Conventional mandibular dentures for patients with severly atrophic mandibles often times present problems with retention, phonetics, function, and pain due to instability. Endosseous implants have been successfully used to restore edentulous mandibles with implant supported fixed bridges, hybrid prosthetic dentures and removable overdenture prostheses. However, oral rehabilitation utilizing two to four implants to support mandibular overdentures has been shown to have success rates of approximately 96% with implants placed in a one or two stage procedure. Numerous authors have also addressed patient satisfaction with the mandibular overdentures. Meijer et al. has reported that patients with two implant-supported mandibular overdentures had higher satisfaction scores than patients who had complete denture treatment.

Woman SmilingHowever, atrophy of edentulous jaws may limit implant placement in the mandible. Anatomic limitations and resorbed alveolar ridges may compromise implant number, length and inclination. The use of standard diameter implants to support an overdenture often requires ridge augmentation procedures in order to place the implant in bone of sufficient volume. On the other hand, in patients of advanced age, having serious medical problems or using anticoagulant therapy, placing more than one standard implant has been shown to have statistically significant increased risk of surgical complications. Small diameter implants placed with flapless surgery to support pre-existing conventional dentures present a method of restoring patients with atrophic mandibles. Advantages of this procedure include implant placement without any bone augmentation surgery, minimally invasive surgery resulting in virtually no bleeding, decreased pain and a decreased cost of treatment.

Clinical data in this study was obtained from an Implant Dentistry Database (IDD) at thr Department of Periodontology and Implant Dentistry New York University College of Dentistry (NYUCD) Kriser Dental Center. This data set was extracted as de-identified information from the clinical information stated from this routine treatment of patients. The IDD was certified by the Office of Quality Assurance at NYUCD. This study is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements.

The patient satisfaction questionnaires showed that after two months of immediate function with small diameter implant supported overdentures (SDISO), patients cleaned very well three times a day and removed the dentures at night. Patients reported wearing the SDISO for longer periods of time than the complete denture (CD) during the day. There was also a significant increase in patient satisfaction with improved denture retention during function, improved patient comfort, and a decreased use of denture adhesives with SDISO compared to CD. There was a higher satisfaction level reported with the occlusion of the prostheses, as well as an improvement in reported ability to understand the patient’s speech with SDISO. The data from the present study also showed that patients had a significant overall appreciation for increase comfort and confidence in social life with SDISO compared to complete dentures.

This is an abstract from “Immediate Loading of Small Diameter Implants in Severely Atrophic Mandibles” Tai, Chih-Han; Lee, Ming-Che; Saito, Hanae; Classi, Anthony; Cho, Sang-Choon; Froum, Stuart; Elian, Nicolas; Tarnow, Dennis at the Ashman Department of Periodontology and Implant Dentistry, New York University.

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