Initial effects of a treatment by fixed partial dentures supported by mini dental implants from a patient's point of view

Abstract

Mini dental implants (MDIs) in dentistry are recommended for cases with adequate bone quality and height, but a lack of alveolar bone width. Some studies well documented successful usage of MDIs for a removable denture support, but studies of MDIs supporting fixed prosthodontic restorations are scarce. We aimed to study the effect of fixed partial dentures (FPD) therapy supported by MDIs or by MDIs and natural teeth, on patients self perceived oral health related quality of life (OHRQoL), self perceived oral aesthetics and self perceived chewing function. A total of 23 patients (10 female and 13 men, age range from 54 to 78 years) were included and 61 MDIs were inserted, 10 in the maxilla and 51 in the mandible. In 14 patients FPDs were constructed only on MDIs and in 9 patients FPDs were constructed on both, MDIs and natural teeth. FPDs on MDIs were replacing mostly mandibular incisors, the second maxillary incisors and the first maxillary premolars. Those FPDs supported by both, MDIs and natural teeth had some MDIs inserted in frontal regions to allow a FPD construction. The three questionnaires: the OHIP-CRO14 for the assessment of OHRQoL, the OES-CRO for assessment of oral aesthetics and the Chewing function questionnaire (CFQ) for assessment of chewing function have been administrated twice:prior to the MDIs insertion and three months after the FPD treatment supported by MDIs had been finished. The CFQ and the OHIP summary scores significantly decreased revealing better OHRQoL and better chewing ability after treatment, and the OES scores significantly increased indicating increased self perceived oral aesthetics (p < 0.01). Clinical examination revealed no periimplant inflammation. Patients' data supplement the initially promising clinical findings. However, further follow ups will be necessary to finally confirm the long term clinical benefit of MDIs.

Full text

Coll. Antropol. 38 (2014) 1: 275–278
Original scientific paper
Initial Effects of a Treatment by Fixed Partial
Dentures Supported by Mini Dental Implants
from a Patient's Point of View
Sanja Per{i}1, Antonija Palac2, Denis Vojvodi}1,3 and Asja ^elebi}1,4
1University of Zagreb, School od Dental Medicine, Department od Prosthodontics, Zagreb, Croatia
2University of Split, School of Dental Medicine, Department of Prosthodontics, Split, Croatia
3University of Zagreb, University Hospital Dubrava, Zagreb, Croatia
4University of Zagreb, University Hospital Centre Zagreb, Zagreb, Croatia
ABSTRACT
Mini dental implants (MDIs) in dentistry are recommended for cases with adequate bone quality and height, but a
lack of alveolar bone width. Some studies well documented successful usage of MDIs for a removable denture support,
but studies of MDIs supporting fixed prosthodontic restorations are scarce. We aimed to study the effect of fixed partial
dentures (FPD) therapy supported by MDIs or by MDIs and natural teeth, on patients self perceived oral health related
quality of life (OHRQoL), self perceived oral aesthetics and self perceived chewing function. A total of 23 patients (10 fe-
male and 13 men, age range from 54 to 78 years) were included and 61 MDIs were inserted, 10 in the maxilla and 51 in
the mandible. In 14 patients FPDs were constructed only on MDIs and in 9 patients FPDs were constructed on both,
MDIs and natural teeth. FPDs on MDIs were replacing mostly mandibular incisors, the second maxillary incisors and
the first maxillary premolars. Those FPDs supported by both, MDIs and natural teeth had some MDIs inserted in frontal
regions to allow a FPD construction. The three questionnaires: the OHIP-CRO14 for the assessment of OHRQoL, the
OES-CRO for assessment of oral aesthetics and the Chewing function questionnaire (CFQ) for assessment of chewing
function have been administrated twice: prior to the MDIs insertion and three months after the FPD treatment supported
by MDIs had been finished. The CFQ and the OHIP summary scores significantly decreased revealing better OHRQoL
and better chewing ability after treatment, and the OES scores significantly increased indicating increased self perceived
oral aesthetics (p<0.01). Clinical examination revealed no periimplant inflammation. Patients’ data supplement the ini-
tially promising clinical findings. However, further follow ups will be necessary to finally confirm the long term clinical
benefit of MDIs.
Key words: mini dental implants, fixed partial dentures, chewing, aesthetics, OHRQoL
Introduction
The selection of the implant's width has been widely
speculated and the manufacturers have recently, in cases
of limited bone anatomy, initiated a series of one piece
mini implants of narrower diameter (1.8 to 2.9 mm).
Mini dental implants (MDIs) are recommended for those
cases with adequate bone quality and height, but a lack
of alveolar bone width1,2. The MDIs for a long term use
have the same surface treatment as wider implants and
are manufactured from the alloy with 4 parts of vana-
dium to increase implants’ strength. Histologically, the
bone appears to be well integrated to the surface of the
MDIs and bone appears to be mature and healthy3. The
MDIs with treated surface and with diameter ranging
from 1.8 to 2.9 mm undergo osseointegration comparable
to that of conventional larger-diameter implants3.How
-
ever, MDIs do not pretend to substitute conventional im-
plants. The MDIs are suitable for patients with narrow
alveolar ridges for retention of complete or partial re-
movable dentures, as well as for a single- or multi-tooth
replacement in alveolar ridges with restricted space for a
larger diameter implants4–8. MDIs can be inserted only in
places where occlusal forces have not been too high, such
275
Received for publication December 19, 2012

as mandibular incisors’ replacements, the lateral maxil-
lary incisor replacement or the first maxillary premolar
replacement4–8.
The advantage of MDIs also lies in minimally invasive
surgical methods (flapless, initial drilling only) required
for insertion. Another advantage of MDIs is immediate
loading possibility in cases of a good primary stabili-
ty3,9,10. Moreover, MDIs allow reduced cost of a treat-
ment, which is very important for the most patients with
limited budget who cannot afford expensive conventional
implants or cannot afford bone augmentation procedure
due to high age and/or general health problems. Survival
rates reported for MDIs have been satisfactory6,11. The
most MDIs studies reported a survival rate and a success
of complete removable dentures retained by MDI’s4,12.
However, MDIs supporting fixed prosthodontic restora-
tions have not been studied extensively.
The aim of this study was to evaluate patients treated
with fixed partial dentures (FPDs) supported by MDIs or
by both MDIs and natural teeth regarding the aesthetics,
chewing function and a quality of life.
Materials and Methods
Subjects
A total of 23 partially edentulous patients received a
fixed prosthodontic treatment (FPD) by means of mini
dental implants (MDIs) or by MDIs and natural teeth
during a period from April 2009 to March 2012 (10 fe-
male and 13 men, mean age 66, age range 54 to 78 years).
All subjects gave the writen informed consent. The study
was approved by the Ethical Committee of the School of
Dental Medicine, University of Zagreb, Croatia.
Mini dental implants
Most patients had inadequate bucco-lingual bone vol-
ume for normal width implants. Therefore, MDIs were
inserted in the frontal region of the mandibule or the
maxilla. In 14 patients FPDs were supported only by
MDIs and in 9 patients FPDs were constructed both on
MDIs and prepared natural teeth. In those cases MDIs
enabled treatment with FPDs, otherwise removable den-
ture would be made. The patients were thoroughly ex-
plained about implants of lesser width, the attendant
risk and the possibility of augmentation procedure and
the insertion of conventional width implants. Panoramic
radiographs were obtained prior the therapy to assess
the bone quality and quantity, to locate important ana-
tomical landmarks, and mark placement sites. Two types
of MDIs were inserted: Sendax Classic Standard (IM-
TEC) (6 patients) and Renew Biocare RE-Mark mini-im-
plants (Swiss) (17 patients). The MDIs, were inserted us-
ing a minimally invasive technique which was without
reflecting the mucoperiosteal flap and with only initial
drilling of cortical and cancellous bone up to a few
milimeters. MDIs were loaded with early loading proto-
col (2–4 weeks after the insertion). The diameters of the
MDIs were ranging from 1.9 to 2.5 mm and the lengths
were ranging from 10 to 15 mm, depending on the avail-
able height of the bone.
A total of 61 MDIs were inserted, 10 in the maxilla
and 51 in the mandible. Fixed partial dentures (FPDs) on
MDIs were replacing mostly mandibular incisors, and
also the second maxillary incisors and the first maxillary
premolars. Those FPDs supported by both, MDIs and
natural teeth had some MDIs inserted in frontal regions
to allow a FPD construction.
Questionnaires
All participants filled in three questionnaires: the
Croatian version of the OHIP14 questionnaire13 (Oral
Health Impact Profil), the Croatian version of the OES
questionnaire14 (Orofacial Esthetic Scale) and the Che-
wing Function Questionnaire15 (CFQ), which represents
the instrument developed by the authors for patient’s
self-assessment of a chewing function. The participants
filled in the questionnaires first before the treatment
had begun and then three months after the treatment
had been finished. At the three month follow-up the pa-
tients were also clinically examined for periimplant mu-
cosal tissue status.
Statistical analysis
The data analysis was made using the SPSS statisti-
cal package (version 17.0, SPSS Inc., Chicago, IL, USA)
Independent samples t-test was used to test the differ-
ence between gender. Paired samples t-test was used to
test the difference between summary scores of the ques-
tionnaires before the treatment and three monthts after
the treatment. P value of less than 0.05 was considered
statistically significant.
Results
Clinical examination of the mucosal tissue surround-
ing MDIs showed no appreciable inflammation after
three months. Independent samples t-test showed no sig-
nificant differences between males and females for age
and any of the observed variables obtained from the
questionnaires (p>0.05).
Mean summary scores, standard deviations, mean dif-
ferences between the two observation stages and a signif-
icance of the difference of the OES, the CFQ and the
OHIP14 questionnaires before treatment and three
months after treatment are presented in Table 1. A sta-
tistically significant differences of the OES, the CFQ and
the OHIP14 summary scores were obtained for all ques-
tionnaires three months after treatment (p<0.01, Table
1). The CFQ and the OHIP summary scores significantly
decreased and the OES scores significantly increased
(p<0.01).
Discussion
The availability of MDIs from 1.8 mm to 2.9 mm in di-
ameter, and the US Food and Drug Administration ap-
S. Per{i} et al.: Fixed Partial Dentures Supported by Mini Dental Implants, Coll. Antropol. 38 (2014) 1: 275–278
276

proval for removable denture support and retention, as
well as for fixed prosthodontic restorations have opened
new options in oral-implant rehabilitation. Clinical stud-
ies with FPDs supported by MDIs are lacking in the liter-
ature and are mostly based on case reports16.Therefore
we studied a group of patients rehabilitated with FPDs
supported only by MDIs or by both, MDIs and prepared
natural teeth. Most of the implants were placed in the
mandible. Our first patients received IMTEC MDIs and
other patients received Renew Biocare MDIs.
Improvement of oral health related quality of life
(OHRQoL) has become the main goal of contemporary
dentistry17–32. Eliminating problems with chewing, speech,
as well as improving orofacial aesthetics contribute to
the improvement of oral health. Overall success of pros-
thodontic therapy can be assessed by patients relying on
the described parameters17–35. Therefore the OHIP14
was used to assess OHRQoL13, the OES to assess orofa-
cial aesthetics14,17 and the CFQ to assess self perceived
chewing function15. Psychometric properties of all three
questionnaires have been tested in previous studies and
were proven to be satisfactory13–16. The OHIP14 ques-
tionnaire measures impact of several domains on the
OHRQoL, such as functional, psychological and sociolog-
ical factors, the OES and the CFQ represent unidimensio-
nal questionnaires measuring only aesthetic impacts14,17
or chewing function15. Summary scores of the three ques-
tionnaires enabled to monitor changes of patients' oro-
facial aesthetics, chewing ability and a quality of life
caused by fixed prosthodontic restorations on MDIs or on
MDIs splinted with natural teeth.
None of the inserted MDIs was lost during the ob-
served period of three months. Clinical examination of
the mucosal tissue surrounding MDIs showed no inflam-
mation after three months. The three month post-treat-
ment OHIP14 and CFQ demonstrated a high and signifi-
cant decrease of summary scores compared to pretreat-
ment period, which was due to a significant increase of
patients' quality of life and chewing function after the
treatment. Furthermore, the OES summary scores
(higher scores describing better aesthetics) significantly
increased as a result of the FPD MDI therapy, demon-
strating the individual’s higher perception and increase
of orofacial aesthetics, which was indeed expected, as the
patients included in the present study suffered from an-
terior tooth loss prior the therapy. Considering that cost
and necessity for a ridge augmentation are sometimes
factors that discourage patients from implants, mini den-
tal implants offer a more economical and definitely less
invasive treatment option. The MDIs are more afford-
able compared to traditional implants.
The results of the present study obtained from the pa-
tients with MDIs supporting FPDs regarding improved
aesthetics, masticatory function and OHRQoL supple-
ment initial positive clinical results considering usage of
MDIs for a FPD support.
The results obtained from patients with FPDs sup-
ported by MDIs reveal the high effect size of the therapy
considering better self-perceived aesthetics, increased
chewing function and overall quality of life at the three
months clinical follow up. Initial patient self perceived
results are promising, as well as clinical findings. How-
ever, further prospective follow ups will be necessary to
finally confirm the long term benefit of FPDs supported
by MDIs.
Conclusion
Effects of the Fixed partial denture therapy sup-
ported by mini dental implants showed satisfactory re-
sults considering increased OHRQoL, increased chewing
function and a better self perceived oral aesthetics at the
3-month observation stage.
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TABLE 1
SUMMARY SCORES OF THE OROFACIAL ESTHETIC SCALE (OES), ORAL HEALTH IMPACT PROFILE CONSISTING OF 14 QUESTIONS
(OHIP14) AND CHEWING FUNCTION QUESTIONNAIRE (CFQ) BEFORE AND THREE MONTHS AFTER TREATMENT AND A
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Questionnaire Before treatment
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OHIP14 30.74±3.12 4.17±1.62 26.57±3.70 34.41 <0.01*
CFQ 27.78±5.51 4.09±1.54 23.70±4.99 22.75 <0.01*

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S. Per{i}
University of Zagreb, School od Dental Medicine, Gunduli}eva 5, 10000 Zagreb, Croatia
e-mail: persic@sfzg.hr
EFEKT TERAPIJE FIKSNIM PROTETSKIM RADOM NA MINI DENTALNIM IMPLANTATIMA
PREMA PROCJENI PACIJENATA
SA@ETAK
Mini dentalni implantati (MDI) preporu~uju se u stomatologiji za slu~ajeve s odgovaraju}om kvalitetom kosti i visi-
nom grebena, ali sa nedostatkom {irine. Neki radovi dobro su dokumentirali uspje{no kori{tenje MDI za retenciju
mobilne proteze, ali nema mnogo istra`ivanja o MDI kao nosa~ima za fiksne protetske radove. Cilj rada bio je istra`iti
u~inak terapije fiksnom djelomi~nom protezom (FPD) na mini dentalnim implantatima ili na MDI u kombinaciji s
bru{enim prirodnim zubima, na kvalitetu `ivota ovisnu o oralnom zdravlju (OHRQoL), oralnu estetiku i `va~nu funk-
ciju prema procjeni samih pacijenata. Sudjelovalo je ukupno 23 pacijenata (10 `ena i 13 mu{karaca, u dobi od 54 do 78
godina) koji su dobili 61 MDI. Deset MDI inserirano je u gornjoj i 51 u donjoj ~eljusti. U 14 pacijenata mostovi (krunice)
napravljeni su samo na mini implantatima, a u devet pacijenata mostovi su napravljeni u kombinaciji na implantatima i
prirodnim zubima. Fiksni radovi na MDI zamjenili su uglavnom donje sjekuti}e, ili drugi gornji sjekuti} i prvi gornji
pretkutnjak. Kod mostova u kombinaciji mini implantata i prirodnih zuba, MDI su inserirani u frontalnim regijama
~eljusti kako bi se omogu}ila izrada fiksnog rada umjesto mobilne proteze. Pacijenti su ispunjavali tri upitnika: OHIP-
-CRO14 za procjenu OHRQoL, OES-CRO za procjenu oralne estetike i CFQ za samoprocjenu `va~ne funkcije. Procjene
su ra|ene dva puta: prvi put prije MDI insercije i drugi put tri mjeseca nakon zavr{ene terapije. Zbroj bodova CFQ i
OHIP upitnika ukazuje na zna~ajno pobolj{anu OHRQoL i na zna~ajno pobolj{anu `va~nu funkciju nakon tretmana, a
zbroj bodova OES upitnika pokazuje zna~ajno pobolj{anje oralne estetike (p<0,01). Klini~ki pregled nije pokazao posto-
janje upale mukoze oko MDI nakon 3 mjeseca. Podaci dobiveni od strane samih pacijenata dopunjuju po~etne obe}a-
vaju}e rezultate klini~kih nalaza. Me|utim, potrebno je dugoro~no klini~ki kontrolirati pacijente kako bi se kona~no
potvrdila dugotrajna korist fiksne terapije na mini implantatima.
S. Per{i} et al.: Fixed Partial Dentures Supported by Mini Dental Implants, Coll. Antropol. 38 (2014) 1: 275–278
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