Mini implants in lower jaw: Less Risky than a regular implant?

Immediate loading of implants is ONLY acceptable when there are at least 4 implants (with 6 or 8 even better) placed in strategic sites across an entire arch. Immediate provisionalization of a single implant is not the same thing, generally a single implant cannot be fully loaded right away, but under some specific circumstances a non-functional provisional crown may be placed. While the final fully loaded restoration will not be placed for several months. Implants with immediate provisional crowns are shown to have a significantly lower success rate (about 90%) compared to a non provisionalized implant (95-98%). If crowns are only lasting an average of 5 years I would say that is an abject failure. Crowns I have placed in long term pts (I am practicing 33 years) have an average life of 15 years. Standard sized root form implants have been shown to have an average life of 15 years, and since “enhanced” surfaces have been introduced (about 7 years ago) the life expectancy is expected to increase. I think that mini implants may be a good alternative for specific cases, like an elderly pt who only needs to get some short term retention for a removable denture. But placing 2 or 3 mini-implants to support a single crown (as was mentioned by Suzi) is not a predictable option, this is an extremely unhygienic situation and is doomed to failure. And where is the cost savings in that? As far as minimal surgery most implants today can be placed with NO or only a small incision. It is only when extensive grafting is required that a relatively large surgery is done and if that is the case mini implants probably cannot be used any way. With up to date methods and materials even these procedures can be minimally invasive. As a whole the profession is striving to find easier, better and longer lasting ways to make implant dentistry more available to more patients. As you said not everyone needs a Mercedes and there are always alternatives, while the alternatives may cost less they should never have a compromised outcome. As far as whether 5 years from now mini implants will be accepted in mainstream dentistry, it is possible they will be accepted for certain specific uses, but it is unlikely they will gain the same wide spread acceptance as standard sized implants, they are too thin to support long term loads and will likely have very high rates of fracture…if this occurs the surgery needed to remove them can be extensive and result in excessive damage to the surrounding bone and soft tissue. Many things have been introduced into dentistry as the “next great hope” only to be forgotten to history. For right now full size titanium root form endosseous implants have an excellent track record and have revolutionized the way we may serve our patients in a safe, and predictable manner. Best regards Dr. David Azar

No, the placement of any implant in the posterior lower jaw still has the same risk. It is the LENGTH of the implant that is the issue rather than the WIDTH (mini-implants are narrower, not shorter). Based on this and your previous question you seem to be attracted to mini implants rather than “usual” implants. Keep in mind that both types of implants are basically the same but mini’s are just narrower. The downside is that mini’s do not provide as much surface to bone contact as “full” sized implants and therefore may not provide the same long lasting reliability, especially if you are considering them to replace molar teeth where there is a lot of chewing pressure. I guess the reason so many people are interested in mini’s is lower cost, but lower initial cost may not translate into lower “long term” cost. As far as a simpler surgery to place mini’s when they fail (and given enough time they very likely will) the aggravation and EXTRA surgery to replace them later may be extensive and more expensive. Dr. David Azar, New York, NY