RESORBED MANDIBLE CASE: BEST TREATMENT PLAN? Reply to Dr John Carroll in Osseonews

Resorbed Mandible Case: Best Treatment Plan?.....A Reply to Dr John Carroll in Osseonews

Dear John Carroll,

Thank you for posting one reference to support your claim on having the numbers and facts on your side. Let me quote the full conclusion that was given in the study that you quoted......

“The results therefore support caution when considering the applicability of implants <= 3mm diameter for single tooth and FPD restorations. Standardized fatigue testing reports for commercially available implants is recommended.”

The keyword is “caution”. The study does not proscribe or condemn outright the use of minis. Instead, it advocates caution because it realizes that its conclusion is deficient and inconclusive because of the following:-

  • Insufficient data. Only 9 samples from Straumann 3.3mm NN, NobelDirect 3.0 and Hi-Tec TRI-N-13 were tested as prescribed.
  • It is a simple overload test and not a cyclic loading test. A simple overload test is one in which you just keep pressing on to the test object until it breaks or bend. A cyclic loading test presses onto the test object intermittently at forces equivalent to those common in the average mouth until it breaks or bend.
  • The introduction to the study itself confesses to its deficiency, “ Cyclic loading tests mimicking years of functional use should ideally be used to test implant designs [Bragger 1999]......ISO 14801; 2003.” Thus a simple overload test is deficient and not conclusive.

Before taking a position, we need much more evidence than from one study that has clear shortcomings. The literature to support the increasing use of minis is quite a lot. I will quote just a few:-

  • The effect of maximum bite force on marginal bone loss of mini-implants supporting a mandibular overdenture: a randomized control trial. Clinical Oral Implants Res. 2010 Feb.
  • Immediate obturator stabilization using a mini dental implants. J Prosthodont. 2008 Aug.
  • Mini-implants to reconstruct missing teeth in severe ridge deficiency and small interdental  space: a 5-year series. Implant Dent. 2004 Dec.
  • Clinical evaluation of single-tooth mini-implant restorations: a five-year retrospective study. J Prosthet Dent. 2000 Jul.
  • Mini dental implants: An adjunct for retention, stability, and comfort for the edentulous patient. Oral Surg/Med/Pathol/Radiol/Endod 2005
  • Immediate loading of narrow-diameter implants with overdentures in severely atrophic mandibles. Sang-Choon Cho, Stuart Froum, Chih-Han Tai, Young Sung Cho, Nicholas Elian, Dennis P. Tarnow.

The gold standard is a double blind randomized control trial. Until that comes, we have to depend on case studies and reviews on minis which is currently quite substantial. We should use both regulars and minis judiciously as both has their pros and cons.

Sincerely, 
K.F. CHOW BDS., FDSRCS

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