How to: Stabilize partial dentures

Most dentists likely have seen the statistics that tell us seniors will represent more than 20% of the total population within the next few decades.1 In light of this fact, many of us are exploring our options for how to better cater to members of the senior population and their specific needs. In many cases, this means providing denture services.

Edentulism remains a widespread issue for senior-aged patients, with the condition affecting 26% of people older than 65. For patients 75 and older, the rate increases to 44%.2 Edentulism isn’t only an issue in senior patients, but in fact affects 7.3% of people between 45 and 64.3 As is evident in the following case report, this younger segment of the edentulous population should be viewed as an expanded patient base. Furthermore, these younger patients will be living with their dentures longer, which supports the need for improved fit, form and function in a long-term solution. While providing denture services is a solid foundation for catering to these and senior-aged patients, many dentists likely have seen that dentures are only part of the solution. Instability is a very common problem with dentures, which causes patients hardship when socializing and eating, and can have a negative impact on their overall quality of life.

Because of this, denture stabilization treatments with dental implants are becoming more common in many offices, including treatments done with mini dental implants. These small implants are an attractive option for both dentists and patients. For dentists, the ability to learn the placement procedure in a one-day seminar means the service can be implemented in the practice easily and affordably. For patients, mini dental implants offer a less invasive procedure at a lower cost than traditional implants. Mini implants also can be placed in patients who do not have enough bone to be candidates for traditional implants, making it a more accessible procedure for patients with significant resorption.

Studies on one mini dental implant system, 3M ESPE MDI Mini Dental Implants, have found success rates for these implants ranging from 91% to 97.4%.4-7 The largest of these studies, which followed 2,500 implants, found that 94.2% remained in place after 5 years.8

While implant treatment is typically thought of as a solution for full-denture stabilization, it also can be very useful in partial denture cases. Like fully edentulous patients, many partial denture-wearers are unhappy with the stability of their appliance, but may not know that a solution exists. By placing mini dental implants to help anchor a partial denture, dentists can give patients the security of both a “belt and suspenders.”

Case presentation
The patient was a woman in her mid-40s who had been with the practice for 10 years, during which time she had received a full upper denture and a double distal extension partial denture in the mandible, with only tooth Nos. 22-27 remaining (Fig. 1). In the process of preparing the patient for the partial denture, I explained the possibility of placing mini implants if she determined she would like greater stabilization.

After approximately one year of wearing the partial, the patient decided she would like to move ahead with implant treatment. We determined that one implant on either side of her remaining row of teeth in the mandible would be most appropriate.

At the placement appointment, local anesthesia was administered and locations for each of the two implants were marked on the patient’s tissue.

A pilot drill was used to penetrate the cortical plate and create entry points (Fig. 2).
A 2.1 x 13 mm 3M ESPE Mini Dental Implant was inserted into each opening and rotated downward with a finger driver, initiating the self-tapping process for the implant (Fig. 3).  

After the implant advanced to a point of noticeable bony resistance, the finger driver was swapped with a winged thumb wrench to further thread the implant into place.  

An adjustable torque wrench was used to make slow, final turns until the abutment head of the implant was visible, but no neck or thread portions were above the tissue (Fig. 4). The placement of the implants took just minutes (Figs. 5 and 6).  

Although immediate loading is possible with this procedure, dentists can opt to allow time for healing by performing a soft reline of the denture instead of immediately placing the housings that snap onto the implants. This patient’s partial denture was relieved in the areas that fit over the implants and soft reline material was used to secure it in place (Figs. 7 and 8). The patient returned two weeks later for placement of the final housings. At this appointment, the status of the implants was checked, and the metal housings were placed on the implants and cured into place in the denture with a hard pick-up material (Figs. 9 and 10). This appointment, too, was completed in a very short amount of time, and the patient was very pleased with the added stability of her partial.

Conclusion
There are a significant number of denture wearers-both full and partial-for whom traditional implant treatment is out of reach, because of various factors including their health, inadequate bone, or an inability to afford such an expensive procedure. For these patients, the alternative that mini dental implants present is a very attractive option. The procedure costs significantly less than traditional implants, does not require an invasive flap procedure, and can be performed in just one day. The added stability that mini implants can bring makes a dramatic difference in the function of patients’ dentures, as well as their confidence.

For the dentist, the procedure is highly rewarding as well. Patients are extremely appreciative of the service, and it also can be quite profitable. The investment required for the one-day seminar and introductory supplies easily can be recouped in just a few cases, after which the dentist can focus on marketing this service to both existing and new patients. The procedure is simple and fast, adding to the dentist’s return on investment. But beyond this, it is gratifying to offer an affordable service to denture patients, many of whom have previously believed there was nothing that could be done to help them. With mini implants, dentists can offer patients a new level of function and improved quality of life with their dentures.

About the Author
Dr. Goodheart is a graduate of the University of Missouri-Kansas City School of Dentistry and completed a general practice residency at the Kansas City VA Medical Center. Prior to completing his dental degree, he spent 5 years working as a registered clinical microbiologist. He is in private practice in Raytown, Mo.

References
1. Murdock SH, Hoque MN. Current patterns and future trends in the population of the United States: implications for dentistry and the dental profession in the twenty-first century. J Am Coll Dent. 1998 Winter;65(4):29-35.
2. A profile of older Americans, Washington DC. 1993, American Association of Retired Persons.
3, Summary Health Statistics for U.S. Adults: National Health Interview Survey, Hyattsville, MD. 2010, U.S. Department of Health and Human Services.