Narrow Diameter Dental Implant

Reporter R3
Moderator

Outline

Introduction
Biomechanical properties
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion

Introduction
Implant in narrow ridge
Ridge augmentation

Narrow diameter dental implant ?

Increase morbidity
Longer healing time
Infection secondary to wound dehiscence

Terminology of Narrow Diameter Dental Implant

Small diameter implant

Narrow diameter implant
Mini implant
Transitional implant
Provisional implant
No consensus on definition

Terminology
Glossary of Oral and Maxillofacial Implants (EAO, AO, AAP, ACP 2007):

Mini implant:
-

implant fabricated of the same biocompatible materials as other impl

ants but of smaller dimensions.

I. Mini dental implant: < 3.0 mm

For interim usage
II. Narrow diameter dental implant: 3-3.5 m
m
For conventional implant usage
Sierra-Snchez et al. 2014
Bidra et al 2013

Mini Dental Implant (< 3.0 mm)

Mini Dental Implant (< 3.0 mm)

Brand

Nation

Diameter
(mm)

Thread length
(mm)

Materia Surface
l

3M MDI

USA

1.8, 2.1, 2.4,

2.9

10, 13, 15, 18

Ti-6Al4V

SLA

Dentatus
MTI

Sweden

1.8

7, 10, 14

Ti

Machine
d

Dentatus
Atlas

Sweden

1.8, 2.2, 2.4,

2.8

7, 10, 14

Ti-6Al4V

Machine
d

Dentatus
Anew

Sweden

1.8, 2.2, 2.4

7, 10, 14

Ti-6Al4V

Etched

Narrow Diameter Dental Implant (3-3.5 m

m)

Narrow Diameter Dental Implant

Brand

Nation

Diamet
er
(mm)

Thread length
(mm)

Material

Surface

NobelActiv Switzerland
e

3.0, 3.5 10-15, 8.5-18

Ti

TiUnite

ITI Roxolid
SLActive

Switzerland

3.3

8-16

TiZr

SLA

ITI SLA

Switzerland

3.3

8-14

Ti

SLA

3i
Osseotite

USA

3.25

8.5-15

Ti

Double
etched

NarrowSky Germany

3.5

10-16

Ti

SLA

Ankylos

3.5

8- 17

Ti

Acid

USA

Outline

Introduction
Biomechanical properties
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion

Biomechanical Risks
Risk of fracture ?
Increased bone stress ?

Deformation Strength of Narrow Implant

In vitro study
Grade IV cp Ti implants
4.1 vs 3.3 vs 3.0 mm implants
30 off-axis loading

Allum et al. 2008

Deformation Strength of Narrow Implant

Standard
diameter
Narrow
diameter

manufacturer

Diameter Max. load

Straumann RN

4.1 mm

989107
N

Straumann NN

3.3 mm

61950
N

Straumann RN

3.3 mm

51539
N

More risk of elastic deformation in narrow diameter implants

NobelDirect

3.0 mm

57253
N

Allum et al. 2008

Deformation Strength of Narrow Implant

In vitro study
Ti-6Al-4V implant
3.3 vs 3.75 vs 5.0 mm implant
30 off-axis loading

Shemtov-Yona et al. 2012

Deformation Strength of Narrow Implant

Diamete
r

Mean load

5 mm

1584115 N

3.75 mm 952103 N
3.3 mm

67457 N

Lower strength of narrow diameter implants

Shemtov-Yona et al. 2012

Bone Stress
Finite element analysis
Mini vs Narrow vs Standard implant
Model - implants inserted into anterior mandibular regi
on

- cortical layers: 1.2mm

Istabrak Hasan et al 2010

Bone Stress
implant

Bone stress

tioLogic 3.7 x 15 mm

95 Mpa

tioLogic 3.7 x 17 mm

95 Mpa

tioLogic 4.2 x 15 mm

90 Mpa

tioLogic 4.2 x 17 mm

55 Mpa

Narrow
diameter

tioLogic 3.3 x 15 mm

105 Mpa

tioLogic 3.3 x 17 mm

105 Mpa

Mini dental
implant

Mini 2.5 x 15 mm

206 Mpa

Mini 2.5 x 17 mm

195 Mpa

Standard
diameter

Higher stress in mini dental implants

Similar result for narrow & standard diameter implants
Istabrak Hasan et al 2010

Outline

Introduction
Biomechanical properties
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion

Biological Evaluation
Soft tissue: biological width
Hard tissue: bone-implant contact

Biological Width
Dogs, mandible
MiniSky (2.8x10 mm) vs NarrowSky (3.3x10 mm)
Non-submerged, submerged placement
Histological analyses

Calvo-Guirado et al 2010

Biological Width
Narrow (3.5 mm)
Nonsubmerged

Mini (2.8 mm)

Nonsubmerged

submerged

3.2 0.1 mm 2.0 0.3

mm

4.3 0.5 mm

3.3 0.5
mm

3.7 0.2 mm 2.4 0.3

Similar to standard-diametermm
implants

4.8 0.1 mm

4 wks

8 wks

submerged

2.9 0.2
Calvo-Guirado
et al 2010
mm

Bone-implant Contact
Narrow (3.5 mm)

Mini (2.8 mm)

8 wks (nonsubmerged)

42.58.7 %

41.50.1 %

8 wks
(submerged)

49.35.2 %

43.10.7%

Similar to standard-diameter implants

Calvo-Guirado et al 2010

Bone-implant Contact (TiZr vs Ti implant)

Dogs, mandible, 8 wks F.U.
3.3 mm ITI implants
Sandblasted & acid-etched surface
TiZr vs Ti implant
Thoma DS et al 2011

Bone-implant Contact
TiZr (3.3x8 mm)

Ti (3.3x8 mm)

2 wks BIC

81.9 6.7 %

79.3 7.1 %

4 wks BIC

81.3 7.8 %

83.4 5.9 %

8 wks BIC

86.9 6.8 %

82.9 9 %

High BIC values of narrow diameter implants

Thoma DS et al 2011

Outline

Introduction
Biomechanical properties
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion

Clinical Evaluation
Survival rate
- Diameter
- Length
- Bone density
- Restoration type
- Position

Bone level

Survival Rate (3.0 mm)

Author / year

F/U

Position

Failure/Total N

Reason

Survival
rate

Polizzi 1999

63M

12, 22, 32-42

1/30

Fracture (69 M)

96.7%

Reddy 2008

12M

12, 22, 32-42

1/31

Mobility (4 M)

96.7%

Sohn 2011

23M

12, 22, 32-42

0/62

(-)

100%

Galindo-Moreno 2012

12M

12, 22, 32-42

4/97

3: loosening
1: infection

95.9%

Oyama 2012

12M

12, 22, 32-42

0/17

(-)

100%

Mazor 2012

12M

2 for 1molar

0/66

(-)

100%

Survival Rate (3.25 - 3.5 mm)

Author / year

Diameter

F/U

Position

Failure/Total

Reason

Survival
rate

Andersen 2001

3.25 mm

36M

12-22

2/32

1: not
integrated
1: mobile (6 M)

93.8%

Hallman 2001

3.3 mm

12 M

Max + Mand

1/160

Not integrated

99.4%

Zinsli 2004

3.3 mm

60 M

Max + Mand

5/298

3: infection
2: fracture

98.7%

Romeo 2006

3.3 mm

84 M

Max + Mand

3/122

infection

Max: 98.1%
Man:96.9%

Survival Rate (3.25 - 3.5 mm)

Author / year

Diameter

F/U

Position

Failure/Tota
lN

Reason

Survival rate

Veltri 2008

3.5 mm

12 M

Max

0/73

(-)

100%

Arisan 2010

3.3 mm
3.4 mm

60124M

Max +
Mand

14/316

7: not
integrated

92.3%

Malo 2011

3.3 mm

132 M

Posterior

12/247

(most in 6 M)

95.1%

Lee 2012

3.3 mm
3.4 mm
3.5 mm

144,58.8
M

Max +
Mand

9/541

6: infection
1: not
integrated
2: screw
fracture

98.1%

Survival Rate (Implant Diameter)

Diameter

Author / year

Failure(%)

3.0 mm

Polizzi 1999, Reddy 2008, Sohn 2011, GalindoMoreno 2012, Mazor 2012, Oyama 2012

0-4%

3.25 mm

Anderson 2001

6%

3.3 mm

Hallman 2001, Zinsli 2004, Romeo 2006, Malo

2011, Arisan 2010, Lee 2012

1-17 %

3.4 mm

Arisan 2010
Lee 2012

10%
0

3.5 mm

Zinsli 2004
Lee 2012

2%
1%

Survival Rate (Implant Length)

Implant length & number of failure
Author / year

8 mm

Zinsli 2004

Arisan 2010

9.5 mm

10 mm
3

Need further research

Survival Rate (Bone Density)

84 M F.U.
3.3 mm ITI implant (grade IV Ti)
Implant failure
- D2 bone: 1 (0.8%)
- D3 bone: 1 (0.9%)
- D4 bone: 4 (7.8%)*
Romeo et al 2006

Survival Rate (Multiple vs Single Implant)

11 yrs retrospective study
3.3 mm implants in posterior area
Nobel , Grade IV cp Ti
Odds ratio of implant failure
- Partial bridge VS single Implant 4.56 : 1

Malo et al 2011

Survival Rate (Implant Position)

5-10 yrs retrospective study
3.3 mm & 3.4 mm narrow implant
Anterior: 99.21%
Posterior: 92.06%*
Arisan et al 2010

Survival Rate of Narrow Diameter Implant

Lower implant survival rate:
Lower bone density
Posterior area
Implant supported bridge

Bone Level
TiZr 3.3 mm narrow implant vs Ti 4.1 mm implants
1 year post loading
bone loss
(mm)

TiZr (3.3 mm)

Ti (4.1 mm)

0.41

0.40

No significant differences
Benic et al 2013

Bone Level

2 vs 3 NDI supporting mandibular overdentures

3.3 mm narrow implants (Straumann ITI)
2
3
implants implants

Pvalue

6 M bone
loss

0.3 0.3

0.4 0.3

0.266

12 M bone
loss

0.5 0.2

0.6 0.8

0.214

0.8 0.5 0.8 0.9 0.342

24 M bone
loss
Non-significantEl-Sheikh et al 2012

Outline

Introduction
Biomechanical risks
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion

Indication
- Narrow ridge
- Limited inter-dental space
Upper lateral incisors or lower incisors
- Limited inter- implant gap

Courtesy of Dr.

Advantage
Less invasive procedure & associated co
mplications
Reduce surgical intervention
Lower cost
Beneficial to medically compromised pt
or elderly pt

Contra-indication (Relative)
- Bruxer
- Lower bone density
- Reduced bone height

Outline

Introduction
Biomechanical risks
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion

Case Reports
31y/o, male

Courtesy of Dr.

Tooth

43

Bone width

3.5

Bone height

Tomo

> 15

Pano

> 15

Apical

> 15

Implant type

Nobel active

Implant

Implant length

11.5

4M Post Implant Placement

5 M Post Implant Placement- Soft Tissue Grafting

1.5M Post FGG - 2nd Stage Surger

y

1M Post 2nd Stage Surgery

Temporary Prosthesis

Case Reports
51yrs, female

Courtesy of Dr.

12,22 Pre-implant Surgery Evaluation

Multiple missing teeth: loss of interdental papilla

Loss of proximal bone level of 13 & 23
Contact point to crest > 5 mm

12,22 Pre-implant Surgery Evaluation

Width of crest: 2-3 mm
Labial concavity
Without bone housing in ideal implant placement

12 & 22 Implant Surgery

Ridge width at crestal level: 2-3 mm

Ridge Split & Expansion

3i full osseotite certain NT 3.25x13 mm

Guided Bone Regeneration

Osseous graft placement

Guided Bone Regeneration

Resolut LT absorbable membrane

2 Weeks Post Implant Placement

Stitches removal

5 Months Post Implant Placement

12-22 soft tissue depression

12-22 Soft Tissue Augmentation

30x10 mm connective tissue graft placement

2 Weeks Post Soft Tissue Grafting

Stitches removal

8 W Post Soft Tissue Grafting - 2nd Stage Implant Surgery

2nd Stage Implant Surgery

Suture

6 Months Post Temporization

2015/04/16 (Temporization)

Outline

Introduction
Biomechanical risks
Biological evaluation
Clinical evaluation
Clinical consideration
Case reports
Conclusion

Conclusion
Narrow diameter implants (3.0-3.5 mm) may be a
n alternative viable treatment
Careful case selection