A 3-Year Follow-up Study of Overdentures

Retained by Mini–Dental Implants
Elena Preoteasa, DMD, PhD1/Marina Imre, DMD, PhD2/Cristina Teodora Preoteasa, DMD3
Purpose: This study evaluated overdentures retained by mini–dental implants (MDIs) as a treatment option
for complete edentulism during a 3-year follow-up period. Materials and Methods: This observational
clinical study included completely edentulous patients who were treated with MDI-retained overdentures.
The MDIs were supplied by the manufacturer. Results: Twenty-three patients received 7 maxillary and 16
mandibular MDI overdentures retained by 110 MDIs. Of the 36 MDIs placed in the maxilla, 8 failed (in two
patients), 2 had compromised survival, 3 displayed satisfactory survival, and 23 were successful. Of the 74
MDIs placed in the mandible, 11 displayed satisfactory survival and 63 were successful. The marginal bone
loss was more pronounced for the MDIs placed mesially (intercalated), in areas of decreased ridge width
and bone density, and with lower values of insertion torque. The overdentures fractured in seven patients; in
4 of them, this corresponded to the implant housing area. Self-reported reasons for patient dissatisfaction
included occasional pain under the overdenture (n = 5) and instability of the maxillary antagonist complete
denture (n = 4). Conclusion: Based on this research, considering its limitations, it is possible to conclude
that survival rates and health status are better for MDI overdentures applied in the mandible than for
those applied in the maxilla. The most severe prosthetic complications encountered were overdenture base
fracture, matrix detachment, and instability of the maxillary antagonist denture. INT J ORAL MAXILLOFAC IMPLANTS
2014;29:1170–1176. doi: 10.11607/jomi.3222
Key words: denture, edentulous, mini–dental implants, overdenture


he mini–dental implant (MDI) overdenture is a relatively recent treatment option for complete edentulism and is indicated especially for patients who
are dissatisfied with their conventional dentures. The
MDIs provide only overdenture retention, not support, as there is an occlusal space between the implant abutment attachment and the overdenture. MDI
overdentures have several benefits compared to other
treatment alternatives. In contrast to the conventional
complete denture, this type of overdenture requires an


Department of Prosthodontics, Faculty of Dental
Medicine, “Carol Davila” University of Medicine and Pharmacy,
Bucharest, Romania.
2Lecturer, Department of Prosthodontics, Faculty of Dental
Medicine, “Carol Davila” University of Medicine and Pharmacy,
Bucharest, Romania.
3 PhD Student and Assistant Professor, Department of
Scientific Research Methodology, Faculty of Dental Medicine,
“Carol Davila” University of Medicine and Pharmacy,
Bucharest, Romania.
Correspondence to: Elena Preoteasa, Department of
Prosthodontics, Faculty of Dental Medicine, “Carol Davila”
University of Medicine and Pharmacy, Str. Ionel Perlea nr. 12,
sector 1, 010208 Bucharest, Romania.
Email: dr_elena_preoteasa@yahoo.com

additionally relatively simple, minimally invasive surgical intervention, but the attachment system and immediate loading of the MDIs ensure increased retention,
stability, and function, with improvements in patient
satisfaction, comfort, and quality of life.1–3 Standarddiameter implant-supported prosthetic alternatives
have shown success, but these are not viable solutions
for all edentulous patients. The MDI overdenture may
be a more appropriate treatment alternative for the
edentulous patient with compromised health and/or
a restricted buccolingual dimension of bone. In these
cases, MDI placement requires fewer and less invasive
surgical interventions (eg, avoidance of bone grafting
procedures and decreased clinical time required for
implant placement, especially when a minimally invasive flapless technique is used), promoting a lower
risk of developing complications and shortening the
healing period.4,5 Given the demographic changes in
the population, especially the aging trend, there is an
increasing need for relevant treatment for the medical problems of older patients, complete edentulism
being one of them. The MDI overdenture is one viable
treatment alternative for this condition, which seems
appropriate to this segment of the population, but
scientific evidence regarding clinical outcomes of the
MDI overdenture is relatively limited.6 Therefore, more

©2014 by Quintessence Publishing Co Inc.

1170 Volume 29, Number 5, 2014

A convenience sample was formed according to the following eligibility criteria. type of denture occlusion. Data were collected after a 3-year follow-up period. MATERIALS AND METHODS An observational clinical study was conducted and implemented. and patient perception and satisfaction. The purpose of this study was to evaluate the MDI overdenture as a treatment option for complete edentulism. are listed in Table 1. Aspects related to coverage of the support area. and all chose this treatment alternative and participation in the study on a voluntary basis. 13 mm. After the surgical intervention. starting 2 hours prior to implant placement. and patient perception regarding the denture were evaluated and considered as factors in this decision. patients with bruxism or xerostomia were advised not to wear the overdenture overnight at least two times per week. and 2.7 Additionally. Excluded were those with severe systemic conditions (eg. Because the role of the MDIs is to improve retention of a prosthetic device. Treatment outcomes were considered in three dimensions: MDI status. Registration of the maxillomandibular relationship aimed to ensure a correct functional vertical dimension of occlusion in centric relation. bisphosphonates) because of the risk associated with the surgical procedure of MDI placement and the potential for these conditions and medications to contribute to a poor prognosis. complete coverage of the support area. Chlorhexidine digluconate 0. the overdenture design aimed to ensure proper support. Completely edentulous patients with conventional complete dentures who were dissatisfied with this treatment alternative. “Carol Davila” University of Medicine and Pharmacy. The MDI overdenture was chosen as a treatment option for mandibular or maxillary complete edentulism. The importance of adequate hygiene procedures was highlighted.2% solution was recommended (twice daily oral rinses) before surgical implant placement and afterward. retention. Principles of lingualized denture occlusion were used. Bucharest. In this respect. uncontrolled hypertension. These were available in four lengths (10 mm. For maxillary dentures. The patients were given information regarding the MDI overdenture. Additionally.4 mm) and used collared balls as attachments.8 mm. Also. The main outcome of this study was the success of the MDI overdenture as a treatment option for the completely edentulous patient. Faculty of Dental Medicine. INC. complete palatal coverage with a postpalatal seal was used. analgesic drugs were recommended if necessary. or who were untreated but expressed fear and reticence toward conventional dentures.Preoteasa et al information is needed to assess the viability and safety of this treatment concept. their quality was analyzed and the clinician decided either to keep or replace them. Patients were taught how to adequately clean the MDIs and the overdenture. The study variables. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. a The International Journal of Oral & Maxillofacial Implants 1171 © 2014 BY QUINTESSENCE PUBLISHING CO. material status. Some of the patients presented with previously made complete dentures. in addition to traditional mechanical cleaning. ie. Also. with a complete peripheral seal was chosen. which addressed patient features and treatment specifics. were included. the correctness of the arrangement of artificial teeth. several instructions were given to the patients. For overdenture cleaning. overdenture status. Premature contacts were checked and eliminated to accomplish the coincidence of centric relation and centric occlusion and obtain bilateral simultaneous stable occlusal contacts in centric occlusion. chemical cleaners (tablets) were recommended. Amoxicillin with clavulanic acid (Augmentin. including the anatomical and functional borders. To ensure a good prognosis. the maxillary lingual cusps articulated with the central fossae of the mandibular occlusal surfaces in centric working and nonworking mandibular positions.1 mm. . and 18 mm) and three diameters (1. they were advised to eat soft foods of moderate temperature. 2. SmithKline Beecham) were administered to patients for 5 days. overdenture status. Patients with complete edentulism who requested treatment at the Department of Prosthodontics. between April and November 2008 were enrolled in the study. and stability. This treatment alternative was indicated for maxillary edentulism when teeth or fixed prosthetic restorations were present in the anterior mandible or when patients had a skeletal Class III relationship with a reverse relation of the edentulous arches. 15 mm. From each patient. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. diabetes mellitus) or receiving particular medications (eg. correct registration of maxillomandibular relationships. The MDIs used were supplied by IMTEC/3M ESPE. denture retention and stability. patients were informed that they would probably feel some discomfort and pain that would disappear in a few days. and patients’ perceptions regarding this treatment alternative. The number of MDIs placed and their locations and dimensions were chosen based on the individual features of the patient and the judgment of the dentist but considered as closely as possible the manufacturer’s recommendations for this type of implant regarding the minimum number of MDIs that should be placed (four MDIs in the mandible and six MDIs in the maxilla). they were advised to use chlorhexidine products to prevent bacterial and fungal infections. The analysis covered MDI status. written informed consent was obtained.

or sensitivity during function • Satisfactory survival: MDIs displaying no clinical mobility or sensitivity during function. 1 was lost during follow-up. or pain during function • Compromised survival: MDIs still present in the mouth. two as a result of MDI fracture. follow-up appointments were attended weekly during Maxilla Mandible Failed 8 0 Compromised survival 2 0 Satisfactory survival 3 11 23 63 the first month postsurgery. 2. In one patient. the mean age was 62 years (range. The other complications that occurred within the 102 MDIs still present at the 3-year follow-up 1172 Volume 29. severe marginal bone loss (less than half of the implant body length). assessed using the previously described scale • Peri-implant marginal bone loss‡: registered as the maximum number of threads devoid of bone on the mesial and distal implant sides • Implant mobility§ • Self-reported peri-implant bleeding: spontaneous or during brushing • Radiolucency at the apical part of the implant‡ Success Overdenture status: • Presence of any technical complication that required repair or maintenance: matrix detachment. 52 to 76 years). In addition to descriptive statistics. sex) Data regarding oral and treatment-related features: • Bone information: bone height. MDI Status Of the 110 MDIs placed.0. In the other patient. The health status of the MDIs. length and diameter of MDIs. at the 2007 Consensus Conference8 and taking into consideration the Albrektsson et al criteria for implant success. Statistical analysis was performed with the Statistical Package for the Social Sciences (version 13. without an indication to be removed. Italy. Of the remaining 23 patients.Preoteasa et al Table 1 Study Variables Table 2 Health Status of MDIs Placed Location Patient’s general attributes (age. 14 showed satisfactory survival. for a survival rate of 92. MDIs that fractured or presented with mobility. removal. .7%. derived from that proposed by the International Congress of Oral Implantology in Pisa. Also. and at 1. §assessed by clinical evaluation. computed tomography) methods. Number 5. all five MDIs that had been placed failed. health scale for the MDI. †assessed with a clinical bone compass. but with either minimal clinical mobility. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. 2 years. Clinical and radiographic (panoramic radiography. but less than half of the implant body length) • Success: MDIs without clinical mobility or sensitivity during function and marginal bone loss of less than two threads Data collection was conducted before and during surgical placement of the MDIs and after surgery. and 3 years postsurgery. 1 year. and cleaning *A ssessed with computed tomography. and 3 years.9 was used as follows: • Failure: MDIs that were lost or removed for any reason. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. marginal bone loss exceeding half of the implant body length. A total of 110 MDIs were placed (36 in the maxilla and 74 in the mandible). Panoramic radiographs were indicated at 6 months. and 86 were considered successful. overdenture fracture or relining Patient perceptions regarding MDI overdenture: • Self-reported reasons for satisfaction/dissatisfaction with this treatment • Frequency of overdenture wearing • Ease of use of MDI overdenture: overdenture placement (insertion). The subjects were treated with 7 maxillary and 16 mandibular MDI overdentures. three of five MDIs placed were lost as a result of progressive marginal bone loss. were used for evaluations. the chi-square and Mann-Whitney tests were used for comparison between groups. 2 had compromised survival. 2014 © 2014 BY QUINTESSENCE PUBLISHING CO. Differences in the health status of maxillary and mandibular MDIs are summarized in Table 2. at 3 and 6 months. RESULTS Sample Characteristics Of the 24 completely edentulous patients initially enrolled. ‡assessed with panoramic radiography. can be summarized as follows: in addition to the 8 failed MDIs. according to the scale presented.* ridge width. all eight failed MDIs had been placed in two female patients and failed within 1 to 2 years after their insertion. All MDIs that failed had been placed in the maxilla.† bone density according to Misch classification7* • Treatment variables: Number and locations of MDIs. together with data obtained through discussions with the patient during recall visits. SPSS Inc). INC. with moderate bone loss (more than two threads. implant insertion torque MDI health status MDI status: • Implant health. 8 failed. Five or six MDIs were placed in the maxilla and four to six MDIs were placed in the mandible. 10 were men and 13 were women.

which appeared most frequently during brushing. overdenture fractures occurred in seven patients. around implants with lower insertion torque values. †Mann-Whitney test. During the 3-year period. MDIs with marginal bone loss of more than one implant thread more frequently presented with radiolucent lesions at the apical part of the implant and were more frequently associated with spontaneous peri-implant bleeding (Table 4). The specific recommendation regarding nighttime wearing of the overdentures was generally not followed. and in MDIs placed toward the midline (mesial/intercalated).003† P = .23 5. but fractures also occurred in regions between implants (n = 2).Preoteasa et al examination are listed in Table 3. Table 3 Complications of MDIs Placed Total (n = 102) Maxillary (n = 28) Mandibular (n = 74) Marginal bone loss 1–2 threads 2–3 threads > 3 threads Total 29 11 5 45 6 4 1 11 23 7 4 34 Apical radiolucency 22 6 16 2 2 0 36 12 48 13 0 13 23 12 35 Complication Mobility Bleeding During brushing Spontaneous Total Table 4 Relationships between Patientand Implant-Related Factors and Peri-implant Marginal Bone Loss Peri-implant marginal bone loss Characteristic < 1 implant > 1 implant thread thread Significance Patient sex Female Male 23 MDIs 34 MDIs 33 MDIs 12 MDIs Mean patient age (y) 62. NS = not statistically significant. In the maxilla.40 mm 0 MDIs 26 MDIs 31 MDIs 3 MDIs 14 MDIs 28 MDIs 32. Overdenture Status During the 3-year follow-up period. they were generally satisfied with the esthetics. In the mandible. Two of these were the patients with implant failures. whereas only three stated that they did not wear it while sleeping. retention. Five of these matrices corresponded to mesial MDIs and three to distal MDIs. The International Journal of Oral & Maxillofacial Implants 1173 © 2014 BY QUINTESSENCE PUBLISHING CO. spontaneous peri-implant bleeding was reported only for MDIs placed in the mandible). clinical prosthetic procedures were required to rectify these problems. with the patients admitting that they followed this advice only for a short time. detachment of the corresponding matrices from the overdenture base occurred in eight MDIs.8 mm 2.64 Bone density 7 D2 D3 D4 28 MDIs 20 MDIs 9 MDIs 9 MDIs 28 MDIs 8 MDIs Implant length 10 mm 13 mm 11 MDIs 46 MDIs 15 MDIs 30 MDIs Implant diameter 1. Patient Perceptions and Satisfaction With respect to patients’ perceptions of MDI overdenture treatment during the 3-year follow-up period.007* NS* – P = . Almost half of the MDIs registered marginal bone loss > 1 thread and peri-implant bleeding. which was related to difficulties during mastication. Marginal bone loss was more severe in women.23 18. – = assumptions not met to apply the corresponding statistical test. Some of the complications had a different distribution depending on location (eg. only one overdenture fractured in the area between implants. overdenture fracture sites corresponded more frequently to the implant housing area (n = 4). the latter patients were not the patients advised to avoid wearing the overdenture during sleep (ie.11 27. Patients’ complaints were related mainly to occasional pain that was described as appearing under the overdentures or related to soft tissue trauma (n = 5). phonation). in sites with decreased bone density.10 mm 2. in patients with a decreased ridge width.44 NS† Mean ridge width (mm) 6. However. Twenty patients declared that they wore the overdenture continuously. INC. those with bruxism or xerostomia). and functionality (mastication. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. Treatment satisfaction was linked to the frequency of overdenture wearing. .014* *Chi-square test.005* P < .013† P = .001* P = .04 60. Some patients perceived instability of the maxillary antagonist denture (n = 4 patients with mandibular MDI overdentures).67 Implant location Mesial (intercalated) Distal 26 MDIs 31 MDIs 33 MDIs 12 MDIs Apical radiolucency Absent Present 52 MDIs 5 MDIs 28 MDIs 17 MDIs 33 MDIs 22 MDIs 21 MDIs 14 MDIs 2 MDIs 10 MDIs Mean implant torque (Ncm) Peri-implant bleeding Absent Present during brushing Present spontaneously P = .001* P = .27 NS† Mean bone height (mm) 17. Overdenture relining was done in five cases.

Preoteasa et al Regarding the ease of use of MDI overdentures. The other patient lost three of her five MDIs. When the problems began to be noticed. the denture was relined. which also have a higher failure rate in the maxilla. who achieved survival rates of 95. She was a highly stressed person with an unbalanced. the patient came to the dentist citing some discomfort related to overdenture wearing. overdenture removal was perceived as being more difficult than overdenture insertion. according 1174 Volume 29. During this study. three implants were lost. . mainly vegan. Adjustments were made to the overdentures and a gradual improvement was noticed that led to a satisfying outcome after 3 weeks. She had reduced bone density (D3 and D4 Misch classification) and hypodivergent facial pattern and had become edentulous only recently (the remaining teeth were the maxillary right canine and premolars).9-year follow-up period. One of these lost all five MDIs placed. and interact socially). After overdenture placement.12 Regarding implant fractures.1% for mandibular MDIs and 83. in general. INC. Treatment was recommended for this condition. After this. compared to fixed prosthetic devices.5 Elsyad et al indicated a survival rate of 96% for MDIs placed in the mandible after a 3-year follow-up period. bone density). PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. they may be less willing to undergo extensive medical procedures. Conventional dental implants typically present problems at the connection between the abutment and endosseous implant. whereas similar survival rates were seen for anterior and posterior MDIs placed in the mandible (posterior 96. which gives maximum satisfaction to the patient because function is rapidly regained (ability to chew. nevertheless. however. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.11 In the current study. Shatkin et al also identified MDI fracture as a complication of MDI overdentures. All patients declared that they perceived cleaning of the overdenture as easy. two MDIs failed because of fractures. most patients (n = 16) said they perceived it as problematic. such as that conducted by Shatkin et al.13 In the current study. Radiographic exams showed that two of the MDIs had fractured. and an appointment was made to remove the remaining fractured implants. Regarding the MDIs that are used to stabilize the dentures.4% for MDIs placed in the mandible after 13 months. These results are concordant with other studies reported in the scientific literature. The patient stated that she desired only some overdenture adjustments because she was suspected to have other medical problems (osteoporosis and hepatic neoplasm). Only six patients reported difficulties with this procedure. the patient complained about phonation deficiencies and perceived some muscular tension and discomfort. In her case. speak. Endosseous dental implants seem to fracture less frequently when supporting overdentures. and they may have limited financial resources. A major advantage of the MDI overdenture is related to the possibility of immediate loading of the MDIs. she came to the office claiming that all her MDIs had been progressively lost. adjustments were made. Number 5.3%). both in the apical part of the implant.9%. Regarding overdenture removal.5%. some aspects need to be clarified.7% within a 3-year follow-up period. but the patient missed this appointment. but they reported that it occurred infrequently (0. Three months after the 1-year appointment. These persons may have multiple general diseases that limit the ability to undergo complex surgical interventions. anterior 96%). generally presenting MDI survival rates above 90%. This behavior of MDIs may be similar to that observed with conventional dental implants. This differing behavior of MDIs placed in the maxilla and mandible is likely a consequence of differences in bone features (eg.8%) during MDI placement. The published evidence comprises data similar to this. During this visit. most often loosening of the abutment screw or fracture of the implant in this location. Positive results were experienced for approximately 1 year.2% for maxillary MDIs within a 2.14 In contrast. diet that included many hard foods. 2014 © 2014 BY QUINTESSENCE PUBLISHING CO. this study presented a survival rate of 92. two new MDIs were placed. Thus.12 They also reported that the MDI survival rate depended on implant location: posterior maxillary MDIs had a greater chance of being lost than those placed in the anterior maxilla (posterior 88. most patients perceived overdenture insertion as quite easy. All of them stated that they cleaned the prosthetic device daily. as it is extremely well suited to this population of often elderly persons. MDI failures occurred only in the maxilla in two female patients. DISCUSSION Nowadays the MDI overdenture is more frequently seen as an optimal treatment option for completely edentulous patients. MDIs placed in the maxilla presented a lower survival rate than those placed in the mandible. denture stomatitis was noted at that time. The authors note that this behavior is similar to that of teeth and different from that of conventional implants. anterior 93. which had been chosen because of the decreased available vertical prosthetic space.10 and Griffitts et al obtained a survival rate of 97. MDI failure was probably related to a slightly increased vertical dimension of occlusion. as supported by some clinical evidence. Five months later. and some patients (n = 6) reported cleaning their overdenture twice a day. but the patient did not attend follow-up medical appointments. and a positive status of the two surviving MDIs at the 3-year follow-up was noted.

who were offered access to this treatment option at a lower cost. The higher strain on mesial MDIs may be explained by their increased role in indirect retention in counteracting tipping forces and overdenture dislodgment during mastication. randomized controlled clinical trials.18. financial. volunteers who were dissatisfied with their complete dentures or who expressed fear and reticence regarding conventional dentures. The results of this study indicate that marginal bone loss around MDIs is not influenced by the implant diameter.19 Patients were generally satisfied with their MDI overdentures. repairing the fractured overdenture. • Overdenture fracture is a relatively frequent complication that occurred most often in the mandible in sites corresponding to implant housing areas. but it provides data to help dentists to understand the behavior of MDI overdentures and offers hypotheses that might be tested in larger. However. to apply a maxillary MDI overdenture) to ensure patient satisfaction. The authors reported no conflicts of interest related to this study. Also. Overdenture fractures were found with a moderate frequency (seven overdentures fractured) and can be explained by the increased security in chewing brought about by the overdenture’s increased balance and retention. The most common location for overdenture base fractures was in the housing area. in the case of mandibular MDI overdentures. Overdenture relining is a complication that has been identified in several studies concerning the topic of MDI or conventional implant overdentures and conventional dentures.16 narrow implants (defined. according to the current results. a finding supported by other studies. In general. ie. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. This might be related to the sample characteristics and study inclusion criteria. or insertion of a new MDI in case of MDI failure). • In completely edentulous patients. respectively. probably indicating that mesially placed implants may be subjected to higher loads than distal implants. and it may be necessary to manage this side effect (eg. studies should be implemented to identify the frequency and types of implant fractures associated with MDI overdentures. as narrower than 4 mm and 3 mm) have an increased risk of fracture. like any other medical treatment. their positive perceptions about this treatment alternative remained constant over time. Taking these aspects together. it may be recommended that dentists ensure proper thickness of the overdenture base or reinforce it to prevent this. the authors emphasize that the current results indicate that a decreased ridge width appears to have a tendency to a more pronounced peri-implant marginal bone loss. Even so. the relatively quick appearance of instability of the antagonistic maxillary complete denture. prosthetic interventions such as adjustment or relining of the overdenture’s acrylic base. INC. probably related to the increased retention and comfort associated with the prosthetic device. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Consequently.Preoteasa et al to Sánchez-Pérez et al15 and Allum et al. the presence of MDIs may induce movements of the occlusal and masticatory field anteriorly. Peri-implant marginal bone loss and matrix detachment were more frequent for the implants located toward the midline (intercalated). which favored an increase in muscular activity. these can be addressed through interventions that have acceptable moderate biologic. with limited financial means. applying an MDI overdenture in the mandible may have a negative impact on the stability of a conventional maxillary denture. which could explain. currently part of 3M ESPE. the following conclusions regarding mini–dental implant (MDI) overdenture treatment can be drawn. although self-reported spontaneous peri-implant bleeding was noted rarely. • Survival rates and health status were better for MDIs placed in the mandible than for those placed in the maxilla. The MDI overdenture. for their support of this research by providing some of the materials and mini–dental implants. small-diameter implants may be considered as the best options for mandibular edentulous patients. The International Journal of Oral & Maxillofacial Implants 1175 © 2014 BY QUINTESSENCE PUBLISHING CO. when present it may indicate more severe MDI marginal bone loss. who often present a decreased ridge width. replacement or change of the matrices of the ball attachments. Also. and clinical costs (eg. indicating that the MDI overdenture may be a more suitable treatment option for mandibular complete edentulism.17 When a patient’s general health status may prevent complex surgical interventions. this is probably related to the relatively thin overdenture base in that region. has potential complications. CONCLUSIONS Based on this research and taking its limitations into consideration. The main limitation of this study is its relative small sample. . Several overdenture deficiencies were noted during the 3-year follow-up period. ACKNOWLEDGMENTS The authors thank IMTEC.

Albrektsson T. Int J Oral Maxillofac Implants 2009. Gargallo Albiol J. Clin Oral Implants Res 2012. 11. Multi-clinic evaluation using mini-dental implants for long-term denture stabilization: A preliminary biometric evaluation. Preoteasa E. 10. 8. Wang HL. Worthington P. 1176 Volume 29.23:515–525. 5. Puyuelo Capablo JL. NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER. Eriksson AR. Satorres-Nieto M. Oppenheimer BD. Willer J. 6. The clinical and radiographic outcome of immediately loaded mini implants supporting a mandibular overdenture. Thomason JM. et al. 14.40:22–34. stability. Gomez S.28:92–99. Pi Urgell J. Implant success.51:309–314. Ellis JS. Kelly SA. 13. St Louis: Mosby. Aspects of oral morphology as decision factors in mini-implant supported overdenture. Int J Oral Maxillofac Implants 1986. 18. Pommer B. Bone density: A key determinant for clinical success. Preoteasa CT. Weber HP.1:11–25. Impact of dental implant length on early failure rates: A meta-analysis of observational studies. A 3-year prospective study. Jemt T. Elsyad MA. Sánchez Garcés MA. Friberg B. Bendkowski A. Mushantat A.38:856–863. Franchi M. Vance JB. Implantretained removable partial dentures: An 8-year retrospective study. Med Oral Patol Oral Cir Bucal 2008. and comfort for the edentulous patient.140:709–712. Esfandiari S. 17. J Am Dent Assoc 2009. Tepper G. 2005:130–141. Mini dental implants for long-term fixed and removable prosthetics: A retrospective analysis of 2514 implants placed over a five-year period. INC. 7.Preoteasa et al REFERENCES 1. and failure: The International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. survival. The impact of loads on standard diameter. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. Implant Dent 2008.13:e124–128. How successful are small-diameter implants? A literature review. 2014 © 2014 BY QUINTESSENCE PUBLISHING CO. 19. Gay Escoda C. Sánchez-Pérez A. Zarb G. Dental Implant Prosthetics.17:5–15. Perel ML. Bulard RA. Feine J. Clin Implant Dent Relat Res 2009. 4. long-term follow-up of turned Brånemark System implants. Lerner H. In: Misch CE. Med Oral Patol Oral Cir Bucal 2010. 16.11:11–23. J Prosthodont 2011. Gallucci GO. Clin Oral Implants Res 2008.20:168–172. Meleşcanu-Imre M. Jornet-Garcia A. Etiology. Natali A. J Prosthet Dent 2005. Compend Contin Educ Dent 2005. Number 5. J Clin Periodontol 2011. J Dent 2012. Misch CE. Joshi R. Fouad MM.26:892–897. Gebreel AA. Posch M. J Oral Rehabil 2011. Marin M. Sohrabi K. 9. Tomlinson RA. Compend Contin Educ Dent 2007. Mini dental implants: An adjunct for retention. Two implant–retained overdentures—A review of the literature supporting the McGill and York consensus statements. Coggiola A. small diameter and mini implants: A comparative laboratory study.24:132–146. Oppenheimer AJ. Collins CP.15:e504–508. MacEntee MI. Pikner SS. Shatkin TE. Consolo U. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005. 2. . Endosseous dental implant fractures: An analysis of 21 cases. risk factors and management of implant fractures. The increased use of small-diameter implants. Frantal S. The long-term efficacy of currently used dental implants: A review and proposed criteria of success. Moya-Villaescusa MJ. Allum SR. Shatkin S.38:827–834. 15. Christensen GJ. 3. Misch CE. Watzek G. Gröndahl K. Loading protocols for dental implants in edentulous patients. Elshoukouki AH.19:553–559. Morton D. Rom J Morphol Embryol 2010. 12.100:e81–84. Marginal bone loss at implants: A retrospective. Collins PC. Walton JN.93:28–37. A clinical trial of patient satisfaction and prosthodontic needs with ball and bar attachments for implant-retained complete overdentures: Three-year results. Bortolini S. Glick N. Griffitts TM.