While ill-fitting dentures may not be considered by some as one of the most serious or health-threatening dental conditions, any dental professional who has spent time speaking with a patient living with a poorly fitting denture knows that the resultant discomfort, inconvenience, and embarrassment is often unbearable. Even after making a considerable investment in a full set of dentures, it is common for the patient to have difficulty eating and or speaking. Many patients opt not to wear one or both dentures, even when they are new, often avoiding social gatherings or eating in public as a result. The number of edentulous adults in the United States continues to rise, and by the year 2020, the number of those in need of one or 2 complete dentures is expected to increase to 37.9 million, as compared to 33.6 million in the early 1990s.1 Statistics show that 25% of those aged 65 to 74 years are edentulous in both arches.2 This illustrates the presence of a considerable and largely underserved patient base, and makes it clear that every dental practitioner should understand the particular needs of those who struggle with improperly fitted dentures.
A Conventional Solution
Conventional implants are a widely accepted and well-known treatment plan for ill-fitting dentures, but the prerequisites for this procedure can be inhibiting and may alienate many patients who are in need of a solution. A common challenge is that a large portion of the implant patient base for complete dentures is geriatric; many of these elderly patients have experienced extensive bone loss or ridge resorption, requiring invasive bone grafting prior to conventional implant placement. In addition, for many who live on a fixed income, the financial burden of the conventional implant procedure is simply untenable. This means that they may choose to live indefinitely with unsuitable dentures that significantly lower their quality of life. Other patients who are elderly, or may be among those who suffer from a variety of health conditions, find the considerable amount of recovery time daunting.
A Promising Alternative
Based on their ability to provide a sustainable solution to ill-fitting dentures with a minimally invasive procedure and lower cost, small-diameter implants (SDIs) (also referred to as mini dental implants) are quickly becoming an extremely viable alternative to the conventional implant procedure.3 SDIs were originally brought to the market as transitional devices to retain a denture while a conventional implant was allowed to osseointegrate. What many practitioners discovered was that if a patient did not return to have these transitional implants removed within 3 to 6 months, they would osseointegrate just as a conventional implant would.4
The US Food and Drug Administration approved SDIs for intraoral use in 1997. Conventional implants have been available far longer, and evidence supports comparable integration. All available research appears to support the use of SDIs when indicated. Histological studies at multiple intervals postinsertion have found integration via “mature and healthy” bone at the light microscope level. This finding is very positive in light of the fact that the implants are often immediately loaded.4 Survival rates are comparable to conventional implants and range in the 90th percentile and upward.5-7 One recent study of 2,500 implants found a 5-year survival rate of more than 94%.Factors to Consider When Choosing the Small-Diameter Implant Procedure
The amount of bone present is one of the most important elements in the decision between a conventional or SDI procedure. Conventional implants require a minimum of 6.0 mm of bone width facial-lingually for insertion, and 10.0 mm or more in a coronal-apical dimension. Naturally, SDIs require much less bone in the facial-lingual dimension (about 4 mm), and can thus increase the likelihood that a patient will have adequate bone to qualify for case selection. Coronal-apical dimensions required for each implant type are similar.9
Another factor to consider is the patient’s health and attitude. For elderly patients or those with compromised immune systems, the minimally invasive procedure, and shortened healing time associated with SDIs is ideal. Because there are no incisions or suturing necessary, the patient will experience minimal postoperative pain and swelling, allowing one to eat comfortably within a matter of hours. Additionally, patients who are reluctant to accept an implant treatment plan for their poorly fitting dentures, due to the high cost and lengthy process of conventional implants, may be better persuaded by the less expensive and relatively fast moving SDI procedure
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