The Mini Implant-supported Long-term Temporary Crowns for Missing Lateral Incisors by Paresh B. Patel, DDS


Missing upper lateral incisors have been found to be present in about five percent of the general population. About 25 percent of this population will get orthodontic therapy, thus requiring the orthodontist/pedodontist and general dentist to come up with the best possible treatment. Two possible solutions can be canine substitution or an implant when skeletal growth is complete. The most frustrating issue with the later is how to satisfy the patient's needs during this time between the completion of orthodontic treatment and the beginning of implant therapy.

We all know what happens when teens are given the typical solution - a retainer with a denture tooth to occupy the missing spaces. It is typically lost or thrown away by accident. Another solution could be a Maryland or Carolina Bridge. The Carolina Bridge is more conservative than the Maryland Bridge and is an adequate medium-term solution.However, most clinicians find teens are not likely to follow post-placement instructions, thus debonding the pontics and creating frustration for everyone. It is important to note that neither of these solutions do anything to stimulate and keep what little bone is left in these edentulous areas.

An effective and aesthetic alternative to these two traditional techniques could be the use of a mini dental implant to support a long-term temporary crown. I suggest this as a long-term temporary solution as most patients at orthodontic completion lack definitive proof that growth is complete. This technique does not involve any preparation to the adjacent teeth and is fairly inexpensive. The mini implant will stimulate the alveolar bone and prevent any ridge atrophy during this time period, which can be as long as five to seven years for growth completion. This solution is very reliable with minimal complications such as loss of the pontic. Finally, when growth is complete, the mini implant is approved for use to support the definitive restoration or can be replaced with a twopiece implant to enhance the final outcome.

Case Report

A 14-year-old patient presents with recently completed orthodontic treatment and has bilateral missing maxillary lateral incisors (Fig. 1). The orthodontic treatment plan that was accepted by the patient and parents was to leave space for eventual implant therapy. At his last prophy appointment it was discovered that he had once again misplaced or lost his flipper, thus bringing up the potential to restore the area with a mini implant and temporary crown. This modality was accepted readily by both the parents and patient. Preoperative aesthetics, occlusion and boney architecture were studied and it was determined that a one-piece mini implant could be placed to satisfy these parameters for a minimum of five years (Fig. 2).



A 2.5 x 16mm mini dental implant was selected to keep within the confines of the bone and minimize any titanium show-through in the tissue. By using a mini dental implant we can preserve bone over this time period, minimize emergency visits to the dental office to rebond a missing pontic and increase patient aesthetics and function.

A single pilot bit of 1.6mm in diameter was used to create osteotomies that perforated the cortical bone and carried to a depth of one-third the implant length. The quality of bone was determined by using the blunt end of an endodontic probe and deemed to be of D3 quality. Based on this tactile information, no further drilling was necessary. The mini implant was then gently rotated to full depth with the use of an implant handpiece (Aseptico AEU-7000) (Fig. 3). The mini implant was then assessed for proper placement and room for occlusion (Fig. 4).

Impressions were taken (Kerr Take One Advanced) for longterm temporary crowns (Glidewell Dental) (Fig. 5). Three weeks later the long-term temporary crowns were delivered and cemented over the mini implants (Kerr MaxCem Elite) (Fig. 6).

Discussion

Long-term temporary crowns supported by mini dental implants have now been used in our office to restore patients until growth is complete with excellent success. When these crowns are removed there is minimal to no inflammation evident. In this particular case, a follow-up photo was taken approximately five years from placement date (Figs. 7 and 8) and shows better gingival health around the mini implant crowns than the natural teeth. Even in a patient with poor compliance with use of his retainer and oral hygiene, the mini implant crown has performed well over this time period. You can see the amount of relapse in the centrals from the day of cementation and the five-year follow up. Once it is confirmed that skeletal growth is complete, the decision to place a more permanent solution will be reviewed. Most every implant manufacturer now offers a mini or small diameter implant. These will vary from the o-ball design to a tapered crown and bridge shape (Fig. 9). I encourage all clinicians who see post-orthodontic patients with missing lateral to consider replacing these teeth with long-term temporary crowns and small diameter implants. Why have your young patients suffer with embarrassing moments where the retainer or resin-retained bridge is lost? Investigate to see if this novel approach is right for you and your practice.

Author's Bio
Dr. Paresh Patel is a graduate of UNC-CH School of Dentistry and the MCG/AAID MaxiCourse. He is the co-founder of the American Academy of Small Diameter Implants and is a clinical instructor at the Reconstructive Dentistry Institute. Dr. Patel has placed more than 2,500 mini implants and has worked as a lecturer and clinical consultant on mini implants for various companies. He can be reached at pareshpateldds2@gmail.com or online at www.dentalminiimplant.com.

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