DENTURE STABILISATION

 Denture stabilization with implants can make a dramatic difference in the lives of patients, providing benefits in function, aesthetics, and overall health. However, for many denture wearers, traditional implant treatment may be unattainable for any number of reasons. A primary factor is frequently the expense of the procedure. Inadequate bone can be a challenge for many patients, requiring extensive bone grafting prior to conventional implant placement. Finally, as patients age, many simply do not wish to devote a great deal of time to a surgical process that can go on for months and requires a considerable amount of recovery time. 

As a general practitioner who has an extensive history placing conventional dental implants, I am an enthusiastic advocate for the traditional procedure. However, I have seen many patients in my practice for whom it is impractical or simply out of reach financially. The last few years have seen a trend developing for a different kind of implant treatment that may provide an excellent solution for some denture patients involving mini-dental implants (MDIs) (also known as small-diameter implants). 

MDIs were initially introduced as transitional devices to retain a denture while a conventional implant was allowed to osseointegrate. What many practitioners found was that if a patient did not return to have these transitional implants removed within 3 to 6 months, they became very difficult to remove, as they too had integrated into the bone.¹ In 2004, the FDA-approved MDI System (3M ESPE) (formerly IMTEC Sendax MDI implants) for long-term use. 

In recent years, this treatment has been increasingly discussed by the implantology community, primarily as a solution for patients who are not ideal candidates for conventional implants or who cannot afford this option. In my practice, it has been particularly appropriate for patients with atrophic mandibles who do not wish to go through the expense or time of conventional implant treatment with significant bone grafting.

The official protocol for placing MDIs is taught to general practitioners as well as specialists in one-day seminars, making it a relatively simple technique to learn. A minimum of 4 implants are recommended for mandibular denture stabilization. The sites for each implant are marked on the patient’s tissue, and a 1.1-mm pilot drill is used to create entry points. The mini-implants are inserted into the pilot holes and then advanced with a progression of a finger driver, winged thumb wrench, and a ratchet. As a clinician with significant experience in implant placement, I use a more advanced procedure utilizing a flap in cases if appropriate, but a basic case can typically be performed without this step. After placement of the implants, the patient’s denture is then fitted with housings that snap onto the o-ring heads of the implants. This allows the denture to be tissue supported but implant retained, which offers the capability of immediate loading. 

Reported success rates for MDIs have ranged from 91% to 97.4%.^2-5 The most comprehensive study tracked 2,500 implants and reported a 5-year survival rate of 94.2%.4 As the body of research for this treatment grows larger, additional evidence can be expected to support the suitability of MDIs in the edentulous mandible