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Mini-implants as provisional anchorage for the replacement of missing anterior teeth: A clinical report
Abstract
This clinical report describes an adult patient referred for orthodontic treatment with mini-implants as anchorage to correct the root angulation of maxillary lateral incisors. The purpose of this report was to demonstrate the versatility of mini-implants placed in a vertical direction in esthetic areas. During orthodontic treatment, some aspects must be observed to preserve the interim restoration against the occlusal loads to avoid screw fracture. A fixed appliance was placed to correct the position of the maxillary anterior teeth and to complete the treatment. Acceptable esthetics and function were achieved.
... The use of orthodontic mini-implants as a replacement for lost incisors due to dental trauma resulted in the preservation of gingival contour and papilla in an adult patient [6]. Dental implants are the preferred treatment for individual agenesis cases, but their application is limited in growing patients. ...
... Craniofacial and dentoalveolar growth can lead to periodontal changes and malocclusion of the implanted tooth, which would not be reflected in the rehabilitated tooth. Therefore, temporary rehabilitation without the inconveniences and limitations of removable or fixed options involving other teeth is an interesting alternative for clinicians dealing with cases of anterior tooth agenesis [6]. ...
... Limited evidence in the literature associates the use of the present technique with the maintenance of alveolar bone [2,3,5,6,10]. The use of miniimplants for rehabilitation purposes is not widely reported, and most available studies involve patients aged 14 years and older. ...
Hypodontia presents a significant challenge when managing dental rehabilitation in adolescent patients. The lack of definitive treatment options during this developmental stage necessitates the exploration of provisional alternatives that provide satisfactory esthetic and functional outcomes. This article aims to showcase a technique for provisional rehabilitation using a temporary anchorage device, specifically a mini-implant, in the context of hypodontia in adolescents. Materials and methods: A 14-year-old patient with hypodontia was selected for this case report. The missing tooth, tooth 12, was replaced with a mini-implant for provisional rehabilitation. The installation procedure and subsequent follow-up evaluations were documented through tomography. Results: Imaging follow-up demonstrated a slight reduction in alveolar bone thickness; however, the overall height of the bone remained well-maintained. This finding suggests that the technique employed in this case offers promising results in terms of preserving alveolar bone integrity during the provisional rehabilitation phase. Conclusion: The presented technique provides both patient comfort and practicality. Moreover, it offers the added advantage of maintaining alveolar bone height, thus serving as a potential alternative to current rehabilitative interventions. Further research and long-term studies are warranted to validate these findings and establish its efficacy in a larger patient population.
... With the advent of mini-implants, the intrusion of one or more extruded teeth can be planned using this anchoring device, benefiting the patient in several ways by simplifying this tooth movement without compromising esthetics. [10][11][12][13][14][15][16] The purpose of this clinical report was to describe the direct use of orthodontic mini-implants for maxillary molar intrusion, and to demonstrate the occlusal stability of the treatment 5 years after completion. ...
... 10,11 The intrusive force was exerted directly on the extruded molars by using only bonding buttons, miniimplants, and elastomeric chains. The intrusion method described in this clinical report is more straightforward than that in previous reports [11][12][13] using mini-implants for intrusion, which benefits the patient. The advantages of this treatment approach include greater predictability of results, 6,7,10,14,15 as it does not depend on patient cooperation; no esthetic compromise; ease of installation of devices involved in the correction; low cost; and the high possibility of eliminating the need for pulp devitalization, periodontal surgery, and more invasive approaches such as surgical intrusion. ...
... Due to their small size, mini-implants can be inserted in various locations, enabling numerous other clinical applications. 12 ...
This clinical report describes a straightforward alternative treatment for adult patients with extruded maxillary molars, who are reluctant to use fixed appliances and complex mechanics. The maxillary molar supereruption of a 57-year-old woman was treated using buttons bonded to the buccal and palatal surfaces of the molars, 2 mini-implants, and elastomeric chains. The intrusion was achieved in 5 months. The treatment stability was observed for 5 years after treatment. © 2016 Editorial Council for the Journal of Prosthetic Dentistry
... Only a few authors have considered XNDI for fixed restoration (Mazor et al. 2004;Anitua et al. 2015). The use of narrow implants as a temporary tooth replacement in young patients as described has only previously been investigated in a case report by a few authors (Jeong et al. 2011;Gurgel et al. 2014). Moreover, to our knowledge, the success rate of immediately restored XNDI is poorly documented in the literature. ...
Aims:
The objective of this study was to assess prospectively the outcomes of extra-narrow diameter implants (XNDI) placed in teenage patients as a temporary restorative option.
Material and methods:
Twenty consecutive young patients presenting one or several missing teeth received XNDI that were immediately restored with composite, Polymethylmethacrylate (Acrylic) or ceramic crown. Clinical and radiographical outcomes were assessed for a minimum follow-up period of 1 year. Additionally, each patient completed retrospectively a satisfaction questionnaire using Visual Analog Scale (VAS).
Results:
A total of 30 implants were placed and followed for a period of 1-7.4 years (mean: 3.59 years). One implant failed after 3 weeks and was replaced successfully. No further biological complications occurred during the follow-up period, leading to an implant survival rate of 96.6%. The patient satisfaction evaluations displayed high levels of comfort and function.
Conclusion:
Immediately restored XNDI to replace missing teeth on teenager patients seems to be an effective temporary restorative option to replace missing teeth in young patients. Composite or ceramic crowns should be preferred. Clinical trials with long-term follow-ups and the assessment of passive egression are needed.
... Postavljeni su retrakcioni konci veličine dve nule u predelu sva četiri prednja zuba (Ultrapak®, Ultradent, South Jordan Utah, USA) da bi se sprečilo curenje gingivalne tečnosti. Između sekutića je postavljena 3) Orthodontic distal movement of the canine and creating the space for inserting a mini-implant 11,12 . 4) Creating direct or indirect composite bonding with the modeling of the canine into a lateral incisor 13 . ...
Hypodontia of the upper lateral incisor, according to its frequency, is the second most frequent one, coming after hypodontia of the second lower premolar (excluding third molars). This developmental anomaly can represent a functional and an aesthetic problem. There is a large number of modes in the treatment of hypodontia of the maxillary lateral incisor. The objective of this study is to present a minimally invasive technique of constructing direct composite veneers in the treatment of hypodontia of the upper lateral incisor, and control results after three years. © 2015 Faculty of Medicine in Niš. Clinic of Dentistry in Niš. All rights reserved.
Background/aim:
Oral trauma is a common event in young patients and can lead to tooth loss, especially after avulsion of a tooth. The aim of this study was to evaluate the survival, esthetic outcomes, ridge preservation, and patient satisfaction of extra-narrow diameter implants (NDIs) as a temporary rehabilitation treatment for young patients who had lost permanent maxillary incisors after an avulsion.
Materials and methods:
This study comprised a prospective clinical and experimental study on a case series of 13 patients (age: 10-14 years) with a history of avulsion of one or more maxillary incisors. The patients received 19 mini-drive locks implants (Intralock) with acrylic resin crowns, divided into two evaluation arms: immediate implant placement (n = 10) and delayed implant placement (n = 9). The cases were followed up every 3 months with an initial tomography (T0) before implant placement and after 1 year (T1). The clinical stability of the implant in the bone and the retention of the provisional implant crown were evaluated, and the esthetic index was calculated at each follow-up. Intragroup and intergroup differences in alveolar ridge height and thickness were compared at T0 and T1, and a questionnaire was administered to assess the patient's perception of the treatment.
Results:
The implant survival rate after 1 year was 78.9%. Alveolar ridge height and thickness increased in all cases at T1 (p < .05). Patients who received immediate implants had greater initial and final alveolar ridge thickness. The esthetic index progressively increased over the investigated time period (p = .001). Only one female patient presented with crown infraocclusion after 1 year. The patients' esthetic perceptions of their smiles significantly improved after treatment (p = .001).
Conclusions:
Extra-NDI had good survival rates, were effective at maintaining alveolar bone, and promoted aesthetic recovery and patient satisfaction with treatment during the period studied.
AimTo review currently available evidence regarding the use of mini-screw implant (MSI)-supported pontics for the transitional management of missing permanent maxillary lateral incisors in children and adolescents.Methods
Indexed databases were searched until October 2019. The following inclusion criteria were imposed: (a) children and adolescents with missing permanent maxillary lateral incisor/s; (b) temporary replacement of missing permanent maxillary lateral incisors with MSI-supported pontics; (c) clinical and radiographic assessment of the outcome [MSI stability and/or alveolar bone (ALB) development]; and (d) follow-up after pontic placement. Commentaries, letters to the Editor, reviews, and studies in adult patients and/or patients with systemic/genetic diseases, with no follow-up, and without clinical and radiographic assessment of the outcome were excluded.ResultsSix out of 225 initially-identified studies were included. All studies were case-reports/series. A variability was observed among studies-assessed regarding the treatment protocol such as in the MSI dimensions, loading time and pontic retention protocol. Results from the included studies indicate that the MSI-supported pontics remained stable, with no infraocclusion and angular bony defect formation, ALB levels and bone density were maintained, and there was vertical ALB development during the follow-up period which ranged up to 99 months. Reported complications included MSI loss due to mobility, crown repair/replacement due to discoloration, and gingival impingement.Conclusions
The limited evidence shows that MSI-supported pontics are useful transitional restorations for missing permanent maxillary lateral incisors in children and adolescents; however, further well-designed clinical trials are needed in this regard.
Mini implants are commonly used in orthodontics and for interim prosthodontic treatment, but evidence for their use in definitive prosthodontic treatment is not clear.
This systematic review evaluated the mini-implant literature to analyze short-term (1 to 5 years), medium-term (5 to 10 years), and long-term (beyond 10 years) survival rates when used for definitive prosthodontic treatment.
An electronic search of the English language literature for articles published between January 1974 and May 2012 was performed by using PubMed and Cochrane databases with predetermined inclusion criteria. Key terms included in the search were mini dental implants, narrow diameter implants, reduced diameter implants, small diameter implants, transitional implants, interim implants, and provisional implants. After a systematic filtering process, the selected articles were subjected to a detailed review, and the data collected were used to calculate the 1-year interval survival rate (ISR) and the cumulative survival rate (CSR).
The electronic database search yielded 1807 titles. By scrutinizing the titles and abstracts with inclusion and exclusion criteria, the researchers identified 9 studies of mini implants for definitive prosthodontic treatment. Of the studies identified, 1 was a randomized controlled trial, 2 were prospective studies, and 6 were retrospective studies. The majority of mini implants were placed by using a flapless surgical technique in the mandibular anterior region to support an overdenture. The 1st year ISR was 94.7% and the CSR over a 9-year period, primarily attributed to data from 1 study, was 92.2%. Most implants were immediately loaded and almost all implant failures occurred during the first year after implant placement.
For short-term survival, the first year ISR of 94.7% of mini dental implants appears encouraging, but the true 1-year survival rate is unknown, as the minimum follow-up period reported for several implants was less than a year. Insufficient information about failures after the first year makes it difficult to draw conclusions about the medium-term survival of these implants. Currently, there is no evidence for the long-term survival of mini implants.
This article reports the use of an orthodontic mini-implant for a temporary crown restoration in a small edentulous space after limited orthodontic treatment.
Two clinical cases are presented: a 23-year-old woman and a 14-year-old boy. In the adult patient, a 2-piece orthodontic C-implant (Cimplant, Seoul, Korea) was placed in a 3-mm wide edentulous space to build up a temporary crown restoration after a short orthodontic treatment to regain space for a missing mandibular right permanent lateral incisor. In the boy, a C-implant was placed in the space resulting from an avulsed maxillary right permanent lateral incisor to prevent aggressive alveolar bone resorption after dental trauma. Both patients were followed for more than 4 years of retention to evaluate the stability of the temporary crown restoration built up on the orthodontic mini-implants.
Both patients had successful long-term results, confirmed by clinical and radiographic examinations. Both were pleased with the results and plan to retain the orthodontic mini-implant temporary crown restoration until they are ready for a permanent restoration later.
A 2-piece orthodontic C-implant system can be used to maintain edentulous space after active orthodontic treatment.
To review the literature to assess the amount of change in height and width of the residual ridge after tooth extraction.
MEDLINE-PubMed and the Cochrane Central register of controlled trials (CENTRAL) were searched through up to March 2009. Appropriate studies which data reported concerning the dimensional changes in alveolar height and width after tooth extraction were included. Approximal height change, mid-buccal change, mid-crestal change, mid-lingual change, Alveolar width change and socket fill were selected as outcome variables. Mean values and if available standard deviations were extracted. Weighted mean changes were calculated.
Independent screening of the titles and abstracts of 1244 MEDLINE-PubMed and 106 Cochrane papers resulted in 12 publications that met the eligibility criteria. The reduction in width of the alveolar ridges was 3.87 mm. The mean clinical mid-buccal height loss was 1.67 mm. The mean crestal height change as assessed on the radiographs was 1.53 mm. Socket fill in height as measured relative to the original socket floor was on an average 2.57 mm.
During the post-extraction healing period, the weighted mean changes as based on the data derived from the individual selected studies show the clinical loss in width to be greater than the loss in height, assessed both clinically as well as radiographically.
Three treatment options exist for the replacement of congenitally missing lateral incisors: canine substitution, a tooth-supported restoration, or a single-tooth implant. Selecting the appropriate treatment option depends on the malocclusion, the anterior relationship, specific space requirements, and the condition of the adjacent teeth. The ideal treatment is the most conservative alternative that satisfies individual esthetic and functional requirements. This article closely examines the three options when replacing a missing lateral incisor with a tooth-supported restoration. These options are a resin-bonded fixed partial denture, a cantilevered fixed partial denture, and a conventional full-coverage fixed partial denture. The specific criteria that must be evaluated for each option is addressed to illustrate the importance of interdisciplinary treatment planning to achieve optimal esthetics and long-term predictability. This article is the second of a three-part series discussing the three treatment alternatives for replacing congenitally missing lateral incisors.
To determine how general dentists, orthodontists, combined dental specialists, and laypeople judged the relative attractiveness of a series of photographs of teeth that included cases with congenitally missing incisors to compare the esthetic appeal of various treatment options.
The photographs included cases with Maryland bridges, dental implants, and orthodontic substitution of the lateral incisors with the canines. Cases with no missing teeth were included as controls. The subjects rated each photograph independently, assigning a number between 1 and 5 for each of a series of 7 bipolar adjectives. Each photograph was given an overall score from 7 (best) through 35 (worst) for use in statistical analysis (ANOVA).
Results indicated that general dentists, orthodontists, combined dental specialists, and laypeople differed in their evaluations of the photographs, which represented multiple treatment options for congenitally missing maxillary lateral incisors.
Including esthetics of the finished result as an advantage or disadvantage for either restoration or canine substitution of the lateral incisors could be misleading to the patient because the judgment of esthetics of a smile can vary from one person to another or from one dental professional to another, as indicated in this study.
Single-tooth implants are commonly used to replace congenitally missing teeth in adolescent orthodontic patients. However, if implants are placed before cessation of facial growth, they will submerge relative to the adjacent erupting teeth. Therefore, it is important to know when facial growth is complete in postpubertal orthodontic patients. The purposes of this study were to determine and quantify the amount of vertical growth of the facial skeleton and the amount of eruption of the central incisors and the maxillary first molars after puberty.
Two or 3 lateral cephalograms taken at pretreatment, posttreatment, and 10 years postretention of 142 males and 159 females were evaluated. Linear regression models were used to determine changes in the parameters with increasing age.
The findings indicate that (1) the growth of the facial skeleton continues after puberty; (2) there is a difference in the amount of growth between the sexes during the second decade of life, and after age 20 the intergender difference is substantially diminished; and (3) the rate of eruption of the maxillary central incisors in females seems to be greater than in males. Prediction tables are provided to help the clinician determine when to take cephalometric radiographs to assess the cessation of facial growth.
The growth of the facial skeleton continues after puberty, but the amount of growth decreases steadily and after the second decade of life seems to be clinically insignificant.
Our aim was to review the experimental literature to determine what is known about functional and morphological tissue reactions around orthodontically loaded temporary skeletal anchorage devices.
The PubMed electronic database and the reference citations in published articles were searched to the end of April 2006. The inclusion criteria were animal studies about orthodontically loaded skeletal anchorage consisting of metallic bone plates or screw implants of 2.2 mm diameter or less. Data on healing time, force application, stability, side effects, and osseointegration were collected by 2 independent readers.
Eight articles met the selection criteria. The healing times ranged from 0 to 12 weeks, and the amount of force varied from 25 to 500 g. Implant stability was generally achieved without severe side effects. Direct bone-screw contact was reported to be 10% to 58%, and osseointegration increased with loading time. Nevertheless, no significant difference in bone-screw contact was found between loaded and unloaded screw implants, or between tension and pressure sides of loaded implants.
This review highlights some positive experimental findings that apply in clinical practice. However, questions concerning optimal force systems, surgical techniques and placement, and healing times remain. Future research should be well controlled and based on standardized protocols to test specific hypotheses.
In the two cases presented here, orthodontic miniscrews were used for interim restorations before completion of skeletal growth. The esthetic and retentive benefits are obvious—since the patient does not need to remove the artificial tooth before eating or have a fixed prosthesis attached to the adja- cent teeth, the patient can brush and floss normal- ly and wear conventional orthodontic retainers.
Recently, many studies have been reported on distal molar movement using temporary anchorage devices. However, the side effects of distal movement, such as distal tipping, rotation, or extrusion, are still unsolved. This article describes the use of the lever-arm and mini-implant system for controlled distal movement of maxillary molars and two clinical cases in which patients were treated with this system. Mini implants are needed to control the point of force application in the posterior area with no anchorage loss. When the length of the lever arm and the position of the mini implant are adjusted, the desired line of action of the distal force is determined with respect to the center of resistance of maxillary molars. The lever-arm and mini-implant system is useful not only for absolute anchorage, but also for three-dimensional control during distal movement of the upper molars.