engleski

Preliminary clinical report of a success of mini dental implants in strategic positions as retention and support for partial removable dentures in patients with linear or almost linear tooth support and low number of remaining teeth

Objectives: Most patients with severely reduced dentitions receive removable partial dentures (RPDs) retained by clasps, attachments or double crowns ; however the proportion of patients dissatisfied with their chewing function and/or esthetics due to ill fitting prosthesis, clasp visibility, mucosal inflammation, needs for repair, etc. can reach up to 40%. Placement of standard size implants in strategic positions for retention and better stability of RPDs has already shown benefits. However, placement of slim implants < 3mm diameter (Mini dental implants, MDIs) in strategic positions could ensure change from linear into a triangular or polygonal more favorable denture support, which would protect the remaining teeth from overload and reduce possible rotational movements of the RPDs. Moreover, clasps could also be avoided. However, the results of a prospective clinical study on that matter has not been reported yet. Methods: Thirty six patients, previous RPD wearers with severely reduced dentition (linear support), slim alveolar ridges (< 5 mm) and a need for new partial denture participated. Both, panoramic radiographs and CBCTs were obtained. Each patients received 2 MDIs (diameter varied from 2-2.9 mm and the length from 10-14 mm, depending on the available bone). The MDIs were inserted without flap reflection. Antibiotics were prescribed 2 hours before surgery and 3 days after. Implants were placed posteriorly from the last tooth in the dental arch on both sides, adjacent to it or at a distance of approx. two tooth width posteriorly. If the insertion torque was over 35 N/cm2 the implants were immediately or early loaded. Twenty eight patients received MDIs in the mandible and 8 in the maxilla. Patients filled in 3 questionnaires: Oral health impact profile (OHIP14), chewing function questionnaire (CFQ) and orofacial esthetic scale (OES) at baseline, after receiving new dentures and its adjustments, at the one-year control exam, and in 22 patients at the 3-year appointment. Panoramic radiographs, as well as periapical images were obtained at baseline, after implant placement, after one year and after 3 years. Periimplant tissue and oral hygiene were also assessed. Results: Seventy two implants were placed. One patient lost one implant and another patient lost both implants (in the mandible) before the denture was delivered. In the patient who lost one implant another was inserted, but was lost too, resulting in the 94.5% MDI survival. No other implants were lost after loading. Patients improved significantly orofacial esthetics, chewing function and OHRQoL (p< 0.05) with consistent results through the first year, as well as through the 3-year observation period (in 22 patients). There was almost no bone loss or periimplantitis, although implant hygiene was not always best. None of the remaining patients´ teeth was lost in the observed period. One O rings was changed. No denture fractures (CoCr framework) or matrices loosening was reported. Conclusion: Insertion of MDIs in strategic positions to provide RPD with more favourable support and retention seem to be a viable and reliable clinical procedure, however more patients and more years of observation are neccessary to aprove the protocol.

slim implants ; mini dental implants ; removable partial dentures ; patients perception

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