Creating Synergy with Conventional and Small-Diameter Implants
Planning for success with maxillary and mandibular overdentures
Brian J. Jackson, DDS
The demand for implant-supported dentures is projected to increase in coming years, and it is important for clinicians to be aware of the variety of options for patients. In many cases, a patient’s bone quality, quantity, and biomechanics, as well as financial means, may call for a blended approach that utilizes conventional-diameter implants (CDIs) and small-diameter implants (SDIs) or mini dental implants (MDIs). When the proper attention is paid to site preservation and careful implant placement, clinicians can achieve both functional and esthetic success for patients.
Oral reconstruction supported by osseointegrated endosseous implants has improved the quality of life for thousands of patients. The demand for implant therapy in the max-illary and mandibular arch is projected to increase as the number of edentulous or partially edentulous patients rises in the future.1 Research has demonstrated long-term success of an implant-retained overdenture prosthesis within the range of 85% to 99%, depending on the specific arch involved.2 Predictable outcomes have been demonstrated when bone quality, quantity, and biomechanics have served as the foundation of treatment planning.3,4
Frequently, clinicians must develop treatment plans for teeth with a poor prognosis, and extraction with site preservation through socket grafting has become a routine procedure.5 Site preservation allows for the development of adequate bone, enabling conventional implant placement while establishing bone density for initial fixation for SDIs.6
CDIs are considered when adequate bone and significant occlusal loads exist or bone-grafting procedures demonstrate a favorable long-term prognosis. However, SDIs are an alternative modality when patients present with diminished bone quality, quantity, and reduced biomechanical loads.7 Utilizing a variety of implant designs and diameters based on the patient’s existing anatomy, medical conditions and monetary constraints can provide a multitude of treatment options. In this case presentation, a thought-provoking treatment plan focusing on bone quality, quantity, age, and biomechanical loads served as the primary considerations in resolving the patient’s chief complaint.
A 41-year-old man presented to the office stating that he did not want to wear partials anymore because they were not comfortable. The patient’s medical history exhibited no significant findings except that he smoked one pack of cigarettes per day. A radiographic survey demonstrated severe horizontal bone loss associated with his maxillary and mandibular teeth (Figure 1). A diagnosis of severe periodontitis was established. The intraoral dental examination revealed a total of 16 remaining teeth in the maxillary and mandibular arches (Figure 2). Class II and III periodontal mobility was exhibited by 9 teeth. The patient was wearing a maxillary transitional removable partial denture (Figure 3).
At consultation, various treatment plans were presented, including saving specific teeth or full-mouth extraction. In addition, the treatment plans included CDIs and SDIs to enhance support, stability, and retention in prosthetic reconstruction. The agreed-upon treatment plan was maxillary and mandibular overdentures. A screw-retained superstructure supported by four CDIs would retain the maxillary overdenture. The mandibular overdenture prosthesis would be retained by four SDIs. The treatment would be performed in a staged approach with extraction and grafting followed by implant placement. Consent, time frame for treatment completion, and provisionalization were reviewed.