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Q: I have been restored with crowns on my front six teeth and a partial in the back for many years now. The partial is one of those partials without clasps that you have mentioned in your older articles. I have seen mini implants advertised on TV that can be done in one day. Is this really true?
A: First, let me compliment you on your choice of restoration that you have been enjoying. I personally think that what you have is a great way to restore a patient. The benefits are plenty. As you mentioned, they are clasp-less, your front teeth stay in even when you remove the back ones, the mechanics of the restoration tend to put less stress on the natural teeth and the palate is left uncovered to enjoy your food better. These are just a few.
Back to your question. It is a great idea to replace the removable partial denture with something permanent like implants. I will address a few things to help clear things up.
First, the use of mini implants for the upper back teeth with opposing natural teeth is not a good idea. The upper bone is very porous, leaving less implant to bone surface area. In addition, mini implants by definition are the smallest implants we have in dentistry. This also provides less implant to bone surface area.
Lastly, most mini implants are one piece. By this I mean that the part that is embedded in the bone and the part that protrudes from the gums are one in the same. By contrast, conventional implants are designed to have the actual implant in the bone and an attachment that is screwed into it. There are many different designs for this part in any implant system that provides for the flexibility to ideally restore a patient. Simply said, things can be customized for the particular situation leading to increased success both functionally and cosmetically.
Secondly, in most cases where a patient has had their upper back teeth missing for a while you will find that the sinus moves down into the area where the roots of those teeth once were. The problem with this is there is less bone available to stabilize the implant when first placed. This would be even harder with mini implant for the same reasons discussed in the previous paragraph. Not enough implant to bone surface area. In most cases, a patient like this will need bone grafted to the area just below the sinus. This will help provide the opportunity for increased bone surface area.
Lastly, you mentioned implants in a day. This has actually become a very common question in my practice. In an effort to give a patient what they a want, implant companies have come up with this sort of marketing. The truth is that implants can be placed in a day with a tooth attached to it. The problem is it is a very specific set of circumstances that need to be present in order to have ultimate success.
Unfortunately, I have seen this idea pushed to its limits, causing failure. This failure does not have to necessarily be in the loss of the implant. It can also be in the final design leading to increased difficulty to maintain the implants. Most commonly, you will see horrible cosmetics, which had the patient known about from the beginning, they would have never done it. I am not saying this as opinion, either. I have had many patients come to me for second opinions once things turned out less that favorable, or before their dentist of record started restoring the case, because they saw the writing on the wall.
I, personally, will not get involved in one of these cases unless all the criteria have been met. It can be done, but all the “stars” have to be lined up just right. I have been involved with many cases where I either re-did the case or came up with a different approach to get the best end result possible. This is one of those situations where, “if it sounds too good to be true it probably is,” holds true. Be wary, but also know that there are ways to give you permanent back teeth that you will enjoy and be proud of for many years to come.
Dr. Frank Vascimini is a dentist practicing in Homosassa. Send your questions to 4805 S. Suncoast Blvd., Homosassa, FL 34446 or email them to him at info@MasterpieceDentalStudio.com.