An alternative for denture wearers

The set-up

“Dr. Ben Oppenheimer reviews the benefits of using small diameter  or“mini” implants, focusing on improved patient satisfaction with complete dentures. Mini implants allow increased ease of placement with reduced surgical invasiveness, along with lower costs, which are attractive features both for dentists and patients. Using mini implants also results in generally high levels of patient satisfaction.  While mini implants have a generally favorable prognosis, there is little doubt that traditional implants have a better track record of long-term success, which should be factored into the decision-making process for dentists and our patients. ”-Dr. Brien Harvey, Team Lead

Despite modern advances in technology and dentistry, edentulism remains prevalent in the U.S., and dentures will continue to play an important role in treatment options for the foreseeable future. By the year 2020, the number of adults in the U.S. in need of one or two complete dentures is actually expected to increase to 37.9 million, up from 33.6 million in the early 1990s.¹ The sheer size of the boomer population will keep the need for dentures high in the coming decades.

Many dentists likely have seen patients suffering with the discomfort, inconvenience and embarrassment of a poorly stabilized denture. These patients must adapt their diets, social lives and daily habits to accommodate their dentures, and it often can be a very disappointing and embarrassing experience. Many patients turn to measures such as over-the-counter reline kits or excessive use of denture adhesive in an attempt to gain added stability, but these solutions rarely provide the level of security these patients are seeking.

Of course, dentists know dental implants can provide stability for dentures, but there are many reasons why traditional implants may not be the ideal option in some cases. The expense of the procedure is often a significant barrier for patients, particularly senior-aged patients who often live on fixed incomes. Additionally, patients who have been edentulous for some time may not have adequate bone to support a traditional implant, necessitating bone grafting treatment if they wish to pursue implants. (Bone grafting, of course, adds more expense and recovery time to the procedure.) Time and quality of life also is a consideration for senior-aged patients. These patients need to think about if they’ll be able to tolerate the time it takes for implants to osseointegrate, as well as the pain that is associated with the procedure. 

The mini dental implant 

These considerations are such that many denture wearers decide traditional implants are not a suitable option. However, an alternative implant treatment may be in reach for many of these frustrated denture wearers. Mini dental implants are growing in popularity, and offer a number of advantages that may make them more suitable for denture wearers. The small diameter of these implants makes them appropriate for patients with inadequate bone for traditional implants. They also cost significantly less than traditional implants, and are placed in a flapless, minimally invasive procedure, making them cost effective for both patients and practitioners. Additionally, these implants can be immediately loaded, allowing dentists to provide a same-day transformation for patients.

The mini implant system with the longest track record is the 3M™ ESPE™ MDI Mini Dental Implant System, which was approved for long-term use by the FDA in 2003. (The system was known at that time as the IMTEC Sendax MDI system.) A number of studies have been performed on this system, finding success rates ranging from 91% to 97.4%.2-5 In a typical mandibular procedure, a pilot drill is used to create entry points for four implants-a full osteotomy is not necessary. The implants-offered in 1.8 mm, 2.1 mm and 2.4 mm diameters-are then inserted into the pilot holes and advanced with a series of tools designed to reach the appropriate level of torque. The patient’s denture then can be retrofitted with o-ring housings that snap onto the ball-shaped heads of the implants. This design allows the patient’s existing denture to be used if it is in acceptable condition, which is often an additional factor in the affordability of the procedure. The system allows the denture to be tissue supported and implant retained, which gives it immediate loading capability.

Matching patients with the right solution

Understanding a denture patient’s wishes and needs is a vital part of the treatment process, and dentists must listen carefully to patients to determine the most appropriate solution. For patients who express an interest in having additional denture security but who do not have a great deal of money to spend, MDIs are an obvious choice. But beyond this, some denture patients-especially younger patients who anticipate wearing dentures for a significant period of their lives-express a desire to have teeth that feel as secure as their natural teeth. For patients with expectations at this level, traditional implants may be the more appropriate recommendation. I have found in many cases that after presenting both traditional implants and mini implants as an option for these patients, many still choose to have mini implants. But it is in the dentist’s interest to manage expectations for these patients and help them understand their choice.

The best candidates for mini implants

Mini dental implants can be used for patients who have worn dentures for any length of time, but I personally have found the most success with two groups of patients. The first group is patients who have worn immediate dentures after extractions for just a few years and who were unhappy with their dentures from the start. For these patients, mini dental implants provide a boost in stability and confidence that can give them the denture-wearing experience they had hoped for. The second group of patients who have the most success with MDIs have worn dentures for a very long time. These patients may have gone through an initial period of acceptance with their dentures, but over the years, ridge resorption and denture wear have taken their toll and the patient finally decides to seek professional assistance. MDIs can have a very dramatic impact for this group, bringing back chewing function and security they lost long ago.

Growing your practice

Mini dental implants make such a noticeable difference in denture patients’ lives that they very often result in additional word-of-mouth referrals to the practice. Although denture patients are typically known for being reticent in discussing their dentures, with MDIs patients often are eager to share their success with friends, social clubs and other acquaintances.
One of the most attractive things about this service for general dentists is that it can be adopted very easily and affordably. Training is offered in one-day seminars, requiring a minimal amount of time away from the practice.

With only a small investment in time and money, dentists can add mini implants to their repertoire and begin offering this life-changing service to patients. In my experience, learning the technique for MDI placement has served as a springboard to more sophisticated implant dentistry. The dramatic benefits that implants bring to patients are satisfying for the dentist as well, making MDIs one of the most rewarding treatments a dentist can offer.

About the author

Dr. Benjamin D. Oppenheimer is a graduate of the University at Buffalo School of Dental Medicine. There he received a Dean’s letter for Academic Excellence as well as the International Congress of Oral Implantologists award. Now he is one of the leading experts in the world on Mini Dental Implants and a fellow of the ICOI. He has taught hundreds of dentists to use minis and has served as a consultant to the IMTEC Corporation, the manufacturer of the MDI product as well as Dental Tech laboratories, Evolution Dental and Global Dental Sciences. He is a key opinion leader to 3M ESPE Dental Implants. He also is the author of a number of scientific journal articles on the subjects of dental implants, bone grafting, mini dental implants and Cone Beam CT for dentistry. As well as offering dental implants, Dr. Ben provides all aspects of patient care for adults in Amherst, NY a suburb of Buffalo.  Dr. Oppenheimer has also served as a business consultant for Jenius Industries Inc. and VBS Holdings LLC. He is a Member of Apex dental solutions, LLC a mini implant marketing agency.