My patient when we first put in 6 mini dental implants to support a full upper denture.

He had enough bone to add in a few more mini implants so we set out to duplicate what he liked about his denture in a fixed porcelain roundhouse bridge.

I took the existing denture that my patient liked the way it looked and made a copy of it in lab putty.  From that Evolution Dental Lab was able to make a exact copy of the denture but out of porcelain and pink porcelain for the gum tissue.

Final full upper roundhouse bridge that will be supported by mini dental implants.

Day of cementation of the fixed full bridge upper roundhouse.  The design is the same as if the bridge was made on traditional size implants.  The patient will brush, floss or water pick to keep the gums clean.

Paresh B Patel DDS

mini dental implants

Dental Implants Charlotte Mooresville Lake Norman NC

Dental Implants Lenoir Hickory Wilkesboro Asheville NC

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Paresh B Patel DDS  Dentist Mooresville NC

Mini Dental Implants

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I really wanted to do some Porcelain crowns over the mini implants but $$$ were scarce in this case so a decision was made to use lab fabricated resin crowns.  I took a standard Poly Vinyl impression and sent the case to Shatkin FIRST Lab.

Nothing new required for me as the dentist.  From there FIRST Labs places the mini dental implant analog into the impression and makes a replica of what is in the mouth.

 The following set of pictures are the resin crowns on the lab mini dental implant model.  I will take clinical photos of the mini dental implant crowns cemented in place in 2 weeks.

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Some of the time, even with orthodontics, there is not enough space to restore the missing teeth with traditional implants (implants with a diameter greater than 3.0 mm).

Most of the patients I have seen either have some sort of removable appliance or a orthodontic retainer with the two missing teeth on it.  The issue is that these teens don't really care to wear their retainer. 

Another solution, the bonded bridge, seems to fail.  While the bonded bridge works well on missing lowers, the clinical data shows that bonded bridges to replace missing upper laterals fail quite often because the central and canine tooth both move to different degrees under chewing function. 

One solution that works well in my hands is a technique that Dr. Todd Shatkin taught me….use mini dental implants.  The Intra Lock or IMTEC Mini Dental Implant can be threaded in between the canine and central.  This mini implant can then hold a crown in place that the patient does not remove.  

This photograph shows a Intra Lock 2.5 x 18mm mini dental implant to replace missing laterals.

www.dentalminiimplant.com

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To confirm I spoke with Valdi at Sam Shatkin's FIRST Labs.  Valdi is the master lab tech at the Lab and he said, 'No problem, Dr. Brown has been doing that for years.'  So with that information in hand I had to give it a try.

So, having the sink or swim kind of attitude, I enlisted the help of a friend and long time patient of mine.  He had a missing upper molar that he desperately wanted back, not to mention he had been bugging me to death about it.

So with the big day here and multiple sizes of Intra Lock mini dental implants in stock, we got John numb with 1/2 a carpule of Lidocaine…not a lot really.  Just enough to get the gum tissue numb.

We made one pilot hole and placed a 2.0 x 11mm mini….and then another pilot hole was made carefully.  One more mini was tightened into place…..was there space for one more?  I looked over at the assistant, she nodded her head in approval.   The patient was just sitting there just like the guy in the cartoon….'A bit wider Mr. Sprinkle, I need to see if this tennis ball, I mean this last mini implant can be fit in' I said. 

So there it was, 3 mini dental implants all snug in place ready to support a molar crown!

An Itero impression was taken and its off to Shatkin FIRST Lab for a PFM Mini Implant Crown. 

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I knew I was in for a challenge, but to my surprise the case turned out well.  Lots of help from Jon at First Impression Dental Lab and getting his bite as correct as possible made the difference in this case.  I do not envy anyone who has to get someones bite established that has no frame of reference and has teeth on the opposite sides! 

Although we did not do as many crowns and mini implants as planned, the case worked out well for the patient.   Most important to him is that he no longer has to wear partial dentures. 

The case has been in function over just over a year (9-25-09) and hopefully I can track the case for several years.  One year post op pan is shown.  I told him if he did not return for the follow up exams every year…I would find him and knock out the rest of his teeth!  Somehow I don't think I would win that boxing match, but he seems like a nice enough guy and will return without threat of bodily harm. 

The Main Event

Now to the real case.  Our new patient, intrigued with implants to replace his missing back upper teeth, saw a prominent and well qualified dentist in his home town of Asheville NC. 

A CT scan (3D – xray) was taken and a very impressive treatment plan was created for our patient.  Bi lateral sinus lifts, bone grafting, PRP(Platelet Rich Plasma), implants, custom zirconium abutments, and zirconium crowns.  The treatment plan could not have been any better.  The one thing that stopped this case dead in its tracks was that it was not affordable to the patient.  As I tell my patients there is only one treatment plan in the end that is right….its the one the patient understands the pros and cons of and can afford.  Apparently he noticed my boxer buddy's new teeth and they got to talking about mini implants…one thing led to another and he ended up coming to my office for a alternative treatment plan. 

Why minis?  Both mini implants and conventional implants are constructed from medical grade titanium alloy.  Mini implants have been researched and used widely now for over 10 years all over the world. Conventional dental implants now have more than 30 years of data, and many dentists will only use these larger implants. I believe that now is the time for a paradigm shift as I have been working with this alternative.   I have no quarrel with others who are uncomfortable with mini implants, but I am ready for a change in thinking and treatment planning for patients that otherwise could not have implant supported teeth. 

After studying his CT scan I told Tim that I though he had enough bone on the palatal slope of his upper jaw to place mini implants and skirt around the sinus pneumatization (dropping down of the sinus balloon to where the bone used to be). The mini implants could support a set of fixed crowns.  Tim was not ready to get rid of the existing bridgework he had on his remaining upper teeth just yet.  We did discuss that when that time comes we ccould extract the remaining upper teeth, place additional mini implants and fabricate a full arch bridge.  This wwould also give us the benefit of cross arch stabilization.   Another challenge to the case was the hyper eruption of the last molar on the lower right side.  The space between the arches had gotten so small I cautioned Tim that we may not be able to get porcelain on the top of the last tooth.

The mini implants were placed, impression made and on this case I tried a modified ridge lap design where there will be a 1mm space from the lingual so Tim can use a electric toothbrush to keep the implants clean.  I know that most dentists who place crowns over mini implants like having the ridge lap design tight to the tissue on both the cheek side as well as the roof of the mouth or tongue side.  I think with having a 1mm space I know the implants can be kept clean.  Minis in place 1mm gap being show from lingual  Occlusion being established…the bridge will be sent back to the lab to final polish the metal. 

 Pan x-ray with crowns in place.  I will have the patient come back in 1 month, 3 months and then 1 year to see how the soft tissue reacts to the 1mm space and how he is keeping thing clean.  The post will get updated with new pictures at those times. 

Paresh B Patel DDS  Mini Dental Implant Dentist

General Dentist Mooresville NC
 

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A patient of mine came to me and said, 'Dr. Patel I am so glad that I had mini implants placed to keep my lower denture from coming out every time I tried to eat or talk….but can you give me some teeth that I don't have to take out?'

After pondering the thoughts of how to make a bridge that most people could afford I saw my friend Ken at the Annual Academy of Mini Implant Dentists in Orlando.  He had a great idea; why not take high quality, 4 layer denture teeth (in my opinion they look better than some porcelain teeth I have seen) and make a fixed bridge for our patients who suffer with dentures?  The more I thought about it the more it made sense.

Why should we tell patients that if I take some really accurate impressions and then make a tracing of how your chewing motions are that I will be able to create a set of dentures that will work?  Its just not true…they might work…but I think most just make do with what they have.  Dentures resting on gum tissue and chewing muscles will always create some sort of problem.  Soreness in the gums, irritations when chewing foods that get under the denture, the list can go on and on and most denture wearers will attest to that.

So with mini implants in hand, and soon in our office, a Cone Beam 3D X-ray its 'time to get to work,' as Ken would say.  After some careful planning we decided to upgrade Vicki's ability to chew by adding 7 additional mini implants on the lower arch.  One Intra Lock 2.0 x 18mm was placed in between the four she had.  3 additional Intra Lock 2.0 x 11mm were placed on each side for a total of 11 mini dental implants.  These will be used to hold a molar to molar (Roundhouse) Fixed Hybrid Denture Tooth Bridge; also know in my office as the Ken Clifford Bridge.  This bridge will be cemented over the top of the mini implants and will not be removed by the patient.

  
The existing denture was modified to allow it to seat over the additional mini implants.      She will comfortably wear her denture until the fixed set of teeth are made.

It will be designed in the same fashion as a traditional fixed hybrid bridge over regular diameter implants.   

I will continue the post as I get the model work back from First Impression's Dental Lab. 

Here is an example of a Fixed Hybrid Mini Implant Bridge.     Photo courtesy of Ken Clifford DDS.   

Visit my dental office on the web at www.dentalminiimplant.com or if you are in Lenoir NC

Visit Dr. Ken Clifford on the web at www.kenclifford.com or if you are in Chico, CA. 

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