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Inside Dentistry

May 2013, Volume 9, Issue 5
Published by AEGIS Communications


Meeting Patients’ Needs with Small-Diameter Implants

Faster recovery times and lower costs mean higher patient satisfaction

Allison M. DiMatteo, BA, MPS

Small-diameter implants, or those implants with a diameter smaller than 3 mm, are used clinically when space is limited and the placement of conventional-diameter implants may be problematic.1,2 Clinical situations that may call for small-diameter implants include those involving limited interradicular bone, thin alveolar crests, or areas for tooth replacement with small cervical diameters.3

The numerous applications of small-diameter implants make them an important clinical tool for dental practitioners, but the satisfaction they can offer patients also makes them a vital practice-building tool. In many cases, small-diameter implants allow dentists to offer more options when designing a treatment plan for patients, including those who present in an edentulous state. The ability to customize care to match the patient’s expectations and budget, as well as potentially reduce chair and healing times, means that small-diameter implants can play an important role in fostering and maintaining patient trust and loyalty.

Addressing Patient Concerns

Pain, cost, and recovery time are three key concerns for patients facing an implant procedure. When clinically appropriate, small-diameter implants can be an attractive option. Most standard-diameter implants are placed with a flap, and although this is a straightforward procedure, it can be more traumatic for patients than flapless techniques.4,5 Because they do not require a surgical flap, small-diameter placement procedures can be less invasive1 and therefore less traumatic. They can also mean less postoperative pain for patients.6

Usually these smaller implants can be placed and restored in an efficient manner; the flapless technique typically requires only minutes for an experienced dentist and the implants can be placed into new extraction sites and loaded immediately.3,7 In addition, small-diameter implants have customarily been less expensive than standard-diameter implants.8

Furthermore, if a small-diameter implant fails, it can be easily removed, and the subsequent healing process is faster (eg, approximately 2 weeks for bone to fill radiographically when a small-diameter implant is removed compared with months when a standard-diameter implant is removed).5 Finally, the survival rates reported for small-diameter implants have been similar to those of standard-diameter implants, regardless of whether they were placed with a flapless or a flap-reflection technique.9

A Viable Option for Edentulism

Small-diameter implants have been used for single-tooth restorations, multi-implant restorations, and the support of overdentures.1,8 Small-diameter implants are ideal for replacing maxillary or mandibular lateral incisors, for which the space is often limited mesiodistally.10 The availability of these implants also has enabled dentists to provide a greater number of fully edentulous and partially edentulous patients with definitive stabilization of their prostheses, whether full or partial dentures or another type of fixed restoration.11-13

The effects of edentulism on an individual include decreased oral facial support as a result of lost hard and soft tissue. This, combined with resorption and decreased lip support and facial height, leaves edentulous people looking prematurely old. In addition to an impaired ability to eat, edentulous individuals also have difficulty speaking.14 Edentulism is often also accompanied by emotional and psychosocial consequences, including a lack of self-esteem, embarrassment, and limited social interaction.15

Although complete removable dentures are the treatment option of choice for many patients, implant overdentures have been shown to be more advantageous. The discomfort and instability of removable dentures can leave people using their tongue, cheek, and lip muscles to keep them in place.16,17 Implant-supported or -retained dentures, on the other hand, are more secure, demonstrate a more stable fit, and provide patients with greater support.14,18 Patients can, therefore, eat more comfortably, maintain their health through better nutrition, speak more naturally, and feel more confident in social settings. When two to four implants are placed to support a full-arch denture, decreased bone loss has been observed, which helps patients maintain a more esthetic appearance.18

Many individuals who could benefit from implant-supported or retained dentures have been reluctant to pursue them. Fear of surgery, cost of implant therapy, and not wanting to be without teeth during a healing period are among the obstacles preventing some edentulous individuals from undergoing implant treatment.9 Although a two-implant overdenture has been considered the standard of care, placing four small-diameter implants may be of greater service, enabling an increased number of suitable patients to experience better oral health and enhanced oral function.4

Conclusion

Small-diameter implants present many advantages. Clinical advantages include easier alignment for an overall easier placement procedure, the ability to be placed in minimal bone with small and narrow osteotomies, and more patient-friendly, immediate-loading capabilities.4 Small-diameter implants may also be beneficial in terms of clinical and esthetic requirements.1 They are indicated for single-tooth restorations as an alternative to—but not a replacement for—conventional bridge restorations and even conventional-diameter implants when space is limited.2,7 In carefully selected cases, small-diameter implants also represent an immediate, lower-cost alternative for addressing edentulism.5 Finally, offering patients a standard of care that satisfies their clinical, emotional, and budgetary needs can be both personally and financially rewarding.

References

1. Dilek OC, Tezulas E. Treatment of a narrow, single tooth edentulous area with mini-dental implants: a clinical report [published online ahead of print Nov 7 2006] . Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103(2):e22-e25.
2. Vigolo P, Givani A, Majzoub Z, Cordioli G. Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations; a 7-year retrospective study . Int J Oral Maxillofac Implants. 2004;19(5):703-709.
3. Degidi M, Piattelli A, Carinci F. Clinical outcome of narrow diameter implants: a retrospective study of 510 implants . J Periodontal. 2008;79(1):49-54.
4. Christensen GJ, Child PL. The truth about small-diameter implants . Dent Today. 2010;29(5):116, 118, 120.
5. Christensen GJ. Ask Dr. Christensen . Dental Economics. 2008;98(9). www.dentaleconomics.com/articles/print/volume-98/issue-9/departments/ask-dr-christensen/ask-dr-christensen.html. Accessed February 15, 2013.
6. Gleiznys A, Skirbutis G, Harb A, et al. New approach towards mini dental implants and small-diameter implants: an option for long-term prostheses . Stomalogija. 2012;14(2):39-45.
7. Flanagan D. Immediate placement of multiple mini dental implants into fresh extraction sites: a case report . J Oral Implantol. 2008;34(2):107-110.
8. Okamoto NW. Engaging the overdenture patient starts in the front office . Inside Dentistry. 2008;4(6):28.
9. Sohrabi K, Mushantat A, Esfandiari S, Feine J. How successful are small-diameter implants? A literature review [published online ahead of print Feb 7 2012] . Clin Oral Implants Res. 2012;23(5):515-525.
10. Romeo E, Lops D, Amorfini L, et al. Clinical and radiographic evaluation of small-diameter (3.3-mm) implants followed for 1-7 years: a longitudinal study . Clin Oral Implants Res. 2006;17(2):139-148.
11. Brandt R, Hollis S, Ahuja S, et al. Short-term objective and subjective evaluation of small-diameter implants used to support and retain mandibular prosthesis . J Tenn Dent Assoc. 2012;92(1):34-38.
12. Erwood I. Stabilizing partial dentures using small-diameter implants . Dent Today. 2010;29(9):116, 118-119.
13. Erwood I. Denture stabilization with small-diameter implants . Dent Today. 2010;29(7):116-118.
14. Vogel RC. Implant overdentures: a new standard of care for edentulous patients—current concepts and techniques . Compend Contin Educ Dent. 2008;29(5):270-276.
15. Fiske J, Davis DM, Frances C, Gelbier S. The emotional effects of tooth loss in edentulous people . Br Dent J. 1998;184(2):90-93.
16. Henry K. Q&A on the future of implants . Dental Equipment and Materials. 2006;11(4). www.dentistryiq.com/articles/dem/print/volume-11/issue-4/focus/qampa-on-the-future-of-implants.html.
17. Rossein KD. Alternative treatment plans: implant supported mandibular dentures . Inside Dentistry. 2006;2(6):42-43.
18. DiMatteo A. Dentures & implants: bringing them together for a winning combination . Inside Dentistry. 2009;5(1):96-104.


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