Small Diameter Implants to Support Full Arch Fixed Partial Denture?

I routinely place 10-12 mini implants for a full arch restoration like you are referring to. I am presently using the MDL implants distributed by my father's company Samuel Shatkin FIRST, LLC. This is a supplier of mini implants and crown and bridge laboratory work to go on the minis. Thanks, Todd

I would never reccommend the minis. Eventhough they have gotten FDA approval...I still always hear from offices placing them they are still losing 1-2 implants over 2-5 years due to overloading. READ THIS ARTICLE - THE FDA NEEDS TO RETHINK WHAT THEY HAVE DONE!!! Measurement of the Fatigue Life of Mini Dental Implants: A Pilot Study Authors: Flanagan, Dennis, Ilies, Horea, McCullough, Paul, McQuoid, Scott DOI:10.1563/1548-1336(2008)34[7:MOTFLO]2.0.CO;2 Journal: Journal of Oral Implantology Issn: 1548-1336 Volume: 34 Issue: 1 Pages: 7-11 The full abstract of this article is available for free: Abstract The fatigue life of mini or small-diameter dental implants is of particular interest because these implants are used to retain and support fixed and removable dental prostheses. The fatigue life of an implant depends on both the implant itself as well as on the physical properties of the bone. However, the capability to predict the fatigue life of a newly placed implant is currently inexistent. This pilot study represents the first step in developing such a methodology and focuses on the design of a cost-effective device to measure the fatigue life of a dental implant. In our measurements, the implant has been mounted in an essentially rigid support, but test specimens can also be bone mounted in vitro. Furthermore, we developed a finite element-based computer model capable of predicting the corresponding fatigue life. The finite element analysis was performed in ABAQUS, and the results predicted by the model correlated fairly well with our initial experimental results. Most of the 2-mm diameter implants fractured after more than a million cycles.

Dear Dr. AJ: There is another option for you, the Cigomatic arch implants, There is a technique with 2 cigo and two anterior implants (7 and 10) or a 4 cigo implants to support a full arch restoration with great success. If you still want to use the mini dental implant technique I would recomend the Arrow Press Changeable implants from Alpha Bio that are 3.3 in Diameter self tapping ,suitable for inmediate loading and have the option of straight or angulated abutments in titanium or a castable similar to a UCLA. This system works actually really well with 8 or more for a full arch. I also Concur With Dr. JB , smaller diameter implants like the 2mm or so are not to my liking eventhough I have never had a problem with one but still..... Cheers

Have you consider possibly expanding with BTI kit or the Messinger Kit. Type 4 osseous support is easily compressed and expanded which may allow the placement of traditional sized fixtures. You may consider Nobelactive fixtures. Have not tries although, they claim to expand rather then remove ossous support. Additionally, I have found with several patients with type 4 osseous support that the bone quality significantly improves following the placement of impant fixtures. Disuse atrophy reversal. If you do not feel comfortable with a fixed appliance and do not think you can expand the ridge you may advise your patient that you will only do the case as an implant supported overdenture. If patient balks, let them go somewhere else. They tend to forget how hard we try to please them when something does not work as planned despite our best intentions. Remeber, do know harm and protect yourself. Good Luck

Hi, I have placed at least 70 full arch fixed restorations on mini implants. Usually 10-12 minis splinted together. I have not had any of the mini implants under full arch roundhouses fail! 100% success over the past 7 years. We also have many dentists who use our MDL mini implants for full arch restorations with similar success rates. The problem of overloading can be an issue if you try to place 12 units on 6 minis but if you use 10-12 there should not be any issues. Thanks, Todd

I would agree with Dr. Berg and recomend the use of Alpha bio's Arrow press system. 3mm or 3.3mm. If possible combine it with regular implants if possible in some areas. Immediate loading is recomene with this system in order to provide cross arch stability. The system provides good results. (3 years of experiene with the system). More preditable and much more easy than bone grafts. Still, the patients must be aware of the long term risks and lower success rates than the regular systems.

I only use the minis in the anterior mandible. I consider minis in the upper as transitional. I wouldn't do the case if the patient will not let you do it right.

I used 3 MDI implants as transitional implants in the anterior mandible after bone grafting. Went to replace them after 9 months with the thought that I'd have a rough time removing them. Nothing could have been further from the truth. Removed easily - no osseointegration. No wonder you need 12-14 to support a denture.

Get an ICAT if you haven't done so already. You may be able to place 4 -5 fixtures and restore with a fixed hybrid bridge. IF that's the case, then consider using guided surgery for implant placement. Good luck.

I too wouldnt do the case if the patient wont let me do it right

No problem with Minis here at all The key is in the prosthetics and following protocol very carefully If you load any implant in one direction for long enough it is going to fracture ,I dont really see the point of the study above ,we are not putting entire occlusal force on one implant ? Thats why you use many minis ,spread the load with good spatial distribution,immidiate load.bone spreading with autoadvanced mini ,the occlusion has got be carefully monitored ,narrow occlusal tables ,low cusp form Get the basics right and it will all work Dont under estimate mini implants at the end of the day its getting the physiology and the physics right Now Imtec has a very cool addition of the Mini Hybrid a 2.1mm diameter one piece implant Many more people can be treated with these for a lot less money and trauma

Before tooth loss, multiple roots spread around the arch support the forces of mastication in a lot of bone in many locations. Narrow diameter implants do the same thing. How on earth did we all get the idea that a few big implants will do better than a lot of small ones with forces spread all around the arch? A properly constructed full arch fixed bridge should be better than "all on four", at least closer to what nature intended! Unless you just enjoy augmentation surgery, I see no justification for not considering narrow diameter implants.

1. question of splinting to natural teeth? Using 4 teeth with endo and post and cores{13 mm roots} and 4 x 2.4 mm by 13 mm imtec implants. Implants…36, 43, 44, 45…teeth…42, 33, 34, 35 2.need to be rigidly cemented 3.need for occlusal table to be narrow . 4. need for occlusal forces to be in an axial pattern , round cusp design, and free of lateral malfunction. Cost factor, time factor, pt resists all other options of treatment…no ext. fast and non-invasive…{very non-cooperative} Full explanation of alternatives from {dentures}[overdentures} to {implant retained partial and crowns} to {full extraction and standard implants with splint} Treatment planned upper overdenture so forces should have been advantageous…. Upper right old bridge was too far to the buccal therefore could not get proper occlusion without building out buccal of lower right and in essence give cantilever forces to those implants. Pt was without teeth in lower right quadrant for some time therefore feels lower right is infringing on his tongue…spread of tongue!! Pt was comfortable for 6 months with temp. splint… only back to mid occlusal of 45 but occlusal table similar. After 6 monthes of placement of implants everything was rock solid. On placing final splint, patient was biting his tongue because final splint went back further distally and the worst incline buccally was the 16, which was to be extacted… pt did not understand what the upper had to do with lower, and why the temp was comfortable. After 2 months of trying to reason with him about the need to change upper and not build out lower, pt has disappeared for over a year and I never got the chance to cement the splint with an appropriate cement. I’ve used minis for numerous situations with great success but not in as challenging a case. I cannot evaluate the outcome after 18 months because I don’t have access to the patient…

Its been almost 1 1/2 years since Dr. AJ asked his question and this thread still gets responses...WOW. I believe that Drs that place a lot of minis do get CB scans on their patients...that way small areas where it would seem impossible to place implants can be found with accuracy. No one thus far has posted about the morbidity of a graft...we all know that not every graft works. Patient age, health, economics all have a factor in presenting treatment options to our patients....to deny this patient's request for another tx modality seems unfair when there are many qualified dentists that would love to look at a CB scan of this patient and help plan the case for mini implants and a fixed set of teeth. Why not present the option to him along with the risks of any implant procedure?