scapel, tissue punch??
Dr. Oppenheimer: I use laser but imagine any of those options are ok. The goal should be to avoid that by using the housings right away.
Q: Is it advisable to avoid placing MDI MAX implants in severely atrophic mandibles that exibit bicortical character unless a 2 mm twist drill is used for the osteotomy?
Dr. Oppenheimer: I would use the 2.1 standard and go 95% of the length of the implant with the 1.1 mm twist drill. I’ve done this often and had better success compared to other solutions.
Q: Would you immediately load a mandibular overdunture with only two implants between the mental foramens?
Dr. Oppenheimer: It’s not about the number of MDIs, its about initial stability of the implants.
Q: How do you handle fees for mdi implants that need to be replaced early on? How do you handle fees on implants that fail?
Dr. Oppenheimer: I do not charge to replace MDIs within the first year.
Q: When you have a ct scan and you see a knife edge ridge and you are flapless how do you not slip?
Dr. Oppenheimer: High speed diamond can be used to dimple the ridge
Q: How do patients clean under multiple unit fixed prosthesis that are cemented to multiple mini’s
Dr. Oppenheimer: Waterpick and good prosthetic design
Q: what is your succes rate for maxilla placed mdi versus mandibular mdi ?
Dr. Oppenheimer: Maxillary implants may be less successful due to bone quality and shape of ridge.
Q: What cement do you use to keep the temporary crown in place and what do you use for permanent crowns?
Dr. Oppenheimer: There are temporization caps that snap on and off. temp bond may also be used.
Q: How long do leave the temporary crown in place before going for the permanent crown?
Dr. Oppenheimer: It depends on the stability and predicted changes of the bone and soft tissue.
Q: Your speaking specifically about narrow diameter implants? What about areas with minimal crestal bone height? The majority of the implants you are showing still require a substantial amount of crestal bone height.
Dr. Oppenheimer: MDIs may not be appropriate in that case–
Q: 18mm Implants? Have you not read the recent literature stating that 8mm implants have the same success rate as conventional implants?
Dr. Oppenheimer: MDIs are NOT conventional implants and are affected by forces differently.
Q: How do you feel about sub-crestal implants, such as the Bicon Short Implants?
Dr. Oppenheimer: My impression is that there are great indications for those implants, similarly, there are reasons why MDIs may be the implant of choice in a specific scenario.
Q: Once again how long do you wait to load/finish fixed cases
Dr. Oppenheimer: It depends…3 months will give you more confidence of integration.
Q: Do you worry about angulation in the lower anterior in terms of lingual artery or facial artery
Dr. Oppenheimer: Yes. we want to palpate down the entire length of the implant we choose to make sure we are not perforating either plate.
Q: what ada code do you use for insurance?
Dr. Oppenheimer: –-D6010–
Benjamin Oppenheimer, DDS is a graduate of the State University of New York at Buffalo School of Dental Medicine where he was acknowledged for Academic Excellence and won the International Congress of Oral Implantologists Award. He is currently a Fellow of the ICOI. With his years of mini dental implant experience, Dr. Oppenheimer has been a lead industry speaker for IMTEC, a 3M Company as well as for some of the industry’s leading mini dental implant restorative dental laboratories. His knowledge of implant hardware, equipment, bone grafting materials & techniques, CBCT, digital implant planning, and minimally invasive implant dentistry have enabled him to help open new opportunities for hundreds of dentists across the nation. Dr. Oppenheimer has authored several scientific articles, and has helped thousands of dental implant patients in his private practice in Amherst, NY.
