Journal of Oral Implantology May 2013 - (Page 287)

CASE LETTER Splinted Zirconia Fixed Partial Denture Supported by Small Diameter (Mini Implants) in the Posterior Mandible: A Case Letter Andrea Mascolo, DDS1* Paresh Patel, DDS2 INTRODUCTION I mplant-supported fixed partial dentures can restore a patient’s missing posterior dentition. However, in sites that are atrophic, standard body endosseous implants may not be properly contained by the available bone, thus violating the principle of encasing the implant in a minimum of 1 mm of bone. Alternatively, solid core one-piece, small-diameter (mini) dental implants can be used in highly selected sites with great circumspection. Mini dental implants have been successfully used to support fixed prosthesis that restore missing maxillary and mandibular incisors as well as mandibular posterior teeth.1 The purpose of this case letter is to demonstrate that splinted mini implants may successfully support a fixed zirconia partial denture in the posterior mandible in highly selected patients and with an appropriate prosthetic design. The use of 2 smalldiameter (mini) implants can reduce the cantilever effect created when using the procedure recommended by Misch (4-mm implant for a 7-mm mesial distal width).2 CASE LETTER A 48-year-old man presented for restoration of his edentulous mandibular left first and second molar sites (nos. 18 and 19) (Figure 1). The patient reported that these teeth were extracted 10 years prior. His medical history was unremarkable and 1 Private practice, Alessandria, Italy. Private practice, Mooresville, NC. * Corresponding author, e-mail: andrea@studiomascolo.eu DOI: 10.1563/AAID-JOI-D-12-00043 2 there were no contraindications to dental implant treatment. After clinical and radiographic examination, atrophic resorption was found in the buccal-lingual as well as occlusal-gingival dimension (Figure 2). Bone sounding evaluation demonstrated less than 5.0 mm of facial-lingual bone. The patient declined any bone grafting or ridge expansion due to fear, costs, and surgical trauma. Occlusal analysis showed group function in lateral movements and a missing maxillary second molar. Based on these parameters, it was decided to use 3 mini dental implants to support splinted premolar-sized crowns with an implant protective occlusal scheme. Buccal and lingual local infiltration was administered with 3.8 mL 2% lidocaine with 1:100 000 epinephrine (Xylocaine). Three 2.5 3 12 mm onepiece mini dental implants (OCO Biomedical, Albuquerque, NM) were placed. Care was taken to keep the implant placement as parallel as possible and to avoid the mandibular canal (Figure 3). Placement seating torque was at 45 Ncm for all 3 implants. After 4 months of healing, conventional full arch crown and bridge impressions were made with polyvinyl siloxane (Take 1, Kerr, Orange, Calif) (Figure 3). Analogs were placed in the impression to be contained in the cast for splinted zirconia crown fabrication. A splinted zirconia core was made to fit down to the square portion of the 3 mini implants and then layered with feldspathic porcelain. (Glidewell Dental Lab, Newport Beach, Calif) (Figures 4 and 5). The occlusal table was made flat and narrow, and to have no opposing contact in the working and balancing excursions. Two weeks later, the splinted definitive crowns were tried in and evaluated for fit, function, and Journal of Oral Implantology 287

Table of Contents for the Digital Edition of Journal of Oral Implantology May 2013

Implantology: Inter-Dependent Worldwide Relationships
Use of Osteotomes for Implant Bed Preparation-Effect on Material Properties of Bone and Primary Implant Stability
The Effects of a Static Magnetic Field on Bone Formation Around a Sandblasted, Large-Grit, Acid-Etched-Treated Titanium Implant
Effect of Platelet-Rich Plasma on the Outcome of Early Loaded Dental Implants: A 3-Year Follow-up Study
Flapless Dental Implant Surgery for Patients on Oral Anticoagulants-The "WarLess Procedure": A Report of 2 Cases
Radiographic Evaluation of Narrow-Diameter Implants After 5 Years of Clinical Function: A Retrospective Study
Histomorphometry of 2 Immediately Loaded Mini Implants Retrieved From Human Mantible After 3 Months: A Light and Scanning Electron Microscopy Report
Splinted Zirconia Fixed Partial Denture Supported by Small Diameter (Mini Implants) in the Posterior Mandible: A Case Letter

Journal of Oral Implantology May 2013