implants - international magazine of oral implantology

I research Fig. 10_CBCT scan for analysis of the anatomical situation. Fig. 11_Checking of the implant positions on the OPG. Fig. 12_Marking of the implant positions on the denture base. Fig. 13_Basal view of the denture after embedding the metal housings. Fig. 14_Clinical situation in the mandible after placement of four mini implants. _Patient case I Originally, the male patient had received a par- tial mandibular denture which was supported by theremainingnaturalteeth.Theremainingpremo- lar (Fig. 2) was not considered to be worth preserv- ing.Sincetheanxiouspatientalsoaskedforatreat- mentwithareasonableprice,theplacementoffour one-pieceMiniDentalImplants(3MESPEMDI)with a diameter of 1.8 mm and an O-ball head was planned. Within the context of the implant proce- dure, the premolar should be extracted. Due to the lowthicknessofthegingiva,itwasnotnecessaryto createaflap:thelocationofthebonecouldbeiden- tifiedexactly.Initially,thedesiredimplantpositions weredetermined.Thepositionsshouldbechosenin a way that the mesial distance from the mental foramen and the neurovascular bundle is at least 7 mm. In addition, a gap between the implants of minimally5mmisrequired.Inthisway,itisensured thatsufficientspaceisleftbetweenthemetalhous- ings which are placed on the implants later on and are used for fixation of the denture base. In the first step, two implants were inserted in the anterior region following the protocol which is recommended by the manufacturer (Fig. 3). For the preparation of the pilot hole, a drill with a diameter thatissmallerthanthatoftheselectedimplantwas used. Moreover, the drilling depth should be one half to one third of the implant length in order to cause bone compression and condensation during implant insertion. This contributes to an increased primarystabilityoftheimplantsandispossibledue to the self-tapping design of MDI. For turning the implant, a silicone cap, a finger driver, a winged thumb driver and a torque wrench were used one aftertheother.Allinstruments—withtheexception of the torque wrench—were used until clear resist- ance was felt. The insertion of the distal implants followedinthesamemannerafterextractionofthe premolar (Figs. 4–6). With the aid of the torque wrench, an insertion torque of 35 Ncm was ob- tained in order to ensure sufficient stability of the implant (Fig. 7). Figure 8 shows the final situation. On the control radiograph it became clear that the implants were placed in the desired positions (Fig. 9). _Patient case II In this case, the female patient, approximately 65yearsold,wasnothappywiththestabilityofher denture. Moreover, she reported that she fre- quentlyhadsorespotswhichcouldbeexplainedby a very narrow and pointed alveolar ridge after the initial clinical examination. The patient obtained detailed information about the situation and the available treatment options and finally settled for three-dimensional radiographic diagnosis in order tolaythefoundationforasimplifieddecisionmak- ing regarding different prosthetic concepts. The radiograph (Fig. 10) confirmed a high and entirelysmallalveolarbone.Withoutcomplexaug- mentative measures, implant placement was not possible. Moreover, it was revealed that, in accor- dancewiththesmallridge,thebonewasdenseand thus ideally suited for the use of mini dental im- plants—judged by the results of the FEM analysis. Since the patient did not desire complex augmen- tation procedures, she opted for fixation of a com- plete denture with MDI Mini Dental Implants. 18 I implants1_2013 Fig. 11 Fig. 10 Fig. 12 Fig. 13 Fig. 14