Standard Implants vs. Mini Implants for Lower Overdenture?

If you ask about conventional implants, everybody says, it works. (also after 10 years) If you ask about minis, some will say it works, some says I'm not sure.

Between those choices I would go with 2 traditional implants, my real choice would be 4 regular and a dolder bar(is not fancy and very old fashioned but after nearly 18 years of making those, I am still to loose or fail one) best of luck

I agree with the above statements...minis are transitionals...they are now approved for regular use however I don't think the FDA did the industry justice with that decision. 2 regular implants will suffice, however I do reccommend 4 for better stability and long term use.

There is no standard, universal answer. It depends on patient preference, health status, bone density, morphology, etc. If a patient is 90 years old and wants to eat better right away, mini-implants may be appropriate for him. Another patient with lupus may decide to have a minimally invasive procedure involving mini-implants rather than two-stage, larger implants. Someone with minimal bone in the anterior region of the mandible may prefer mini-implants rather than undergoing bone graft. On the other hand, a severe bruxor may require two or four conventional implants. It would be wise to consider each patient as a unique individual with unique needs and preferences in deciding what implants to recommend. Whether one recommends mini-implants or conventional implants, it would also be wise to order a CAT-scan before arriving at a treatmentment plan. You might be surprised at what you might find. On the subject of durability, I've done literally hundreds of mini-implants since 2001 and have very few fail. Those that fail can be easily replaced, and immediately.

I agree with JCC's response. First of all, you must have enough jaw bone to place conventional implant, otherwise the Mini will be a better choice. Also, it depends your health condition and your expectation of the implant. Dental implant is not as good as your own teeth. Remember, it is only a way to help you to stablize your denture. Although some Drs. do not like Mini because the Mini has not long enough history, and not as many literature as the conventional implant to show the results. However, materialwise mini is prettry much same as the conventional one. I do see the Mini will be a great hit in the near future. Hope this help.

Two piece implants are mostly a better choice. The 5 year clinical results in the field are starting to show that Abutments can wear. So with mini's , the ability to replace is not available as they are just one piece. The true defimition of the minis is an implant that is 3 millimeters or less and are only approved for long term use. If you ask the actual company, you may be surprised that they consider long term as more than one year. The two piece implants have a much longer history and are approved for permanent use meaning forever. The marketing of these companies needs to be more comtrolled and claims should be clear but unfortunately, they are not. Welcome to who has the slickist pitch. Drive safe and stay around. Drill safe and follow the literature.

Lisa, Dental offices that place and restore implants are sort of like car dealerships. They may carry a single type of implant that they are familiar with or they may offer multiple brands of implants. Some simple types of implants could be considered analogous to an inexpensive Kia.They might not last long but you could buy two for the cost of a Mercedes.Of course there are different models within many brands of cars or implant providers. Some models have better service reputations and some have more expensive parts that are expected to last longer. When all is said and done there is no one right way or wrong way. The best advice I can give to you is to choose the person you feel most comfortable with. The one who you feel is looking out for your best interest and that you have the most confidence in. Then believe in his ability to improve your life. Good Luck

Lisa, Mini implants were always used as transitional implants a few years ago. Now the implant companies are marketing these implants the same as the traditional implant. If you talk to anyone who has placed implants for more than 10 years, they will tell you that standard implants give us the best long term results. 2 implants will cost as much as 4 mimi implants. Most women will get excellent retention with two standard implants. More stability will be seen with a bar attachment. I would steer you away from the mini implants, long term data is not available.

I don't agree with JRB above. FDA has not done anything unfair to the implant industry. I am yet to place even a single mini-implant as yet, but my common sense and reading of literature tells me mini implants aren't as bad as they are made out to be. Like every thing else in life there is a time and place for every thing. Very aptly said above by JCC if a 90 year old person who does not have requisite quantum of bone for regular implants and can't eat and is probably going to live for a few more years say 5-7 years then mini implants would be the fastest solution. If the patient has a pencil thin bone and doesn't want bone augmentation or can't have it Mini implant would be the humane way to treat such a case. Remember, blanket approval and blanket disapproval, both should be approached skeptically. Medical practice is also about being humane to all living beings. It's foolish to throw away a handy weapon in your armamentarium. It's also foolish to treat every patient with the same medicine. Each case carries it's own diagnosis and thus it's own cure. Mini implants are useful to dentists restoring some teeth-less patients, no matter how far and in between they might be. I wouldn't use them for every patient needing an implant, but I would certainly reserve them for some special cases. Ask both of your dentists their justification for their line of treatment and choice of implant system.

I am currently using both systems of implants (fulls and minis). In fact, I just did a case with minis and full sized implants yesterday. In a full mouth case, I typically place the full size implants and mini-implants at the same time. While the full size implants are integrating, the mini-implants provide retention for the denture and keep pressure off of the full size implants. When the full size implants are fully integrated, I remove the mini-implants. Personally, I prefer full sized implants for the final product. If the bone is so minimal that minis are your only option, you would be better off to augment the bone prior to placing implants. I don't agree with someone using minis for all cases. They work well in type 1 and 2 bone, but I have seen many mini-failures in type 3 and 4 bone.

If you analyze the biomechanical system made of the implants/dense bone/overdenture being with Oring attachments, and change one variable:implant 4 x 2mm dia 13mm long, Vs 2 x 4mm dia 13mm long. you might may be surprised to learn that: the 4 minis is a better mechanical system. If you are interested, I can build onto this with more detailed data.

Ouch, a 2 mm mini implant, even grade V alloy is without question a severe compromise at best. As most of you know the mini implants have been used for long term use by the FDA with emphasis being on more than 6 months. A 2 mm thread leaves, 1 mm for the main implant body and 1/2 mm of either side for stabilization. You may want to check with the barod of Florida however I understand that there are hundreds of cases under investigation surrounding the use of mini implants. In my opinion the only place for an implant less than 3 mm in diamater is the very compromised anterior mandible with type 1 of 2 bone. Just because it can be done certainly does not mean you should do it. Dot the i's and cross the t's because a 2 mm diameter is disaster long term, in my opinion. Read Misch's Surgical text book on bone physiology, BIC, alloy grades and so much more. You will learn more than anybody could ever teach you. Duke Aldridge, MAGD, MICOI, DDS

Dear Terry, I don't quite understand. Are you saying that the 4X2 mm is better or the 2X4 is superior? Please explain. More details will be appreciated. Thank you....

I would love to see scientific data, more specifically a meta-analysis and not clinical reports or manufacturers data supporting the use of mini implants in the mandibular space. Yes there are some cases where the patient may be better served with mini implants, (age, atrophic mandible and simply won't go thru hip, ramus, etc surgery). I don't have any idea how you can get thread depth on a 2 mini implant and have any structural support left in the middle of the implant. May I suggest you contact the Florida Board of Dental Examiners and ask them how many implant fractures/complaints they are dealing with. If you choose to use mini's then I suggest you know the Hounsfeld units/Quality of bone, inform your patient and get ready for failure at a much higher degree/percentage then implants that have a such a greater Bone to Implant contact ratio. (In somoe cases 100's time as much BIC. Don't be fooled. If you are thinking of using mini implants for anything then transitional use (Hello, this is how they were first introduced) then I can only suspect that you have not been thru a thorough implant course of 300 hours or more. Please, Please be careful mini implants are not an implant builder. Patients will talk. With that said maybe your patient is one of a a very few who only has enough bone for a mini implant and won't go thru a further surgery. Best of Luck, think twice Duke Aldridge, MAGD, MICOI

I have to say that JCC comment has been the most rational so far. I also would like to mention one factor that my other colleagues may forgot. Although the main reason for placing implants in your case Lisa (and many other cases) is to stabilize a full denture or even bridges and crowns, we are missing one of the most advantages of dental implants (at least in my personal humble opinion). The benefit I love the most about dental implants is PRESERVING THE JAW BONE. I will not go into details but with proper treatment planning end execution dental implants will preserve the bone around them sometimes for the rest of the patient's live. 4 implants will preserve more bone than 2. Traditional implants will preserve more bone than minis. If you are 90 years old and you don't have good bone to start with I believe Minis will work. However if you are younger (70 or early 80) and you can financially and medically afford 4 traditional implants I will go for that. I also will recommend placing 2 implants in the back and 2 in the front (if bone permits) again to preserve as much as bone possible. Now remember this website and others will give you just raw ideas. Your well-trained dentist is the best person in the world to assess your individual case. I hope this will help and I hope that some of my friends will agree with me. Good Luck!

I have been placing implants for over 20 years and have placed many different brands and clones. I started placing mini implants about 4 years ago strictly to support dentures. For the anterior mandible I have not seen a failure or fracture. A minimum number I believe is 4 but when able I usually place 6. Intra Lock produces a slightly larger diameter than Imtec so those are preferable I think but I have placed many Imtecs. It is of course preferable to place traditional root form implants but the costs are beyond some people, particularly when you start including parts such as locators (preferable)-4 implants with locators can get quite expensive. Mini implants in the maxilla are definitely not the best idea, very unpredictable.

As a patient I would ask what are the reasons to use these different implants in the same indication. Are they using mini-implants to prevent bone-augmantation or just because it is his only brand. Normally two normal implants work very well in the lower jaw. The only reasons to use more implants can be that you still have your teeth in the upper jaw or problems with the nerf in the lower jaw for instance. The use of 4 mini-implants instead of two finds it reason in the fact that this person doesn't trust the loadi from the implants on the bone with bone resorption for instance. In this case you spread the load. That's the difference between two normal or four mini-implants. So maybe the four mini-implants can be something for you if you don't want bone-augmentation if this is necessary and mini-implants can prevent this.

JCC you are dead right we are dealing with patients and personalities and a whole host of unique individual issues Thats why we are Dentists and not mechanics Any engineer will agree Biomechanical system is better with 4 implants even if mini over 2 standards ..ANY DAY The key is the prosthetic protocol ..If minis are used correctly (and they are often not )then they will RETAIN the dentures for ever If the retrofitting procedure is not executed perfectly you are making a fixed bridge design implant SUPPORTED Of coarse the little minis will fail! A tent peg with retain a marquee but it will not work as a foundation for a house

I fully agree what bdmckelvy@hotmail.com has stated.

I have placed both mini implants and standard implants. The success rate for mini implants in my case depended a lot on the system. Most of them are hopeless as permanent fixtures and are best treated as transitional. I'm not going to mention names lest it hits a raw nerve with people who like to call others idiots. For mini implants, I try to place 2.5mm or 3.0mm fixtures made by a certain manufacturer. The latter is as good as some standard implants but costs only $100. Only problem is, there is less margin for error as the ball attachments must all be well-aligned.

Dr. Yee brings up good points. Placing minis does not make on an implantologist. They atr very mush like chickenplants and have a very narrow use. The arguement that the FDA has approved them is a poor one look at the other things the FDA has approved and then had to recend. Let's see what time and TRUE clinical results yield.

I do agree with there is a time and a place for minis! However they should almost never be used to handle the final prosthesis. I do agree with Holzclaw...Type 1 and 2 are maybes....however I don't see too many patients in their late years (60-90 yrs old) with this type of bone....AUGMENT is key...AUGMENT if you don't have the bone then put full size implants... I am not saying there are other factors to consider, however I don't leave anything to chance...I use what I know is predictable! Minis are taking a risk!

As a Prosthodontist, I have been placing,restoring, and maintaining implants for 16 years. My office has become somewhat of a repository for failed implant cases from specialists and generalists in the area. Failed mini-implant cases are beginning to come in to my office now. Loss of integration or implants breaking off level with the bone, due to prosthesis overload, seems to be the main theme in most of these cases. Cutting one of these out of the mandible is difficult. IMHO they should only be used during the transition phase under a removable appliance IF the patient has committed to definitive implant reconstruction with bone grafting and/or regular sized implants. Mini-implants will probably become known as substandard care in the next few years, possibly damaging the image of implant dentistry in the eyes of the general public.

Dr. SEASHOLTZ, You are 100% correct. Too many of our fellow doctors fell for this hype and are not thinking or not thinking correctly. Your term "definitive implant treatment" hits the nail square on the head.

Okay, so I am a mom whose son needs two implants in the second front teeth because his adult teeth are missing. I just learned of the mini implants, but after reading all of the above, I am more confused than ever...

Susan - The above posts are referring to a procedure used to replace ALL teeth in an arch, not just missing upper lateral incisors. You will find many other sections on this site discussing mini implants versus standard implants for single tooth replacement. Your son sounds like a good candidate for imlants - you just need to get at least one opinion from a dentist who routinely does implants. Don't make the mistake of thinking you can decide on the best plan just by reading about other people's situations.

Susan, I agree with Dr.Clifford. It's very easy to get persuaded in one ( conventional or mini implant ). If you speak to a clinician who strongly advocates conventional implants, he/she will give you all the reasons why you should get those assuming your son IS a candidate for the implant treatment. Then, you speak to dentists who place minis only, they will give you all the reasons why minis are for your son. Ultimately, you have to think about what your son's expecting from treatment outcomes and other conditions such as cost, healing period, long term proven track record... I for one believe minis do have their place not just as transitional devices but again, it's ultimately your decision. Talk to someone who has placed both types for BOTH TRANSITIONAL AND PERMANENT purposes and get some idea there. It's easy to get persuaded one way listenig to biasd opinion either way.

The bottom line is that with conventional implants there is a tremendous amount of research proving long term success up to 40 plus years. However with Mini's there is no research for long term success, with a substantial number of implant dentists feeling that minis should ONLY be used for transitional use. If I were the patient or the treating doctor there is no doubt as to which type of implant I would choose.

A common argument for the use of mini implants to support a lower denture is that if one fails it is easy to replace. Bone loss is a major reason for their failure. In a narrow ridge, will that lost bone regenerate? Maybe, but if not can you really keep replacing them. What is the domino effect in this situation?

Dear Lisa, There is considerable controversy per mini vs standard implants. The minis were first presented as provisional implants. I use mini's as a provisional and there is about a 30% failure rate in my hands with mini's. I have a1% failure with standard implants I remove them as soon as I am ready to astivate the standard implants. All I can say is I am university trained in implant dentistry and very experienced and wouls not place them in a relative. They have a place and should not be over used. The inexperienced and usually the undertrained, ill informed Docs gravitate to the mini's. It looks easy, inexpensive, fast etc. but they should be restricted to dense bone and over-engineered and the Doc STILL HAVE GOOD SURGICAL SKILLS.

The minis will work for a while in the lower jaw. I do not recommend them in the upper due to the lower density of bone. I use them in my practice as a temporary implant. They are transitional implants, yes you can get lucky and they may last for aome years. The cost for minis for the lower is around $3500.00 for all the implants, not inclusive of the denture a bar retained overdenture with implants (regular implants) is aprox $15,000.00 to $ 25,000.00. This depends on many factors, but gives the patients outstanding function. You get what you pay for!

Dear Mike, You could have the standard implants placed and at the same time some minis to anchor you denture ASAP. Then use the minis as temporary implants. I do this with regularity and the patients love this option. As I see you have issues with the fee. Trust me this is cheaper than gum treatment, root canals and crowns inorder to keep your lower teeth. Plus, implants are more reliable than teeth, when they reach the stage of great need.

Having read all the comments above, I want to make a few points. (1) re "Minis only work in type 1 & 2 bone and fail in Type 3&4. If you attend any training on minis you will find that they are only indicated in Type 1 & 2. Of course they are likely to fail if you use them OUTSIDE of their indications. I suspect a conventional implant would fail if you attempted to stabilise a knee with it.(2) An analysis of all data on minis shows a success rate of over 95%. If you are not achieving this, perhaps you need to consider your case selection and technique. (3) Minis are not intended to take the place of wider implants on the whole- they are however an excellent option for patients who do not have enough bone, money, space or are not physically up to the rigours of implant surgery. These are the indications taught by the companies who sell minis. (4) show me any dentist who can place 2 conventionals for the same cost to the patient as 4 minis. (5) Could someone please back up all these statements about "hundreds of cases pending" etc. You all demand scientific rigour on the one hand then make these sweeping statements with no evidence on the other. I should clarify, I use both types of implants in my practice, and strongly believe there is a place for both. I am however tired of reading these posts about how unsuccessful a treatment is when I can show you hundreds of happy patients who I am treating based on good clinical evidence.

J. Johansen. Couldn't have said it better. I do too place both types of implants and feel the same way about the topic. It's frustrating when some who don't even place minis make generalization about them ( or about regular implants ). I guess time will tell.

And can I add Dr Hughes, your statement " The inexperienced and usually the undertrained, ill informed Docs gravitate to the mini’s." is not only offensive, but how on earth can you provide the evidence to back that statement up?

Dr. Johannsen, IT IS WHAT IT IS........TO BAD.

I agree with Dr. Hughes, mini implants are below the standard of care when used as a definitive treatment for an implant prosthesis. When a pt. pays for implants, minis or real implants, the think they have implants. Regardless of the fee they paid, when the mini implants fail break or lose their ability to retain the prosthesis, it gives Implant Dentisry a black eye in the public. With conventional implants you have choices, if the pt. wants to upgrade the prosthesis and add implants for a fixed pros, the option is there. I would highly argue that four mini implants are as retentive as two with locators. I would not do either, because they are both a maintainence nightmare. Place at least four implants then use locators if you want initially and work the patient into a fixed prosthesis, by adding one or two more implants in the future. Mini implants are useless for most everything, except maybe a provisional.

Dr. Johannsen, I would ignore closed minded and INexperienced comments about mini implants.

Dr. Wallardsen, Thank you for your support and opinions. I am not making my comments because I am trying to be condescending. I have encountered numerous other GP's that did not have alot of implant training other that a prosthetic course or two, that started placing mini's and then started having problems mostly due to their limited understanding of anatomy, basic principles of root form surgery, bone density etc. I too am a GP, however I made a serious effort to obtain the proper education and training and still continue to do so. There is alot more to this than meets the eye. Taking a weekend course or two does not cut it. One has to become a serious student again.

Sergio if you mention mini implants and inexperienced in the same sentence I know you are INEXPERIENCED. GO do some composite fillings and cleanings you have no business doing implants.

dr.hack. i think i can say I have placed closed to 400 implants ( more conventional than minis ) so if you get offended by me saying 'ignore inexperienced ones opinion about minis', TOO BAD. This is why I make the statement I made about ignoring bald and yet very uninformed accusation and generalization about ANYTHING coming from people like you period.

by no means, Im trying to brag. I know many clinicians who have far more experience than I have in implant dentistry. My point is, if you are going to generalize something you better have some decent amount of exposure on that.

Dr. Hack and Dr. Sergio, If you are just placing and restoring mini's, and have only been trained for mini's then you may consider learing more about dental implantology. If you are already well trained then it's your call.

Fear leads to arrogance. Life has passed some of you by. Good luck in your ivory towers.

I have placed close to 100 Imtec minis over the past 3-4 years. I've had 3 fail. All due to path of insertion issues. The success rate is the same for full size implants. Basically, all of my failures have been due to path or occlusion issues. I will only place implants under dentures that meet what I consider to be acceptable standards. Detures must have verticalized occlussal scheme period. From what I have seen in my practice and from others, vast majority of failures occur after loading...after improper occlusion has been applied. Bottom line, use what ever you want, mini or maxi, success is in the bite[chew].

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

No minis on the maxilla!!! If money is an issue go for the minis on the lower, but remember you get what you pay for. I'll leave it at that.

As usual Dr. Hughes your postings are a joy to read. If your only tool is a hammer all your problems look like nails. I am gratefull for mini implants, it gives me another option for treatment. Dentists who don't do alot of surgery (flaps, sinus lifts, bone grafts)do seem to prefer mini implants. I can only hope they know their limitations (the Dentist and the mini implant).

It is now 2011 and I see no comments dated since 2009. I am 74 years old 8 of my front teets still on the lower, the rest are gone after having bridges there for many years. I have had a lower denture with a bridge running on the inside and hooks around the two corner teeth for about a year and can't get used to the thing. As I read about implants and mini implants on this site I am no more clever than before. Can someone please tell me what the experience has been now 3 years later. At age 74 I may have yet 20 years to go.

AS a prospective patient. I second the above. It is now 2011. Can we have some updated info please? And can it be scientifically based - or at least rational and grounded rather than sectarian bickering? And can it please include info on single implants (lower molars). Thank you.

Multiple minis are as good as a few conventional implants, in my experience and opinion. 2.5mm diameter implants by MDL are best in the maxilla - a minimum of six and preferably 10 if sinus allows.

I need to replace a single tooth in my lower left jaw. I believe it is a #20 tooth. I have good natural teeth on either side of the space but I already have two bridges and would like to avoid another. I am 54, in good health, and I have three kids in college. Unfortunately, I cannot afford a traditional implant. My questions are should I just leave the open space among my teeth or choose a quality mini implant that I can afford? Assuming I have enough bone, is a mini implant with a larger diameter - say 2.5 mm, considered a better quality choice than say a 1.8 mm post? Thanks for any advice, Lil Phil