Narrow Diameter Dental Implant
Reporter R3
Moderator
Outline
Introduction
Biomechanical properties
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion
Introduction
Implant in narrow ridge
Ridge augmentation
Narrow diameter dental implant ?
Increase morbidity
Longer healing time
Infection secondary to wound dehiscence
Terminology of Narrow Diameter Dental Implant
Small diameter implant
Narrow diameter implant
Mini implant
Transitional implant
Provisional implant
No consensus on definition
Terminology
Glossary of Oral and Maxillofacial Implants (EAO, AO, AAP, ACP 2007):
Mini implant:
-
implant fabricated of the same biocompatible materials as other impl
ants but of smaller dimensions.
I. Mini dental implant: < 3.0 mm
For interim usage
II. Narrow diameter dental implant: 3-3.5 m
m
For conventional implant usage
Sierra-Snchez et al. 2014
Bidra et al 2013
Mini Dental Implant (< 3.0 mm)
Mini Dental Implant (< 3.0 mm)
Brand
Nation
Diameter
(mm)
Thread length
(mm)
Materia Surface
l
3M MDI
USA
1.8, 2.1, 2.4,
2.9
10, 13, 15, 18
Ti-6Al4V
SLA
Dentatus
MTI
Sweden
1.8
7, 10, 14
Ti
Machine
d
Dentatus
Atlas
Sweden
1.8, 2.2, 2.4,
2.8
7, 10, 14
Ti-6Al4V
Machine
d
Dentatus
Anew
Sweden
1.8, 2.2, 2.4
7, 10, 14
Ti-6Al4V
Etched
Narrow Diameter Dental Implant (3-3.5 m
m)
Narrow Diameter Dental Implant
Brand
Nation
Diamet
er
(mm)
Thread length
(mm)
Material
Surface
NobelActiv Switzerland
e
3.0, 3.5 10-15, 8.5-18
Ti
TiUnite
ITI Roxolid
SLActive
Switzerland
3.3
8-16
TiZr
SLA
ITI SLA
Switzerland
3.3
8-14
Ti
SLA
3i
Osseotite
USA
3.25
8.5-15
Ti
Double
etched
NarrowSky Germany
3.5
10-16
Ti
SLA
Ankylos
3.5
8- 17
Ti
Acid
USA
Outline
Introduction
Biomechanical properties
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion
Biomechanical Risks
Risk of fracture ?
Increased bone stress ?
Deformation Strength of Narrow Implant
In vitro study
Grade IV cp Ti implants
4.1 vs 3.3 vs 3.0 mm implants
30 off-axis loading
Allum et al. 2008
Deformation Strength of Narrow Implant
Standard
diameter
Narrow
diameter
manufacturer
Diameter Max. load
Straumann RN
4.1 mm
989107
N
Straumann NN
3.3 mm
61950
N
Straumann RN
3.3 mm
51539
N
More risk of elastic deformation in narrow diameter implants
NobelDirect
3.0 mm
57253
N
Allum et al. 2008
Deformation Strength of Narrow Implant
In vitro study
Ti-6Al-4V implant
3.3 vs 3.75 vs 5.0 mm implant
30 off-axis loading
Shemtov-Yona et al. 2012
Deformation Strength of Narrow Implant
Diamete
r
Mean load
5 mm
1584115 N
3.75 mm 952103 N
3.3 mm
67457 N
Lower strength of narrow diameter implants
Shemtov-Yona et al. 2012
Bone Stress
Finite element analysis
Mini vs Narrow vs Standard implant
Model - implants inserted into anterior mandibular regi
on
- cortical layers: 1.2mm
Istabrak Hasan et al 2010
Bone Stress
implant
Bone stress
tioLogic 3.7 x 15 mm
95 Mpa
tioLogic 3.7 x 17 mm
95 Mpa
tioLogic 4.2 x 15 mm
90 Mpa
tioLogic 4.2 x 17 mm
55 Mpa
Narrow
diameter
tioLogic 3.3 x 15 mm
105 Mpa
tioLogic 3.3 x 17 mm
105 Mpa
Mini dental
implant
Mini 2.5 x 15 mm
206 Mpa
Mini 2.5 x 17 mm
195 Mpa
Standard
diameter
Higher stress in mini dental implants
Similar result for narrow & standard diameter implants
Istabrak Hasan et al 2010
Outline
Introduction
Biomechanical properties
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion
Biological Evaluation
Soft tissue: biological width
Hard tissue: bone-implant contact
Biological Width
Dogs, mandible
MiniSky (2.8x10 mm) vs NarrowSky (3.3x10 mm)
Non-submerged, submerged placement
Histological analyses
Calvo-Guirado et al 2010
Biological Width
Narrow (3.5 mm)
Nonsubmerged
Mini (2.8 mm)
Nonsubmerged
submerged
3.2 0.1 mm 2.0 0.3
mm
4.3 0.5 mm
3.3 0.5
mm
3.7 0.2 mm 2.4 0.3
Similar to standard-diametermm
implants
4.8 0.1 mm
4 wks
8 wks
submerged
2.9 0.2
Calvo-Guirado
et al 2010
mm
Bone-implant Contact
Narrow (3.5 mm)
Mini (2.8 mm)
8 wks (nonsubmerged)
42.58.7 %
41.50.1 %
8 wks
(submerged)
49.35.2 %
43.10.7%
Similar to standard-diameter implants
Calvo-Guirado et al 2010
Bone-implant Contact (TiZr vs Ti implant)
Dogs, mandible, 8 wks F.U.
3.3 mm ITI implants
Sandblasted & acid-etched surface
TiZr vs Ti implant
Thoma DS et al 2011
Bone-implant Contact
TiZr (3.3x8 mm)
Ti (3.3x8 mm)
2 wks BIC
81.9 6.7 %
79.3 7.1 %
4 wks BIC
81.3 7.8 %
83.4 5.9 %
8 wks BIC
86.9 6.8 %
82.9 9 %
High BIC values of narrow diameter implants
Thoma DS et al 2011
Outline
Introduction
Biomechanical properties
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion
Clinical Evaluation
Survival rate
- Diameter
- Length
- Bone density
- Restoration type
- Position
Bone level
Survival Rate (3.0 mm)
Author / year
F/U
Position
Failure/Total N
Reason
Survival
rate
Polizzi 1999
63M
12, 22, 32-42
1/30
Fracture (69 M)
96.7%
Reddy 2008
12M
12, 22, 32-42
1/31
Mobility (4 M)
96.7%
Sohn 2011
23M
12, 22, 32-42
0/62
(-)
100%
Galindo-Moreno 2012
12M
12, 22, 32-42
4/97
3: loosening
1: infection
95.9%
Oyama 2012
12M
12, 22, 32-42
0/17
(-)
100%
Mazor 2012
12M
2 for 1molar
0/66
(-)
100%
Survival Rate (3.25 - 3.5 mm)
Author / year
Diameter
F/U
Position
Failure/Total
Reason
Survival
rate
Andersen 2001
3.25 mm
36M
12-22
2/32
1: not
integrated
1: mobile (6 M)
93.8%
Hallman 2001
3.3 mm
12 M
Max + Mand
1/160
Not integrated
99.4%
Zinsli 2004
3.3 mm
60 M
Max + Mand
5/298
3: infection
2: fracture
98.7%
Romeo 2006
3.3 mm
84 M
Max + Mand
3/122
infection
Max: 98.1%
Man:96.9%
Survival Rate (3.25 - 3.5 mm)
Author / year
Diameter
F/U
Position
Failure/Tota
lN
Reason
Survival rate
Veltri 2008
3.5 mm
12 M
Max
0/73
(-)
100%
Arisan 2010
3.3 mm
3.4 mm
60124M
Max +
Mand
14/316
7: not
integrated
92.3%
Malo 2011
3.3 mm
132 M
Posterior
12/247
(most in 6 M)
95.1%
Lee 2012
3.3 mm
3.4 mm
3.5 mm
144,58.8
M
Max +
Mand
9/541
6: infection
1: not
integrated
2: screw
fracture
98.1%
Survival Rate (Implant Diameter)
Diameter
Author / year
Failure(%)
3.0 mm
Polizzi 1999, Reddy 2008, Sohn 2011, GalindoMoreno 2012, Mazor 2012, Oyama 2012
0-4%
3.25 mm
Anderson 2001
6%
3.3 mm
Hallman 2001, Zinsli 2004, Romeo 2006, Malo
2011, Arisan 2010, Lee 2012
1-17 %
3.4 mm
Arisan 2010
Lee 2012
10%
0
3.5 mm
Zinsli 2004
Lee 2012
2%
1%
Survival Rate (Implant Length)
Implant length & number of failure
Author / year
8 mm
Zinsli 2004
Arisan 2010
9.5 mm
10 mm
3
Need further research
Survival Rate (Bone Density)
84 M F.U.
3.3 mm ITI implant (grade IV Ti)
Implant failure
- D2 bone: 1 (0.8%)
- D3 bone: 1 (0.9%)
- D4 bone: 4 (7.8%)*
Romeo et al 2006
Survival Rate (Multiple vs Single Implant)
11 yrs retrospective study
3.3 mm implants in posterior area
Nobel , Grade IV cp Ti
Odds ratio of implant failure
- Partial bridge VS single Implant 4.56 : 1
Malo et al 2011
Survival Rate (Implant Position)
5-10 yrs retrospective study
3.3 mm & 3.4 mm narrow implant
Anterior: 99.21%
Posterior: 92.06%*
Arisan et al 2010
Survival Rate of Narrow Diameter Implant
Lower implant survival rate:
Lower bone density
Posterior area
Implant supported bridge
Bone Level
TiZr 3.3 mm narrow implant vs Ti 4.1 mm implants
1 year post loading
bone loss
(mm)
TiZr (3.3 mm)
Ti (4.1 mm)
0.41
0.40
No significant differences
Benic et al 2013
Bone Level
2 vs 3 NDI supporting mandibular overdentures
3.3 mm narrow implants (Straumann ITI)
2
3
implants implants
Pvalue
6 M bone
loss
0.3 0.3
0.4 0.3
0.266
12 M bone
loss
0.5 0.2
0.6 0.8
0.214
0.8 0.5 0.8 0.9 0.342
24 M bone
loss
Non-significantEl-Sheikh et al 2012
Outline
Introduction
Biomechanical risks
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion
Indication
- Narrow ridge
- Limited inter-dental space
Upper lateral incisors or lower incisors
- Limited inter- implant gap
Courtesy of Dr.
Advantage
Less invasive procedure & associated co
mplications
Reduce surgical intervention
Lower cost
Beneficial to medically compromised pt
or elderly pt
Contra-indication (Relative)
- Bruxer
- Lower bone density
- Reduced bone height
Outline
Introduction
Biomechanical risks
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion
Case Reports
31y/o, male
Courtesy of Dr.
Tooth
43
Bone width
3.5
Bone height
Tomo
> 15
Pano
> 15
Apical
> 15
Implant type
Nobel active
Implant
Implant length
11.5
4M Post Implant Placement
5 M Post Implant Placement- Soft Tissue Grafting
1.5M Post FGG - 2nd Stage Surger
y
1M Post 2nd Stage Surgery
Temporary Prosthesis
Case Reports
51yrs, female
Courtesy of Dr.
12,22 Pre-implant Surgery Evaluation
Multiple missing teeth: loss of interdental papilla
Loss of proximal bone level of 13 & 23
Contact point to crest > 5 mm
12,22 Pre-implant Surgery Evaluation
Width of crest: 2-3 mm
Labial concavity
Without bone housing in ideal implant placement
12 & 22 Implant Surgery
Ridge width at crestal level: 2-3 mm
Ridge Split & Expansion
3i full osseotite certain NT 3.25x13 mm
Guided Bone Regeneration
Osseous graft placement
Guided Bone Regeneration
Resolut LT absorbable membrane
2 Weeks Post Implant Placement
Stitches removal
5 Months Post Implant Placement
12-22 soft tissue depression
12-22 Soft Tissue Augmentation
30x10 mm connective tissue graft placement
2 Weeks Post Soft Tissue Grafting
Stitches removal
8 W Post Soft Tissue Grafting - 2nd Stage Implant Surgery
2nd Stage Implant Surgery
Suture
6 Months Post Temporization
2015/04/16 (Temporization)
Outline
Introduction
Biomechanical risks
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion
Conclusion
Narrow diameter implants (3.0-3.5 mm) may be a
n alternative viable treatment
Careful case selection
