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Lock in Your Profit: The Reliable Use of Mini Implants by Dr. Raymond Munz, DDS

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Mini-dental implants have become an increasingly popular treatment option for denture stabilization. Not only is this treatment plan easily affordable for the patient, but it is also less invasive with minimal recovery time.

Let us be honest here: We dentists rarely make our patients’ holiday card list. However, if a patient is offered an affordable solution for a loose denture at a reasonable cost using a procedure that is essentially pain free, you just might land on someone’s fruitcake route next season. Approached in an intelligent way, with proper training and study, mini-dental implants can be a boon to the general practitioner.

Although the excitement of Mrs. Smith’s fruitcake is not a great motivator, increasing practice revenue is on every dentist’s wish list for 2015. The optimal business model for dental practices should include increasing production, decreasing chair time and selecting reliable products. I recently had the opportunity to see how product reliability influences the bottom line. Choosing the most reliable and predictable mini-implant helped lock in my profit picture.

In my experience, mini-dental implant failures are typically seen within the first thirty days after placement due, almost strictly, to mobility. Therefore, immediate primary stability is essential when placing mini-implants.

Throughout my career I have used several mini-implant systems and there are a lot of similarities among them. I have come to realize that the comparative strengths and weaknesses, as well as additional features of certain implant systems directly affect my purchasing strategy. A recent denture stabilization case persuaded me to more carefully consider the implants currently on the market.

Case Presentation
A relatively healthy, 88-year-old male presented himself at my office with the chief complaint of loose upper and lower dentures—eating particular foods and speaking was a challenge. He was completely edentulous. His medical history was essentially unremarkable other than high blood pressure, which was controlled by medication.

He had no previous history of alcohol, drug or tobacco use. Cone beam X-ray of the mandible indicated the patient had 11mm buccal-lingual and 20mm superior-inferior of Type II bone, a more than adequate ridge (Fig. 1) for implant placement. In short, the patient’s profile indicated a good candidate for mini-dental implants.

The patient was advised on all treatment options, including no treatment at all. I suggested that he might also get a second opinion from an oral surgeon.

After considering the substantial cost difference and healing period for conventional implants compared to mini-dental implants, the patient opted for the latter. The treatment plan was as follows:

On the day of treatment, duplicates were created and impressions were taken of both upper and lower dentures prior to surgery. The patient was given a local anesthetic at each implant site: #22, #24, #26 and #28. Four mini-implants were selected and placed via a flapless procedure without a surgical stent. Drilling approximately one-third of the length of each implant with external irrigation (Fig. 2), the following were placed: (1) 2.2 x 14mm, (1) 2.0 x 13mm and (2) 2.0 x 15mm (Fig. 3). I used mini-implants I had in inventory from two different companies—three Lew MDI implants from Park Dental Research Corp.and one from what we’ll call “Brand X.” Interestingly, Lew MDI implants have Cog Lock threading (Figs. 4 & 5), which provides mechanical anti-rotational barbs for immediate and long-term stability as well as a critical aid in preventing mobility. This feature is unique to Lew MDI implants.

This Cog Lock threading became the redeeming factor after Brand X’s implant, which lacked this feature, failed in just a little over 30 days. Although a soft reline, JUELL Cure Soft of the lower denture was in place for two weeks post-op, Brand X’s mini implant (#28) came out when the patient removed his denture on day 33.

Discussion
When the patient returned to my office with the failed implant in tow, I gave him the option of replacing the implant immediately. The patient requested a new implant, at which time I decided to use a 2.0 x 17mm Lew MDI, taking advantage of the Cog Lock anti-rotational barbs. My primary goal was to satisfy this patient while maintaining a profitable case.

The procedure was again flapless and without a surgical stent. Local anesthetic was administered at the implant site. The pilot hole was drilled approximately 5mm in depth with external irrigation. The implant was placed without complication and 35Ncm of torque was achieved.

Medium metal housings were picked up in the denture using a JUELL Cure Hard reline acrylic. The patient was given post-op instructions and scheduled to return in two weeks for a follow-up exam.

Conclusion
It has been more than six months since the Lew MDI implants were placed. All four implants are presently functioning and to the patient’s complete satisfaction. The patient’s chief complaint of not being able to eat particular foods and speaking without impairment was completely resolved with denture stabilization.

For decades, general practitioners in the dental arts have been presented with frustrated patients with loose dentures. The complaints include being embarrassed in social and family settings, disagreeable odors, inability to eat certain foods, etc.

The options to resolve these acute complaints were limited to the physics involved in the wearing of removable dentures and especially the lower “floating denture.” No more! The advent of mini-dental implants has changed the landscape, resulting in satisfied, more confident denture patients, and a more rewarding work experience for the entire dental team while adding to the dentists’ bottom line. With minimal training and study, a licensed dentist can easily adapt this unique modality into a busy office, adding another high-level service for patients. That’s what dentistry is all about.
Dr. Raymond Munz has been practicing quality dentistry for more than 25 years and has placed more than 10,000 implants. A founding member of the International Academy of Mini Dental Implants and a fellow of the American Academy of Small Diameter Implants, he has also placed thousands of mini-dental implants. Dr. Munz earned his bachelor’s from the State University of New York in Albany, and his doctorate from Virginia Commonwealth University.

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