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Mini Dental ImplantsMini Dental Implants
Implant – titanium alloy or other implantable material
Implant Dimensions (<2.5mm diameter)
Fused Abutment (for additional strength)
Atraumatic Placement (minimal surgery)
Crestal anaesthesia (no regional block)
Transmucosal placement (no flaps)
Implant placement with (a single pilot hole of defined size)
e.g. <1.5mm
Immediate Loading
Demonstrable cost benefit analysis
Specifications
Specifications
14. IndicationsIndications
1. Immediate stabilisation of a fixed or removable prosthesis
2. Transitional stabilisation of prosthesis
(during conventional implant “no-load” healing period)
3. Immediate support for compromised natural teeth
(Periodontal Disease / Endodontic Problems)
15. 4. Interim abutment for failing fixed or removable prosthesis
5. Orthodontic anchorage applications
6. Compatible with all existing implant systems
7. Provisional repair of a broken prosthesis
IndicationsIndications
17. Implant EngineeringImplant Engineering
MDI 1.8mm diameter
MDI Max 2.2 mm diameter
Available in 10, 13, 15, 18mm lengths.
Implant and abutment are a single unit.
O-Ball and Flat Head abutment designs.
High-Strength Titanium Alloy construction.
18. Implant EngineeringImplant Engineering
Unique self-tapping thread design.
Anti-rotational flat on implant thread surface.
Implants are surface etched.
Implant packaged for efficient delivery.
Metal Housing and O-Ring packaged separately
19. Titanium AlloyTitanium Alloy
(Titanium, 6 Aluminum, 4 Vanadium)(Titanium, 6 Aluminum, 4 Vanadium)
62.5% Higher tensile strength
than the strongest commercially pure,
Grade IV CP titanium.
21. Patient GroupsPatient Groups
Medical: Minimal Surgery in nearly all groups
Financial: Low cost
Anatomical: Atrophic ridges
Bruising with Flap Surgery
conventional implant placement
22. ContraindicationsContraindications
Medical Psychiatric Disease
Chronic Facial Pain Syndromes
History of Infected Endocarditis
Rheumatic Fever – not necessarily
Surgical Severe Jaw Atrophy
Grade 4 Bone Density – not necessarily
Heavy Occlusion
Gross Dental Sepsis
Immediate Tooth replacement
23. Anaesthesia – Crestal Infiltration
No surgical flap required
No osteotomy site created
Only one drill required
Self-tapping mini-implants
Immediate loading
Multiple restorative options
Surgical PrinciplesSurgical Principles
25. Peel off labels
lot, size, and catalog number.
Add to a patient’s chart for tracking
The Implant PackageThe Implant Package
26. The MDI Implant suspended from a plastic cap
in the glass vial. Once the pouch is opened the
vial can be placed in a surgical tray awaiting
implant insertion.
The Implant PackageThe Implant Package
27. The MDI Implant can be carried
to the mouth utilizing this cap.
Implant Delivery SystemImplant Delivery System
31. Step 2Step 2
Implant Insertion ProcedureImplant Insertion Procedure
Use plastic cap and housing to deliver implant
Implant may also be delivered by the finger driver
Insert implant into pilot opening
Rotate clockwise with downward pressure
Rotate until firm bony resistance is felt.
41. Winged Thumb WrenchWinged Thumb Wrench
Thread the implant until it
becomes difficult to turn.
If no significant resistance
is met prognosis is poor
the site lacks the required
density for predictable
success.
42. Step 4Step 4
Ratchet WrenchRatchet Wrench
The Extension may be
useful when the clinician
is attempting to access an
MDI implant between two
natural teeth.
43. Use of Ratchet WrenchUse of Ratchet Wrench
Use in small, carefully
controlled increments.
If great resistance is
encountered pause
momentarily between turns.
This will allow the bone to
adjust to the implant.
44. The finger on the top of
the ratchet wrench ensures
control of the ratchet and
ensures correct seating of
the implant
Use of Ratchet WrenchUse of Ratchet Wrench
55. Block Out ShimsBlock Out Shims
Block Out Shims 9mm in length.
Prevent the acrylic locking to abutment
Cut to a length so that only O-Ball is exposed.
61. Chairside relineChairside reline
Clean denture
Mix cold-cure acrylic
Fill abutment holes
Wait - until acrylic does not run
Seat denture
Close lightly in occlusion
Allow acrylic to polymerize
62. Chairside relineChairside reline
The cleaned and dry denture
is filled with cold-cure
acrylic and allowed to
polymerise until it is not
runny. The denture is then
seated and the patient is
instructed to close lightly in
centric occlusion
63. Finishing ProceduresFinishing Procedures
Remove elastomeric shims
Trim flash
Fill any minor voids or discrepancies
Finish denture borders and polish
Perform final occlusal equilibration.
It is important that the shims are always removed.
The denture is relieved of flash and any voids are filled.
A reline procedure and occlusal equilibration completes the process.
The patient is then instructed in denture placement, removal, and oral hygiene.
67. Recall and MaintenanceRecall and Maintenance
ACCESS™
Toothbrush
Plaque removal procedures
Cleaning denture housings
Modification of retention (New O-Rings)
Review placement and removal
Time for a new denture??
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0
100
200
300
400
500
Outcome MDI Implants (Sendax)
Mini Dental Implant Center New York
Outcome @ 4 years
Presented to FDA
1996 - 2000 166 406 11
Patients Implants Failed Implants
2.7%2.7%Crestal Bone Loss < 1% / yrCrestal Bone Loss < 1% / yr
79,000 Implants79,000 Implants
1999-20021999-2002
Failure 1%Failure 1%
Data sourceData source
IMETC Quality AssuranceIMETC Quality Assurance
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• History:History: Medical – Dental
• ExaminationExamination
- Sepsis / Perio Status / Occlusion
• InvestigationsInvestigations
- OPT / Lat Chin / P/A’s Bone Density
- I.D. Nerve / Sinus Status
- Implant Sites / Selection / Templates
- Study Models / Crown Bridge
- Putty Jig / Suck Down Splint
• Prosthetic EvaluationProsthetic Evaluation
- Existing / Conversion
- New Prosthesis
Case PlanningCase Planning
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Case PlanningCase Planning
InvestigationsInvestigations
OPT / Lat Chin / P/A’s Bone Density
I.D. Nerve / Sinus Status
Implant Sites / Selection
Templates
Computer Planning
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Dental Implants and Nerve InjuryDental Implants and Nerve Injury
Conventional Dental ImplantsConventional Dental Implants
Nerve Injury thought to mirror that of wisdom tooth removalNerve Injury thought to mirror that of wisdom tooth removal
1.5%1.5%
Flap Surgery Implant Placement
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Dental Implants: 2 Stage Placement
Neurology Status
Ellis: J. Prosthetic Dent 1992
Persistant Parasthesia
13%
Normal Neurology, 87%
Normal Persistant Parasthesia Total
Nerve InjuryNerve Injury
266 patients266 patients
Stage 1
60%
17%
Stage 2
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Mini-Implants and Nerve InjuryMini-Implants and Nerve Injury
Zone 1Zone 1
Mini Implant Technique - less likely unlikely to injure nerve
- No Flap
- Single Stage technique
Zone 2Zone 2
Mini-Implant Flapless Technique – less likely to injure
- lingual nerve
- Nerve to mylohyoid
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Mini-Implants and Nerve InjuryMini-Implants and Nerve Injury
Zone 2Zone 2
Mini-Implant Flapless Technique – inferior alveolar nerve injuryMini-Implant Flapless Technique – inferior alveolar nerve injury
- calibrate magnification of OPT settings
- template selection of implant length
- Simplant 8 Computer Planning
- crestal anaesthesia
- angulation of implant
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Criteria for SuccessCriteria for Success
Albrektsson et alAlbrektsson et al
implant - immobile when tested clinically
radiograph – no evidence of peri-implant radiolucency
vertical bone loss <0.2 mm annually after 1year of service
an absence of :
pain
Infection
neuropathies / parasthesia / violation of the mandibular canal
successful abutment systemsuccessful abutment system
Peckitt 2003Peckitt 2003
successful superstructuresuccessful superstructure
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OutcomesOutcomes
Crown & Bridge
Outcome
10 years 15 years
Bridge Survival 87% 69%
Meta-Analysis of fixed partial denture (bridges) survival: Prostheses and abutments
Scurria M et al - Journal of Prosthetic Dentistry 1998 79;.4, 459-464
Failure after 15 years – Dental Caries abutments
Crown & Bridge
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Dental ImplantsDental Implants
Implant Abutment Loosening / Fracture
5 to 45% of cases
highest during the first year of function
Reduced by preloading abutment / prosthetic screws
Still a fairly common problem
Nonlinear contact analysis of preload in dental implant screws
Sakaguchi R.L. - Borgersen S.E.June 1995
Int. Journal of Oral and Maxillofacial Implants - Vol. 10 No. 3 pp 295-302
MDI Sendax
MTI Monorail
Bicon Q-Implants
85. 10/05/15 85
Informed ConsentInformed Consent
Treatment Contract
Existing Condition
Treatment Options / Choice
Success Rates / Complications
Terms of Postoperative Care
Funding Arrangements
Complication Management
No Absolute Guarantees
86. 10/05/15 86
Informed ConsentInformed Consent
Treatment Contract
ComplicationsComplications
Poor Bone Density
Knife Edge Ridge
Pain
Infection
Chrome Cobalt Dentures
Fractured Implant
Denture Fenestration
New Denture Provision
Nerve Injury
Implant Loss
A strategy should be agreed with respect to lost implantsA strategy should be agreed with respect to lost implants
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Case ProtocolCase Protocol
Case Selection andCase Selection and Contract
Local Anaesthesia techniqueLocal Anaesthesia technique
MDI TechniqueMDI Technique
Antibiotic CoverAntibiotic Cover
AnalgesiaAnalgesia
Oral HygieneOral Hygiene
Keep Prosthesis in 3 daysKeep Prosthesis in 3 days
Review at 1 weekReview at 1 week
Mandatory AuditMandatory Audit
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Patient Comment @ 1 monthPatient Comment @ 1 month
Patient SatisfactionPatient Satisfaction
• Like he has his own teethLike he has his own teeth
• Retention ExceptionalRetention Exceptional
• Post op Pain – Mild toothachePost op Pain – Mild toothache
• Analgesia – 24 hoursAnalgesia – 24 hours
• Eating improvedEating improved
• Taste food “as it really is”Taste food “as it really is”
• Appearance is very goodAppearance is very good
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Best Practice in ProstheticsBest Practice in Prosthetics
Mini-Implant Retained Overdentures
Audit – unacceptable prosthetic morbidity in NHS
Few Contraindications
Good acceptance / Low Trauma – no flaps – 1 visit
Excellent Retention / Superior Cosmesis
Normal Mastication
Implant stability over 90%
Low Cost – Interest Free Loans
Mobile visiting surgeons / backup
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Crown and Bridge SalvageCrown and Bridge Salvage
Suck down splint
Courtesy: http:// www.imtec.com
108. 10/05/15 108
Crown and Bridge SalvageCrown and Bridge Salvage
Courtesy: Dr Norman Andrews BDS MGDS RCS
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F.I.R.S.T.F.I.R.S.T.™ System™ System
Fabricated Implant Restorations and Surgical TechniqueFabricated Implant Restorations and Surgical Technique
Immediate tooth replacement
MDI Implant and fabricated Restoration
Model Surgery from Dental Cast
Surgical Template
100 F.I.R.S.T. restorations to date
No failures – Todd Shatkin (personal communication)
1048 MDI Implants1048 MDI Implants
3.5 year outcomes3.5 year outcomes
(1 third cases Crown & Bridge)
97.65% Success Single tooth
98% Multiple teeth
The following two title slides highlight the applications of the total system.
Applications of the MDI system (continued).
Applications of the MDI system (continued).
The following two title slides list the features of note of the MDI system.
Additional MDI system features (continued).
One of the most important features of the MDI Implant is its construction of titanium alloy. This gives it a tensile strength 62.5 percent higher than the strongest commercially pure, grade four CP titanium.
This graph demonstrates the increased tensile strength of alloy vs. pure titanium.
Patients may be compromised medically, financially, or anatomically and cannot benefit from conventional implant therapy.
The following group of slides outline, demonstrate, and display MDI system overdenture prosthetics and placement techniques.
This title slide lists the seven most important features of the MDI surgical and prosthetic protocols.
These are the five basic steps required to accomplish an MDI procedure. MDI has a five step technique compared to customary 30 step procedures required for conventional implant placements.
This is the front of the MDI package. Note the peel off labels containing lot, size, and catalog number. They are designed to be added to a patient’s chart in order to be able to track vital information and aid in reordering procedures.
This is a close-up photo of the package showing the MDI Implant suspended from a plastic cap in the glass vial. Once the pouch is opened the vial can be placed in a surgical tray awaiting implant insertion.
The MDI Implant can be seen here suspended from the cap, metal housing and O-Ring. It can be carried to the mouth utilizing this cap.
This is a photo of the MDI 1.1 mm surgical drill. An MDI drill is also shown in a latch- type hand piece.
The pilot drill shown on a demonstration model penetrating the cortical plate. This is the only drill necessary in the placement procedures for an MDI Implant.
Another close-up view of the initial penetration of tissue and cortical plate.
Once the initial pilot hole depth is obtained the implant insertion procedure is the next step.
The plastic cap and housing, as mentioned before, may be used to deliver the implant to the site. The implant may also be delivered by used of the Finger Driver. It has a friction grip and is designed as an implant carrier as well as a beginning driver.
If you have used the plastic cap to deliver the implant to the site remove it now by squeezing the neck of the cap to separate it from the head of the implant.. The Titanium Locking Pliers can act as an aid in holding the implant firmly in place during this procedure. Next, attach the Finger Driver to the head of the implant. After inserting the implant into the pilot opening, through the attached gingiva, rotate clockwise while exerting downward pressure. This procedure initiates the self- tapping process and is used until noticeable bony resistance is encountered.
This photograph illustrates an MDI Implant being removed from the glass vial. As mentioned before, the implant is suspended from the O-Ring and Metal Housing which is attached to the plastic cap of the vial.
The plastic cap and O-Ring housing delivers the implant to the site (model).
The plastic cap is used here to deliver the MDI Implant to its site in the mouth.
This is a photograph of the Finger Driver. Note the O-Ring on the end of the driver. It gives the driver the ability to act as an implant carrier as well as the initial driver in the MDI insertion procedure.
The Finger Driver is rotated clockwise while exerting downward pressure(model).
The Finger Driver continues the initial insertion.
This is a clinical photograph of an MDI implant in a starter site awaiting the use of the Finger Driver to initiate the self- tapping process.
This is a close-up photograph of the MDI Winged Thumb Wrench.
This is a photograph of the MDI Winged Thumb Wrench on a display model.
A clinical photograph of the MDI Winged Thumb Wrench in use.
A quarter-inch squareRatchet Wrench is used in the final stage of MDI Implant placement. The MDI Ratchet Wrench Adapter and Extension are seen in this photograph. The Extension may be useful when the clinician is attempting to access an MDI implant between two natural teeth.
This photograph demonstrates use of the Ratchet Wrench on a display model during the final stage of seating the MDI implant.
Note the clinician’s finger on the top of the ratchet wrench. It insures that the implant is seated properly in position without any excess movement of the instrument.
This is a clinical photograph of two seated MDI Implants. Notice that the thread portions of the implants are not visible.
The following group of slides demonstrate the intra-oral retrofitting of a denture using the 0- Ball abutment of the MDI Implant with the O-Ring and Metal Housing of the MDI system.
This display model photograph showing four seated MDI Implants illustrates the ideal positioning in a mandibular case; five to eight millimeters from each other.
The first stage in retrofitting a denture is to transfer the position of the O-Ball abutments to the tissue bearing surface of the denture. This can be accomplished with a number of similar techniques. The heads the abutments can be tipped with an indelible pencil to mark their positions , or a soft wash, wax, or Triad can be used. The following groups of slides demonstrate the use of a Triad material to accurately locate the position of the abutments.
A soft Triad liner has been placed inside the denture. The denture has been seated in the mouth. In this photograph you can see the impressions left by the MDI O-Ball Abutments.
This is a photograph of all four MDI O-Ball Abutment impression marks in the Triad. The pencil marks are clearly visible through the impression material.
Pencil marks are clearly visible on the tissue bearing surface of the denture after the Triad is removed. They reveal the exact locations where the O-Rings and Metal Housings will reside.
This is a photograph of the acrylic bur beginning to enlarge an opening around the locations on the denture where the abutment heads will reside.
Four evacuated holes in the denture are waiting to receive the acrylic resin.
Four evacuated holes in the denture are waiting to receive the acrylic resin.
This is a close-up of a group of Block Out Shims.
The Block Out Shims are cut to length and seated on the abutments (model).
In this clinical photograph four Block Out Shims are seen cut and in place over each implant abutment. Each abutment is lubricated to prevent any acrylic lock on.
This is a photograph of a display model with four Metal Housings seated on abutments.
This is a photograph of a display model with four Metal Housings seated on abutments.
A clinical view of the assembly awaiting the denture.
The cleaned and dried recesses of the denture are then filled with cold-cure acrylic and allowed to polymerize until it is not runny. The denture is then seated and the patient is instructed to close lightly in maximum intercuspation.
Timer is set for three minutes.
It is important that the shims are always removed. They are only used during the retrofitting process. Upon setting, the denture is relieved of flash and any voids are filled. A reline procedure and occlusal equilibration completes the process. The patient is then instructed in denture placement, removal, and oral hygiene.
Remember, always removed the Shims after the denture it is retrofitted.
This is a view of a completed denture with the O-Rings and Metal Housings in place..
A completed case; smile. When considering the and the mandibular overdenture as a treatment option, you are in effect changing the functional status and classification of your patient .The MDI system can offer a new option to your patient population who previously might not have been able to benefit from recent advances in implant technology.
.
MDI patients will now become members of your routine recall and hygiene program. Modifications in the amount of retention and cleansing of the female element of the MDI system can be accomplished during these recall visits. Patient instructions in placement, removal and care of their denture is also essential and recommended. The ACCESS Toothbrush is an excellent device aiding in your patients home care hygiene program. In some cases, this might be an appropriate time to discuss a new denture with the patient!
The ACCESS Toothbrush is specifically designed and engineered for effective MDI Implant home care.
Unique curved bristles with built in memory provide the optimum position for aggressively cleaning abutment surfaces at the gum line. They have the required integrity to remove plaque and debris from implant prosthetics while gently stimulating the surrounding soft tissue. This photograph demonstrates the ability of ACCESS to wrap itself around the entire abutment and thoroughly clean all surface areas.
This is a photographic display of the Standard MDI Surgical Cassette, MDI Implants and system instrumentation. All parts have been previously discussed and displayed in this presentation.
low frequency of sensory alteration cf third molar surgery 1.5%
implants posterior to the mental foramen (zone 2) any increase figure
60% stage 1
17% stage 2
lip (64%), the chin (46%), gingiva (32%) and the tongue (14%)
88% patients normal routine
5% felt that implant treatment was disadvantageous
low frequency of sensory alteration cf third molar surgery 1.5%
implants posterior to the mental foramen (zone 2) any increase figure
60% stage 1
17% stage 2
lip (64%), the chin (46%), gingiva (32%) and the tongue (14%)
88% patients normal routine
5% felt that implant treatment was disadvantageous
low frequency of sensory alteration cf third molar surgery 1.5%
implants posterior to the mental foramen (zone 2) any increase figure
60% stage 1
17% stage 2
lip (64%), the chin (46%), gingiva (32%) and the tongue (14%)
88% patients normal routine
5% felt that implant treatment was disadvantageous
low frequency of sensory alteration cf third molar surgery 1.5%
implants posterior to the mental foramen (zone 2) any increase figure
60% stage 1
17% stage 2
lip (64%), the chin (46%), gingiva (32%) and the tongue (14%)
88% patients normal routine
5% felt that implant treatment was disadvantageous