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Can You Replace All of Your Teeth With Mini Dental Implants One at a Time

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INTRODUCTION
Aesthetic dentistry has evolved throughout the past few decades, specifically in the field of implantology. Patients are preferring endosseous procedures to traditional dentures and other removable prostheses to increase stability and comfort, and to decrease pain.1 Conventional implants require several procedures involving multiple appointments and upwards of a year until completion; although some newer techniques promote a faster completion fourth dimension. The "All-on-four" technique is an immediate conventional implant procedure in which four large-diameter implants (2 in the anterior and 2 in the posterior) are inserted at a 45° bending to take advantage of the bachelor bone and to reduce the demand for bone augmentation and/or sinus lift.ii

According to Nobel Biocare's All-on-4 treatment concept manual, a minimum of 5.0 mm in os width and 8.0 mm in bone height is necessary to brainstorm the procedure.3 (All-On-4 is a registered patent owned by Nobel Biocare developed together with Paulo Malo, DDS, PhD, at the MALO CLINIC.) Though the All-on-four technique claims to eliminate the need for bone augmentations and sinus lifts, these procedures cannot always be eliminated if the bone quantity does non meet the requirements due to the large diameter of a conventional implant.i-2,4 While the All-on-4 technique offers adequate back up with 4 implants, the endosseous procedure is still invasive and time consuming compared to the firsthand and early loading procedures used with mini dental implants. The All-on-four oftentimes requires a minimum of iv to six months before the final restoration is fully completed.four In addition, if one of the 4 implants fails to integrate or fails following placement of the restoration, the unabridged restorative procedure must be restarted, additional surgery performed, and the restoration remade. Considering the boilerplate fee for All-on-4 is in the range of $30,000 to $40,000 per dental arch, this technique is non affordable for most dental patients.

Technique Using Mini Dental Implants Recently Introduced
Immediate and early on loading endosseous procedures with mini dental implants are more desirable to patients in many instances because of the speed of completion, an affordable fee, and it is a less invasive procedure with reduced postoperative discomfort.4 The modest size of the mini dental implants (available in several lengths and diameters) eliminates the need for bone augmentation and/or sinus lifts. This is because the mini dental implant tin can be angled into available bone rather than augmenting the bone.4 The Shatkin Fabricated Implant Restoration and Surgical Technique (F.I.R.S.T.) (patent USPTO No. 7,108,511 B, September 2006; developed by Todd E. Shatkin, DDS) provides for mini dental implant(due south) to exist placed and restoration(s) cemented in one patient visit.5 The about recent innovation, Prepare on Half dozen (Fix on Half dozen is a registered trademark owned by Shatkin F.I.R.S.T., adult by Todd E. Shatkin, DDS) offers a combination of the Shatkin F.I.R.S.T. technique using 6 to 8 (or 10) mini dental implants with a 12-unit stock-still detachable zirconia full-curvation restoration with o-band implant housings. The restoration is only removed at recall cleanings equally the dentist is able to snap off the Gear up on SIX restoration. The hygienist will then completely clean the implants, the restoration, and the surrounding tissue and easily reinsert the restoration without patient discomfort. This Fix on SIX procedure is completed in a fraction of the patient'southward and the dentist's time as required by the All-on-iv technique. The success rates of the firsthand loading mini dental implant endosseous procedures are competitive with the All-on-4 technique. If one of the mini dental implants were to neglect with a Fix on Half-dozen restoration, the failed mini implant tin be easily replaced with a new mini implant and o-ring housing placed in the same or dissimilar location. In improver, the Gear up on SIX restorations are considerably more than affordable than the All-on-4 with approximately a 50% to 66% savings. Consequently, the FIX on SIX restorations are more desirable to the patient due to their affordability, greater comfort, reduced treatment time, and the less invasive nature of the procedure.

Figure 1. CBCT scan from consult.

Stock-still partial dentures are commonly supported by mini dental implants to provide a natural, artful appearance for the patient. In recent years, zirconium dioxide (zirconia) frameworks take been used in dentistry for fixed restorations.6 The introduction of zirconia has allowed the fabrication of metallic-gratis prostheses via CAD/CAM technology. The result is improved aesthetics with increased success and reliability.seven There is as well evidence that at that place is less plaque accumulation on zirconia, helping to preclude postoperative gingival problems.8 The compages of these zirconia-based prosthetics enables superior strength and chewing resistance on the posterior teeth relative to other ceramics.5,9 Due to its favorable chemic limerick and mechanical properties, clinicians have been eager to utilise zirconia in implant-supported restorations after its continued success in tooth-supported restorations.ten

The following example study (Figures 1 to 15) presents a clinical report of mini dental implants with the Gear up on 6 technique. The employ of 6 to 8 (or ten) mini dental implants allows for the functional and aesthetically pleasing zirconia fixed prosthesis to exist supported. Using CBCT technology, a zirconia prosthetic restoration was created and fixed over Shatkin F.I.R.S.T. mini dental implants (past Intra-Lock) using o-band housings processed into the zirconia framework.

CASE REPORT
A 56-yr-one-time male person patient with an upper denture presented for a consult on May 13, 2016. He had come in later seeing the Shatkin F.I.R.S.T. boob tube marketing campaign. At the consult, our new patient had a CT scan (using our Shatkin F.I.R.S.T. CBCT machine for pre-op and post-op scans) (Figure 1), treatment plan, and impressions taken for a Set up on SIX detachable-removable bridge (Figure 2). To minimize the discomfort and to eliminate the existing issues with his old denture, a zirconia bridge was prescribed and designed to fit on the mini dental implants that would exist placed. Zirconia was called as the fabrication material due to its forcefulness and durability and resistance to plaque. A treatment plan for placing 10 Mini Bulldoze-Locks (MDL [Intra-Lock]) in the maxillary curvation using the Shatkin F.I.R.S.T. technique for mini dental implant placement was chosen. He was asked to return in 2 weeks for his procedure and placement of a temporary bridge.

Effigy ii. Dental model made using the impression taken at the consult engagement. Figure iii. The tissue was marked using a Thompson marking pen through the surgical guide stent to get a visual for placement of the mini implants.
Effigy 4. Holding the CT guided stent still in preparation of placing mini implants. Figure 5. Using the Shatkin F.I.R.Southward.T. Pilot Drill Guide and 20:1 MDL Contra Angle Commuter to brand Pilot hole.
Figure 6. Placing mini dental implant through the CT guided stent with xx:1 handpiece. Effigy vii. Fully seating the mini dental implant later on removing the surgical guide stent.
Figure 8. After placing the first v mini
dental implants, the clinician checks for proper alignment.		 Figure nine. The 10 mini dental implants were placed in the maxilla. Discover the bottom of the foursquare is level with the gingiva, and the ball and square are above tissue.
Effigy ten. Placing all 10 micro metal housings on the mini dental implants. Figure 11. Terminal restoration before placement of o-rings.

About one month later, the patient returned, signed the consent form, and handling was begun. A local anesthetic (ii carpules of Septocaine with epinephrine [Septodont]) was administered. A CT guided stent from Shatkin F.I.R.S.T. Lab was used in this example. The position of the 10 implants was marked using a Thompson marker pen and the CT guided stent (Effigy 3). Nine Intra-Lock mini dental implants were used on the upper maxillary arch, size 25 mm/15 mm at Nos. three to 6 and nine to 13; and one 25 mm/11 mm for No. 8. The CT-guided stent was used throughout the procedure (Figure four), removing it between final placement of each implant, using the patented F.I.R.S.T. technique. When finished placing all x implants using the Shatkin F.I.R.S.T. process, the housings were placed, and A1 Luxatemp (DMG America) was used to create the temporary bridge. The patient liked the temporary. Impressions were taken and sent to the Shatkin F.I.R.S.T. Lab (Figures 5 to 8). Two prescriptions (penicillin 500 mg, Norco five/325) were sent to the patient's pharmacy, and an appointment for ii weeks was made for the delivery of the permanent FIX on Six detachable-removable span.

Ii weeks later, the patient returned, and the temporary was removed. The FIX on Half-dozen detachable-removable roundhouse restoration was and so placed (Figures 9 to 12). The FIX on Half dozen restoration had skilful aesthetics, and the patient was happy (Figure 13 to xv). The patient was given a Shatkin Water Flosser and a Sonicare (Philips Oral Healthcare) toothbrush. These are provided as a part of the treatment to our mini implant patients for optimal dwelling house care. These accept been very successful hygiene tools to keep the soft tissues healthy and clean between checkups, when the Set up on SIX is removed.

CLOSING COMMENTS
This article presents an alternative to All-on-4 that is less expensive, less invasive and painful, and demonstrates faster results while utilizing zirconia, a stiff and biocompatible dental material. Set on 6 is a beautiful zirconia restoration that can exist removed by the clinician while providing the patients with the feel and aesthetics of a fixed prosthesis. Creating a fixed prosthesis that is able to withstand the occlusal forces applied, while providing cosmetic appeal and patient satisfaction, is an enduring task for all dentists.eleven Today in dentistry, zirconia has traditionally been used in fixed partial dentures as tooth-supported restorations.ix,10 With nearly cases that use zirconia as a fixed restoration, high success rates have been recorded, mostly college than 95%.ix Zirconia'southward ability to increment the immovability of a prosthesis by upwardly to 30% to 40% has made it a good candidate for use in fixed-hybrid cases.eleven The utilize of CT applied science increases zirconia'south stability in conjunction with decreasing failure rates of these restorations, due to the industrial processing.

In this case study, the patient was dissatisfied with his upper denture because of cracks in the acrylic forth the palate, and the dentures were not comfortable to clothing, and food would trap under them. By designing a fixed zirconia bridge (FIX on Half dozen) instead of acrylic dentures or a hybrid acrylic fixed span, the patient volition no longer have these negative experiences. The use of zirconia instead of acrylic increases durability of the prosthesis while too offering the comfort of fixed restoration and healthier surrounding gingival tissues.

References

  1. Babbush CA, Kutsko GT, Brokloff J. The All-on-Four immediate role treatment concept with NobelActive implants: a retrospective report. J Oral Implantol. 2011;37:431-445.
  2. Jensen OT, Adams MW, Cottam JR, et al. The All-on-iv shelf: maxilla. J Oral Maxillofac Surg. 2010;68:2520-2527.
  3. All-on-4 handling concept [procedures manual]. Kloten, Sweden: Nobel Biocare Services; 2011.
  4. Shatkin TE, Petrotto CA. Mini dental implants: a retrospective assay of 5640 implants placed over a 12-twelvemonth flow. Compend Contin Educ Dent. 2012;33(3, special issue):2-9.
  5. Larsson C, Vult von Steyern P, Sunzel B, et al. All-ceramic 2- to 5-unit implant-supported reconstructions. A randomized, prospective clinical trial. Swed Dent J. 2006;30:45-53.
  6. Glauser R, Sailer I, Wohlwend A, et al. Experimental zirconia abutments for implant-supported single-tooth restorations in esthetically enervating regions: 4-year results of a prospective clinical study. Int J Prosthodont. 2004;17:285-290.
  7. Gargari One thousand, Gloria F, Napoli Eastward, et al. Zirconia: cementation of prosthetic restorations. Literature review. Oral Implantol (Rome). 2010;3:25-29.
  8. Rimondini 50, Cerroni 50, Carrassi A, et al. Bacterial colonization of zirconia ceramic surfaces: an in vitro and in vivo report. Int J Oral Maxillofac Implants. 2002;17:793-798
  9. Komine F, Blatz MB, Matsumura H. Electric current status of zirconia-based fixed restorations. J Oral Sci. 2010;52:531-539.
  10. Guess PC, Att W, Strub JR. Zirconia in fixed implant prosthodontics. Clin Implant Dent Relat Res. 2012;xiv:633-645.
  11. Cobb GW Jr, Metcalf AM, Parsell D, et al. An alternate treatment method for a stock-still-detachable hybrid prosthesis: a clinical study. J Prosthet Paring. 2003;89:239-243.

Dr. Shatkin is a graduate of the University of the Pacific School of Dentistry. He is the president emeritus of the International Academy of Mini Dental Implants and the owner of Shatkin F.I.R.South.T., a mini dental implant specialty laboratory. He practices full-time in Amherst, NY, a suburb of Buffalo. He holds memberships in the ADA, AGD, New York State Dental Society, Eighth Commune Dental Society, Erie County Dental Society, Metropolitan Dental Report Society, International Higher of Oral Implantologists, Greater New York Dental Implant Study Group, and American Academy of Cosmetic Dentistry. During final 12 years, he has placed more than than fifteen,000 mini dental implants, utilizing them for denture stabilizations, single and multiple tooth replacements, and for full-curvation reconstructions, with a success charge per unit of 95%. Due to his positive experiences using mini dental implants, he adult the patented Fabricated Implant Restoration and Surgical Technique (F.I.R.S.T.). This technique features a mini dental implant with a lab-fabricated, finished unmarried-tooth replacement in one visit, usually accomplished in less than 30 minutes; the same results in less than an hour for 3 to v units, and less than 2 hours for a total-arch restoration, all with minimal or no patient discomfort, affordable fees, and the opportunity for a dentist to significantly build the do's earning with minimal startup costs. His implant articles take been published in many dental publications, such as Compendium of Standing Education in Dentistry, Dental Economics, and DentalTown. He lectures internationally on mini implants. He can be reached at (716) 839-1700 or via electronic mail at the address tshatkin@gmail.com.

Disclosure: Dr. Shatkin is the owner of Shatkin F.I.R.South.T. and developer and patent owner of technologies presented in this article.

Ms. Sadkin graduated from Hobart and William Smith Colleges with a bachelor of science in biochemistry. She is currently a second twelvemonth dental student at the University of Pittsburgh Schoolhouse of Dentistry. She can be reached via electronic mail at abs91@pitt.edu.

Disclosure: Ms. Sadkin reports no disclosures.

Mr. Shatkin is a quaternary yr pre-dental student at Country University of New York at Buffalo. He is majoring in history with a pocket-size in chemical science and plans to attend dental school in the autumn. He can exist reached via email at the post-obit address: hatkij01@post.buffstate.edu.

Disclosure: Mr. Shatkin reports no disclosures.

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