1) A 57-year-old woman had congenitally missing maxillary canines bilaterally. Her over-retained deciduous canines had almost no roots left, leaving her alveolar ridge extremely thin. 2) Options to replace the canines included a flipper, partial denture, bridge, or implants. Due to concerns over cost, time, and need for bone grafting, the patient preferred small diameter implants. 3) Small diameter implants provided a less invasive solution without bone grafting that was less expensive and faster than standard implants. The deciduous canines were extracted and small implants placed in under 10 minutes each. Resin crowns were placed directly on the implants.

1. Replacing Over-retained
Deciduous Maxillary Canines
with Small Diameter Implants
Dr. A. F. Paghdiwala
Pearl Dental Arts, Newtown, PA
www.pearldentalarts.com
1-888-PEARL81 or 215-504-4070

2. A 57 years old school teacher,
had congenitally missing
maxillary permanent canines bilaterally

3. Due to resorption,
both canines had almost no roots

4.  The presence of roots gives bulk and
volume to the alveolar bone
 Since the roots of the deciduous canines
had resorbed and there were no
permanent teeth underlying them, the
alveolar ridge was extremely thin bucco-
lingually apical to the deciduous canines

5. Options available to replace the
over-retained canines
 Flipper
 Cast Partial Denture
 Fixed Bridge
 Maryland Bridge
 Implant Supported Crown
After discussing the pros and cons
of the various options,
the patient preferred to get an
Implant supported crown

6. Why the patient had reservations
about getting implants
 Fear and Anxiety
 Cost
 Time
 Need for Bone Grafting- another
invasive procedure, increasing her fear
and anxiety

7. Advantages of small diameter
implants for this patient
 Less invasive
 Only one drill needed - osteotomy completed
faster
 No need for bone grafting, no need to reflect
flap - less anxiety for patient
 Less expensive - implant less expensive,
separate abutment not needed, less chairside
time
 Treatment completed faster
 Small diameter implant, easier to fit when
available room and width of bone compromised

8. The deciduous canine was
extracted

9. Steps in Placing
Small Diameter Dental
Implants
Each Implant takes less than 10 minutes
and usually, no incision or suturing is needed
• Local Anesthetic
• Osteotomy with 1.1 mm surgical drill, x-ray
• Insert the Implant with a finger wrench
• Place it in some more with a Wing Nut
• Secure it in completely with a mini wrench

10. Steps in placing the implant-
Implant is threaded in with a finger wrench

11. Steps in placing the implant-
Implant inserted some more with wing nut

12. Steps in placing the implant-
Implant seated to position with mini wrench

13. The dental implant was placed
3M (Imtec) MDI Max Standard O-Ball 13mm.

14. A Composite Resin Build-up
was made directly onto the
implant

15. Radiographs Two Weeks Post-op

16. The resin build-ups were
prepped, impressions made,
Porcelain Crowns cemented

17. Radiographs Two Years Post-Op

18. Photographs four years post-op

19. Radiographs four years post-op

20. Another case, showing a missing tooth
to be replaced by a small diameter
implant

21. Implant inserted

22. Missing tooth built up directly
on top of Implant with resin
This small diameter implant with resin buildup
has been in function for 8 years

23. Another case, showing two missing
teeth restored mini implants and PMCs
These two mini implants and crowns
have been in function for four years

24. Conclusion
• small diameter implants are usually
placed to support removable dentures
•For replacing individual teeth,
standard diameter Implants are usually
the method of choice

25. •However, some patients may not be
prepared to accept implants for various
reasons:
- fear and anxiety
- cost of treatment
- length of time involved
• In addition, oral conditions may not
allow standard diameter implants, such
as reduced mesio-distal space or
inadequate width of bone bucco-
lingually

26. In these cases, small diameter dental
implants may be presented to the
patient as a less invasive, less
expensive, faster treatment option for
replacing the missing teeth.
In this presenter’s experience,
a direct resin build-up
right onto the small diameter implants
can be an extremely inexpensive and
quick temporary cosmetic solution for a
patient short on time and finances