CHICAGO—There is spirited debate in the field of implant dentistry about proper use of mini dental implants.
Proponents are urging wider use of the shorter, less costly procedure while others advocate a more conservative approach until several long-term outcomes studies are published, according to the American Academy of Implant Dentistry.
Concerns also have been raised about whether general dentists who adopt mini implants receive sufficient implant training. Though mini-implant companies provide weekend training sessions, AAID believes such instruction falls short of what dentists must know before adding implants to their practices.
"Dentists need to be well versed in implant dentistry before using mini implants," said Kim Gowey, DDS, a past AAID president. "Without extensive implant knowledge, they will not know proper surgical techniques and all the basics about bone healing critical for implant success. If you want to practice implant dentistry, there are no shortcuts for gaining the necessary knowledge and training."
In a plenary-session presentation at the recent AAID annual scientific meeting, Todd Shatkin, DDS, said mini implants are half the diameter of traditional implants--almost toothpick size--and the insertion procedure is less invasive and half the cost of traditional implants.
"Mini implants made from titanium alloys are strong enough to withstand normal chewing force and can be used confidently for immediate-load, long-term restorations," said Dr. Shatkin.
He added that he now uses mini implants for stabilizing dentures, single-tooth implants and even full-arch restorations.
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"The FDA has approved some mini implant systems for long-term use, and patients can have a denture stabilized in about an hour or get a single-tooth implant in 30 minutes," Dr. Shatkin said.
Dr. Shatkin reported findings from a Feb. 2007 article of his that showed his overall success rate with mini implants was 95 percent. He noted implants are now widely accepted in the dental profession for denture stabilization and crown and bridge applications.
For stabilizing dentures, Dr. Shatkin explained that four mini implants are inserted in the front of the patent's lower jaw. It requires mild anesthesia. The dentist adjusts the denture to snap on to the implants and secure it. Denture wearers also can remove the prosthesis for cleaning and snap it back in place.
Concerns about inadequate research
Italian dental researcher and practitioner Matteo Chiapasco, MD, presented a more conservative view to AAID meeting attendees, stressing there is inadequate scientific literature supporting long-term use of mini implants and no well-defined protocols to determine clinical situations for which they should be indicated.
"Adopting any procedure without sufficient research would bring us away from practicing evidence-based dentistry and back to the '70s and '80s when decisions were made from clinical experimentation," said Dr. Gowey.
According AAID President Jaime Lozada, DDS, there is concurrence for using mini implants to stabilize a denture and for insertion in tight spaces between teeth, but many implant dentists do not use them for single tooth or multiple implant placements.
"For placing implants in an extraction site, in most cases, it's in the patient's best interest to use a traditional implant to help preserve the bone and promote better osseointegration," Dr. Lozada said.
Olivia Palmer, DMD, an AAID Fellow practicing in Charleston, S.C., believes mini-implants aren't designed to support normal-size crowns for single-tooth implants.
"The chewing force applied from a crown could overwhelm a mini implant and put way too much pressure on the bone," Dr. Palmer said. "This can lead to bone loss and eventual implant failure."
AAID credentialing program offers rigorous implant training
For general dentists and specialists alike, the AAID credentialing program is an excellent investment in the future as the popularity and success of implants continues to rise.
The exam for the Associate Fellow credential consists of a written test and an oral examination, which includes defense of three clinical cases that the candidate completed.
Applicants must be licensed dentists who have at least 300 hours of postdoctoral or continuing education in implant dentistry, divided between the sciences related to implant dentistry (such as anatomy, immunology and pharmacology) and clinical implant education.
Candidates must pass the written exam before applying to take the oral/case part, and both must be completed successfully within four years.
For more information, go to American Academy of Implant Dentistry.