Institute for Periodontics and Implant Dentistry

The Truth About Mini-Implants

What is the difference in an Implant and a Mini-Implant?

The first modern, root form implant was developed by a Swiss orthopedic surgeon in the 1960’s. The mini-implant was developed in the late 1970’s but not put into use until the 1990’s.

The original intended use of mini-implants was for temporary use to help hold temporary teeth while more stable, conventional implants healed. That is part of how mini-implants received FDA approval.

Mini-implants received long term approval through a loophole that many medical devices use to get on the market for patient use. The regulatory review process known as 510(k) for a section of the FDA law covering medical devices. Manufacturers typically show their product has “substantial equivalence” to a “predicate device” that has already been legally marketed. A claim of substantial equivalence does not mean the device(s) must be identical. Substantial equivalence is established with respect to: intended use, design, energy used or delivered, materials, performance, safety, effectiveness, labeling, biocompatibility, standards, and other applicable characteristics.
That standard can perpetuate problems. Your device is similar but only in theory. It can fall within certain narrow standards to get approval and then be used in off-label means once it is on the market.
A conventional implant is considered to have an overall diameter of 3.0mm or greater and a mini-implant is one with a diameter less than 3.0mm. A regular implant is typically two pieces: the part that goes into the bone that replicates the missing tooth root and a piece that ties to it called the abutment. This connection is vital for several reasons. First, teeth and bone are rarely in a straight line. In the front of your mouth, teeth have more of a shovel shape with a bend as they leave the bone and emerge through the gum tissue. Second, the shapes of teeth are much wider than the diameter of a mini-implant (less than 3mm). This abutment allows the doctor to replicate the shape a natural tooth has as it emerges through your gums into the oral cavity. This is much better cosmetically because the gum tissues contour to the abutment giving you the most realistic and esthetic profiles possible that most replicate what you naturally had. It also gives contours as nature intended allowing for normal homecare and maintenance making cleaning identical to natural teeth. The abutment connection also allows the doctor the ability to correct for angles that your body dictate to get your bite (occlusion) correct for less stresses and more longevity.

The mini-implant procedure was originally intended for medically compromised patients, patients with extreme bone loss that cannot be rebuilt and financially compromised patients. That use has been expanded, inappropriately, to all patients and all applications.

False Claims about Mini-implants:

They hurt less than conventional implants…in both mini and conventional implants, the bone and gums are numbed, a small opening is made for the drill and then a small hole or osteotomy site is drilled to the diameter of the implant being placed. You would be hard pressed to tell if a 2.2mm osteotomy site or a 3.3mm or 4.7mm osteotomy site was prepared. I have patients who have conventional implants placed tell me almost daily that they took nothing more than ibuprofen and had no pain. I think the amount of pain has more to do with the surgeon’s ability and the patient’s pain tolereance.

No need for complex flap surgery…that sounds like a great selling point. The reason they market that way is the though that these “mini” implants are so small that there is no need to see the underlying bone or anatomic structures. Only with in-depth surgical imaging like a computer aided tomograph (dental CAT scan), use of computer software to pre-plan a virtual surgery and the fabrication and use of a surgical guide that is custom 3-D printed from the scan and surgical plan can this be accomplished SAFELY and EFFECTIVELY with almost 100% assurance of the implants position. That is not done in these cases. A hole is drilled to the placer’s ability and experience and the mini-implant is placed “in the dark.”

Shorter Healing Time…bone and gum heal at the same rate, regardless of the type of injury. There is no magic elixir that makes bone integrate to a mini-implant faster than a conventional implant.

No need for bone grafts…typically, this is a guess, because a flap is rarely, if ever performed, to assess the actual bone for these cases. It is highly likely that parts, or most of the implant aren’t completely in bone when they are placed, but this is never confirmed.

Mini-implant look and feel just like regular teeth…The only time this is true is in people with extremely small, narrow teeth such as the front lower four incisor teeth and the maxillary lateral incisor (next to the front two center teeth). In people with extremely limited space with minimal bite forces, mini-implants are often a good choice in those limited areas. Otherwise, in teeth with a normal diameter, the tooth becomes the equivalent of a bowling ball sitting on top of a pencil. This causes unnatural emergence profiles (how the tooth appears to come up and out of the gum tissue), and causes oral hygiene difficulty. This difficulty in adequate cleaning causes more problems such as trapped odor, gingivitis, and ultimately leads to bone loss. Conventional implants are made to mimic the diameter of the natural tooth they are replacing with home care usually being no different than it would be for the tooth it is replacing.

Mini-implants are significantly cheaper than conventional implants…Although prices vary, mini-implants are not significantly cheaper than conventional implants, and in some cases, can be more expensive. For example, to replace a molar tooth, it takes only one conventional dental implant which Blue Cross Blue Shield values at $1500. To replace the same molar with mini-implants, it requires two implants splinted together under one crown to try to approximate the force a conventional implant can absorb. Blue Cross Blue Shield values one mini-implant at $1300. So a conventional implant molar replacement would be $1500 and a mini-implant molar replacement would be $2600. Uninformed buyers don’t know this.

Number of implants needed

Molar with 3 mini-implants

Conventional single implant to replace a molar

A single Zimmer implant to replace a molar.

 

 

 

 

 

 

 

 

 

The negatives with mini-implants

Mini-implant do not emerge like conventional implants making esthetics difficult.Hygiene is difficult with mini-implants.
A doctor can take a single day course and legally begin placing them into patients the following day with no further training.
Limited angle correction.
Much higher chance of fracture in normal function.
Many doctors that place them, place significantly more than needed expecting one or more to fail. That’s not what should be an expected outcome.

Two lower incisors with mini-implants

Poor hygiene and esthetics with mini-implants

2 mini-implant incisors

2 mini-implant incisors

 

 

 

 

 

 

 

 

 

The positives with mini-implants

Are excellent for temporary anchorage or as additional anchorage in a denture case.
Are good for extremely atrophic ridge patients (small/minimal bone) who can’t have their bone rebuilt.
Are good for someone looking for a slightly less expensive option.
Are good for patients with limited space in mandibular incisor areas or maxillary lateral incisors.
Are excellent to obtain temporary anchorage in patients undergoing orthodontics that don’t want to wear headgear.

Summary

Don’t let the hype and marketing fool you when considering mini-implants. Also, go to an implant surgeon like a periodontist or oral maxillofacial surgeon who has been trained for years in the field of dental implants, bone and surgery, or minimally, a general dentist who has completed a multi-week course in dental implants. Let an experienced and qualified surgeon help educate you so you can make an educated and informed decision about dental implants and what type is best suited for your specific situation.
Just remember, when something sounds too good to be true, it usually is.

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Vampire Gum Rejuvenation (TM)

Platelet-Rich Plasma (PRP)

Most everyone has heard about Vampire Facials.  For people on the hunt for a unique and effective facial treatment, many people have found the tremendous benefits of “Vampire Facials.”  Technically referred to as a platelet-rich plasms (PRP) facial, this type of treatment got its name based on the blood-based procedure used.  In recent years, doctors have learned that the body has properties in it that greatly promote self-healing.  Platelet-rich plasma therapy is a form of regenerative medicine that can harness those abilities and amplify the natural growth factors your body uses to heal tissue.

What is plasma and what are platelets?

Plasma is the liquid portion of whole blood.  It is composed largely of water and proteins, and it provides a substrate for red blood cells, white blood cells and platelets to circulate through the body.  Platelets, also called thrombocytes, are blood cells that primarily cause blood clots, but they also contain many other necessary growth healing functions.  Platelets play a KEY role in the body’s natural healing process.

What is platelet-rich plasma (PRP) and what are PRP injections?

In medicine, especially regenerative medicine, platelet-rich plasma therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints.  These techniques use each individual patient’s own healing system to improve musculoskeletal problems.

PRP is harvested by taking from one to a few tubes of your own blood and running it through a centrifuge  in a special process to concentrate the platelets.  In medicine, PRP has been found to significantly enhance the healing process and shown to improve function and reduce pain.

Platelet-rich plasma. Autologous conditioned plasma, is a concentrate of platelet-rich plasma derived from whole blood, centrifuged to remove red blood cells. blood test tube, centrifuge, syringe, and test tube with layers of blood components

Advantages of PRP

Some of the key advantages of PRP are that they can reduce the need for anti-inflammatories or stronger medications like opioids.  In addition, the side effects of PRP are almost non-existent because, since the injections are created from your own blood, your body will not reject or react negatively to them.  Also, the concentration of advanced healing and growth factors, increase your own body’s healing potential exponentially.

Gum recession

Gum recession occurs when gum tissue wears away, exposing areas of the tooth root that should be covered by gums and bone.  This recession may lead to increased sensitivity, especially when eating or drinking hot or cold foods.  It also exposes areas of the tooth that don’t have a protective coating which makes the tooth more susceptible to decay and other issues.  Because gum recession tends to happen slowly with rarely any pain or discomfort, many people do not realize it is happening to them.  If left untreated, gum recession will eventually lead to tooth loss with progression.

Gum grafting

Gum grafting is a type of dental surgery performed to correct the effects of gum recession.  It is a surgery, where traditionally, a periodontist removes healthy gum tissue from the roof of the mouth and uses it to build the gum back up where it has receded.  It has been a proven technique that has been performed successfully for well over 50 years.

Types of grafts

Traditionally, there are a variety of gum grafts available , and the type of surgery depends on the extent and severity of damage, the condition of the remaining soft tissue, and a person’s individual needs.

  • Connective tissue grafts: In this procedure the periodontist removes tissue from the roof of the mouth by making a flap and taking tissue from underneath the top layer, stitches the tissue onto the existing gum tissue to cover the exposed tooth root, and then stitches the flap on the roof of the mouth where they took the tissue.
  • Free gingival grafts: This is the preferred method for people with thin gums who require extra tissue to enlarge the gums.  The periodontist grafts tissue directly from the top layer of tissue on the roof of the mouth and stitches the tissue to the existing gum area.
  • Pedicle grafts: This is the preferred method for people who have abundant gum tissue growing near the exposed tooth.  In this procedure, the periodontist grafts tissue from the gum around or near the tooth needing treatment.  The tissue is only sectioned leaving one edge intact.  This tissue is then repositioned covering the exposed tooth root and held in place with stitches.

Variations on traditional grafts

Because the types of grafts mentioned above do come with some risks and involve multiple surgical sites, other methods that modify their technique have been developed.  One modification of connective tissue grafts and free gingival grafts is done using AlloDerm.  AlloDerm is a donor tissue that comes from human donor tissue, thus eliminating the need to remove tissue from the roof of your own mouth.  The donated tissue is minimally processed leaving a dermal matrix that provides a guide for your body to use expanding on the available gingival tissue using its own regeneration process.  Donors are screened for contagious diseases, and a review of medical records and social history are also performed before the tissue is considered for processing.  The downfall to this type of graft is that there are no cells that promote healing or growth.  The tissue is foreign, so sometimes there can be an inflammatory response or delayed healing.

Another very popular variation is the Pinhole technique. In this technique, a less aggressive manipulation of the gum tissue is performed through a tiny “pinhole” puncture.  The gum is freed up and elevated to cover the root of the tooth.  Tiny strips of collagen are packed under the gum tissue to support it in place and act as a matrix to allow new tissue to repopulate the area.  The advantages are that no tissue is removed from the roof of the mouth so there is no additional surgery site, and with the pinhole technique, multiple areas can be addressed simultaneously.  The negatives are that patient compliance is a MUST. The healing period is 6-8 weeks before a patient can function on the area or begin normal oral hygiene.  Another negative is that there are no cells present that promote healing or growth.

Vampire Gum Rejuvenation(tm)

In a quest to improve on the mousetrap, Dr. Lance Culley thought there had to be a way to provide the benefits of less invasive surgery but have the benefit of a quick healing with cells present that could promote growth.  The opportunity arose where a patient, for religious reasons, could have no materials used in the surgery other than tissue harvested from themselves.  This patient had other health issues that made it very risky to harvest palatal tissue.  After discussions with the patient of possibilities, risks and outcomes, Dr. Culley decided to attempt to use PRP harvested from the patient as the graft.  The outcomes were amazing.  At the 2 week follow-up, there was 100% root coverage in a severe defect that would have been difficult to correct using any existing techniques.  The area was healed beyond what would normally be expected using tissue from the roof of the mouth.  Dr. Culley used this technique in several other patients with equal success.  At that time, he decided to Trademark the technique as Vampire Gum Rejuvenation(tm).  The benefits of the technique are: multiple areas of the mouth can be treated at the same time; there is no second surgical site; there is no chance of disease transmission because only the patient’s own blood is used; there is no chance of rejection; there are cells that promote healing, reduce swelling, and reduce post-op pain; more severe defects can be repaired; and patients can resume normal activities sooner than with other techniques.

Am I a candidate?

Almost everyone is a candidate.  The following conditions would negate you as a candidate for PRP and for the Vampire Gum Rejuvenation ™ technique.

  • Critical thrombocytopenia (low platelet count)
  • Hypofibrinogenemia (deficient fibrin in the blood)
  • Haemodynamic instability (collapse)
  • Sepsis (infection)
  • Acute and chronic infections
  • Chronic liver disease
  • Anti-coagulation therapy that cannot be discontinued (warfarin, coumadin etc)
  • Metastatic diseases
  • Anemia
  • Certain bleeding disorders

CALL US TODAY TO SCHEDULE YOUR FREE CONSULTATION TO SEE IF YOU ARE A CANDIDATE FOR THE VAMPIRE GUM REJUVENATION(TM) TECHNIQUE. WE LOOK FORWARD TO HELPING YOU. (731)660-6244

 

 

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