EdenteV2, Istex, Corpus, bibRecord, 003861

Clinical evaluation of single-tooth mini-implant restorations: A five-year retrospective study

Identifieur interne : 003861 ( Istex/Corpus ); précédent : 003860; suivant : 003862

Clinical evaluation of single-tooth mini-implant restorations: A five-year retrospective study

Auteurs : Paolo Vigolo ; Andrea Givani

Source :

The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 2000.

RBID : ISTEX:7262DBD0F5916E445D0E826E3D81631A398862C8

English descriptors

KwdEn :
- Alveolar bone, Bone density, Bone quality, Clinical evaluation, Custom posts, Customscrewed post, Dent, Dental implants, Dichotomic records, Edentulous, Edentulous arches, Edentulous areas, Edentulous jaws, Edentulous patients, Final crowns, First premolar, Gingival inflammation, Implant, Implant diameter, Implant innovations, Implant restoration, Implant survival rate, Incisor, Kerr italia, Lekholm, Marginal bone resorption, Maxilla, Maxillofac, Mucosal response, Observation period, Occlusal, Occlusal contacts, Occlusal scheme, Oral maxillofac implants, Osseointegrated, Osseointegrated implants, Periodont rest dent, Periodontal, Periodontal disease, Porcelain occlusal, Premolar, Prosthetic, Prosthetic dentistry, Protrusive movements, Provisional resin crowns, Retrospective, Retrospective multicenter evaluation, Retrospective study, Same prosthodontist, Same surgeon, Sample group, Second stage surgery, Single teeth, Small diameter implants, Soft tissues, Space problems, Standard implant restoration, Success rate, Temp bond, Temporary cement, Toronto study, Total implant survival rate, Trauma, Trauma trauma, Ultimate pullout force, Wide diameter implants, Zarb.
Teeft :
- Alveolar bone, Bone density, Bone quality, Clinical evaluation, Custom posts, Customscrewed post, Dent, Dental implants, Dichotomic records, Edentulous, Edentulous arches, Edentulous areas, Edentulous jaws, Edentulous patients, Final crowns, First premolar, Gingival inflammation, Implant, Implant diameter, Implant innovations, Implant restoration, Implant survival rate, Incisor, Kerr italia, Lekholm, Marginal bone resorption, Maxilla, Maxillofac, Mucosal response, Observation period, Occlusal, Occlusal contacts, Occlusal scheme, Oral maxillofac implants, Osseointegrated, Osseointegrated implants, Periodont rest dent, Periodontal, Periodontal disease, Porcelain occlusal, Premolar, Prosthetic, Prosthetic dentistry, Protrusive movements, Provisional resin crowns, Retrospective, Retrospective multicenter evaluation, Retrospective study, Same prosthodontist, Same surgeon, Sample group, Second stage surgery, Single teeth, Small diameter implants, Soft tissues, Space problems, Standard implant restoration, Success rate, Temp bond, Temporary cement, Toronto study, Total implant survival rate, Trauma, Trauma trauma, Ultimate pullout force, Wide diameter implants, Zarb.

Abstract

Abstract: Statement of Problem: Placement of small diameter implants often provides a solution to space problems in implant restoration. Analysis of the success of this type of implant restoration has not been clearly determined. Purpose: This 5-year retrospective study presents results from 52 mini-implants for single-tooth restorations placed in 44 patients from 1992 to 1994. Material and Methods: Dental records of 44 patients with 52 mini-implants placed during 1992-94 were reviewed. The implants were all placed by the same surgeon and the single-tooth custom screwed posts with cemented crowns were positioned on the implants by the same prosthodontist. Results: The results achieved by the mini-implant rehabilitation were similar to those reported for standard single-tooth implant restoration. Total implant survival rate was 94.2%. Two implants were lost at second stage surgery, and another was lost after temporary loading. Conclusion: The results suggest that single-tooth mini-implant restoration can be a successful treatment alternative to solve both functional and esthetic problems. They may represent the preferred choice in cases where space problems limit the use of standard or wide diameter implants. (J Prosthet Dent 2000;84:50-4.)

Url:

https://api.istex.fr/document/7262DBD0F5916E445D0E826E3D81631A398862C8/fulltext/pdf

DOI: 10.1067/mpr.2000.107674

Links to Exploration step

ISTEX:7262DBD0F5916E445D0E826E3D81631A398862C8

Le document en format XML

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<abstract xml:lang="en"><p>Statement of Problem: Placement of small diameter implants often provides a solution to space problems in implant restoration. Analysis of the success of this type of implant restoration has not been clearly determined. Purpose: This 5-year retrospective study presents results from 52 mini-implants for single-tooth restorations placed in 44 patients from 1992 to 1994. Material and Methods: Dental records of 44 patients with 52 mini-implants placed during 1992-94 were reviewed. The implants were all placed by the same surgeon and the single-tooth custom screwed posts with cemented crowns were positioned on the implants by the same prosthodontist. Results: The results achieved by the mini-implant rehabilitation were similar to those reported for standard single-tooth implant restoration. Total implant survival rate was 94.2%. Two implants were lost at second stage surgery, and another was lost after temporary loading. Conclusion: The results suggest that single-tooth mini-implant restoration can be a successful treatment alternative to solve both functional and esthetic problems. They may represent the preferred choice in cases where space problems limit the use of standard or wide diameter implants. (J Prosthet Dent 2000;84:50-4.)</p>
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<aid>65572</aid>
<ce:pii>S0022-3913(00)65572-5</ce:pii>
<ce:doi>10.1067/mpr.2000.107674</ce:doi>
<ce:copyright type="other" year="2000">Editorial Council of The Journal of Prosthetic Dentistry.</ce:copyright>
</item-info>
<ce:floats><ce:e-component id="mmc1"><ce:caption><ce:simple-para id="sp0010">Portuguese PDF</ce:simple-para>
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<ce:alt-e-component><ce:caption><ce:simple-para id="sp0015">Portuguese PDF</ce:simple-para>
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<head><ce:article-footnote><ce:label>☆</ce:label>
<ce:note-para>Reprint requests to: Dr Paolo Vigolo, Via Vecchia Ferriera, 13, 36100 Vicenza, ITALY, Fax Number: (39)444-964545, E-Mail: paolo.vigolo@ntt.it</ce:note-para>
</ce:article-footnote>
<ce:dochead><ce:textfn>Original Articles</ce:textfn>
</ce:dochead>
<ce:title>Clinical evaluation of single-tooth mini-implant restorations: A five-year retrospective study</ce:title>
<ce:author-group><ce:author><ce:given-name>Paolo</ce:given-name>
<ce:surname>Vigolo</ce:surname>
<ce:degrees>Dr Odont, MScD</ce:degrees>
</ce:author>
<ce:author><ce:given-name>Andrea</ce:given-name>
<ce:surname>Givani</ce:surname>
<ce:degrees>MD, DDS</ce:degrees>
</ce:author>
<ce:affiliation><ce:textfn>Vicenza, Italy</ce:textfn>
</ce:affiliation>
<ce:affiliation><ce:textfn><ce:sup>a</ce:sup>
Private Practice</ce:textfn>
</ce:affiliation>
</ce:author-group>
<ce:abstract><ce:section-title id="st0010">Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para id="sp0020"><ce:bold>Statement of Problem:</ce:bold>
 Placement of small diameter implants often provides a solution to space problems in implant restoration. Analysis of the success of this type of implant restoration has not been clearly determined. <ce:bold>Purpose:</ce:bold>
 This 5-year retrospective study presents results from 52 mini-implants for single-tooth restorations placed in 44 patients from 1992 to 1994. <ce:bold>Material and Methods:</ce:bold>
 Dental records of 44 patients with 52 mini-implants placed during 1992-94 were reviewed. The implants were all placed by the same surgeon and the single-tooth custom screwed posts with cemented crowns were positioned on the implants by the same prosthodontist. <ce:bold>Results:</ce:bold>
 The results achieved by the mini-implant rehabilitation were similar to those reported for standard single-tooth implant restoration. Total implant survival rate was 94.2%. Two implants were lost at second stage surgery, and another was lost after temporary loading. <ce:bold>Conclusion:</ce:bold>
 The results suggest that single-tooth mini-implant restoration can be a successful treatment alternative to solve both functional and esthetic problems. They may represent the preferred choice in cases where space problems limit the use of standard or wide diameter implants. (J Prosthet Dent 2000;84:50-4.)</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
</head>
<body><ce:sections><ce:para id="p0010"><ce:display><ce:textbox id="b0010"><ce:textbox-body><ce:sections><ce:para id="p0015"><ce:italic>Single-tooth mini-implant restorations demonstrated a rate of success similar to those reported by previous studies for standard single-tooth implant restoration. Therefore, a mini-implant may represent a valid treatment alternative when space problems occur.</ce:italic>
</ce:para>
</ce:sections>
</ce:textbox-body>
</ce:textbox>
</ce:display>
</ce:para>
<ce:para id="p0020">The rate of success of implants in the edentulous mouth has encouraged dentists to extend this application to the replacement of single missing teeth. Highly evolved surgical techniques and the introduction of special components for single-tooth replacements allowed functional and esthetic improvements.<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 The use of standard-sized or of wide-diameter implants is suggested to allow favorable contact surface between the bone and the implant itself.<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup>
</ce:cross-ref>
 Occasionally, lack of space does not allow the dentist to place implants of such dimensions. An adequate solution in these circumstances, when single-tooth restorations are needed and the space is not sufficient to insert a standard or a wide diameter implant, is the mini-implant.</ce:para>
<ce:para id="p0025">From the data available in the literature, regular-sized osseointegrated implants showed similar behavior in the rehabilitation of totally and partially edentulous arches and in single-tooth replacement.<ce:cross-refs refid="bib1 bib3 bib4 bib5 bib6 bib7 bib8 bib9 bib10 bib11 bib12 bib13 bib14 bib15 bib16 bib17 bib18 bib19 bib20"><ce:sup>1,3-20</ce:sup>
</ce:cross-refs>
 With regard to the rehabilitation of totally edentulous arches, Ahlqvist et al<ce:cross-ref refid="bib6"><ce:sup>6</ce:sup>
</ce:cross-ref>
 studied osseointegrated implants in 50 edentulous jaws during a 2-year observation period. The implant survival rate was 89% in the maxillae and 97% in the mandibles. Zarb and Schmitt<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup>
</ce:cross-ref>
 studied, prospectively, the 5- to 10-year results of treatment of edentulous patients with osseointegrated implant-supported bridges. At the end of the 5- to 10-year observation period, 88.32% of the implants remained osseointegrated and 85.04% of these implants were used to support 43 fixed prostheses and 5 overdentures.</ce:para>
<ce:para id="p0030">For rehabilitation of partially edentulous arches, Van Steenberghe<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup>
</ce:cross-ref>
 evaluated the prognosis of the osseointegration technique applied for the rehabilitation of partially edentulous jaws a multicenter retrospective study. The observation time varied between 6 and 36 months after prosthetic reconstruction. The success rate for the individual implants in the maxilla and mandible was 87% and 92%, respectively. Zarb and Schmitt<ce:cross-ref refid="bib11"><ce:sup>11</ce:sup>
</ce:cross-ref>
 studied prospectively the results of osseointegrated implants placed in partially edentulous areas in the posterior zones. One hundred five implants were placed in 46 edentulous areas in 35 patients. After periods of loaded service ranging from 2.6 to 7.4 years (mean 5.2 years), of the 41 implants placed in maxillae, 40 (97.6%) remained in function, and of the 64 placed in mandibles, 59 (92.2%) remained in function, with an overall implant survival rate of 94.3%. Zarb and Schmitt<ce:cross-ref refid="bib12"><ce:sup>12</ce:sup>
</ce:cross-ref>
 also reported an average success rate of 91.5% for implants placed in the anterior part of partially edentulous mouths both in the maxilla and in the mandible.</ce:para>
<ce:para id="p0035">With regard to single-tooth restorations, Cordioli et al<ce:cross-ref refid="bib1"><ce:sup>1</ce:sup>
</ce:cross-ref>
 reported the clinical experience of 47 patients treated for a single-tooth replacement exhibiting a total implant survival rate of 94.4%. Engquist et al<ce:cross-ref refid="bib18"><ce:sup>18</ce:sup>
</ce:cross-ref>
 evaluated the outcome of single-tooth restorations on Brånemark implants performed during the period 1984-1989, showing an overall survival rate of 97.6%. McMillan et al<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup>
</ce:cross-ref>
 investigated the nature, timing, and frequency of complications associated with single-tooth implant therapy in a dental hospital and 2 dental offices and they determined an implant survival rate of 96%.</ce:para>
<ce:para id="p0040">The literature provides laboratory studies that show the different results when using different diameter implants. Ivanoff et al<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup>
</ce:cross-ref>
 studied the influence of diameter on the integration of titanium screw-shaped implants in rabbit tibia by means of removal torque measurements and histomorphometry. They inserted implants 3.0, 3.75, 5.0, and 6.0 mm in diameter and 6.0 mm long through one cortical layer in the tibial methaphyses of 9 rabbits and allowed them to heal for 12 weeks. The implants were then unscrewed with a torque gauge and the peak torque required to shear off the implants was recorded. The biomechanical tests showed a statistically significant increase of removal torque with increasing implant diameter. Two distinct studies have questioned the importance of implant diameter: In the first study,<ce:cross-ref refid="bib22"><ce:sup>22</ce:sup>
</ce:cross-ref>
 the effect of diameter and length on the pullout force required to extract hydroxylapatite-coated implants from dog alveolar bone was compared. After 15 weeks of integration, implants of 3.0, 3.3, and 4.0 mm diameter and 4, 8, and 15 mm length were pulled. The results of this study showed that the ultimate pullout force correlated strongly to implant length, but not to diameter. The second study<ce:cross-ref refid="bib23"><ce:sup>23</ce:sup>
</ce:cross-ref>
 compared the pullout resistance of small and large diameter (3.25 and 4.25 mm) dental implants placed in the mandibles of 5 embalmed humans and the relationship of these implants to bone density. The maximum pullout force required for the large diameter implants was 15% greater than that required for the small diameter implants, but the difference was not significant. In the same study, a significant positive correlation between the pull-out resistance and the bone density for both the large and small diameter implants (<ce:italic>P</ce:italic>
 <.05 and <ce:italic>P</ce:italic>
 <.01, respectively) was noted. However, the real clinical significance of torque and pullout tests is controversial.</ce:para>
<ce:para id="p0045">The aim of this retrospective study was to collect and summarize 5 years of clinical data on a group of patients treated with the use of 2.9-mm mini-implants (3i Implant Innovations, Inc, Palm Beach Gardens, Fla.) for single-tooth restorations in a private clinic environment.</ce:para>
<ce:section id="s0010"><ce:section-title id="st0015">Material and methods</ce:section-title>
<ce:para id="p0050">Between 1992 and 1994, 197 patients were offered implant treatment in a private practice; a total of 638 implants were inserted. A sample group of 44 patients (26 women and 18 men) was investigated; 8 patients exhibited dental agenesia, 17 had lost teeth from dental trauma, and 19 missed teeth as a result of caries or periodontal disease. During the inclusion period, these 44 patients were provided with mini-implants supporting single restorations to replace the missing teeth. The ages ranged from 18 to 74 years (mean age of 35). All patients were in good health. All patients in the sample group returned for recall and all 44 are included in the initial and final data.</ce:para>
<ce:para id="p0055">A total of 52 2.9 mm mini-implants (3i Implant Innovation, Inc) were positioned after a 2-stage surgical technique (Fig. 1).<ce:display><ce:figure id="f0010"><ce:label>Fig. 1</ce:label>
<ce:caption><ce:simple-para id="sp0025">Patient missing maxillary lateral incisor because of agenesia. Canine in lateral position has been modified slightly to assume morphology at lateral incisor position. Mini-implant inserted in canine area.</ce:simple-para>
</ce:caption>
 <ce:link locator="gr1"></ce:link>
</ce:figure>
</ce:display>
The 2.9-mm implants were chosen because no space was available for wider implants. Because of space problems the surgeries had to be carefully accomplished with the guidance of a template to decrease the risk of damaging the adjacent teeth and to reduce the difficulties in the prosthetic phase due to poor positioning of the implant. If an implant had to be placed in an extraction site, a 2-month waiting period allowed esthetic healing of the soft tissues before implant placement. Five implants were inserted at the extraction time of traumatized maxillary lateral incisors so as to accelerate the treatment. The total number and type of teeth replaced by implants, the length of the implants used, and the quality of the bone<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup>
</ce:cross-ref>
 in the implant sites are presented in Tables I through III.<ce:display><ce:table id="t0010" colsep="0" rowsep="0" frame="topbot"><ce:label>Table I</ce:label>
<ce:caption><ce:simple-para id="sp0030">Site, cause of tooth loss, and number of single teeth replaced using mini-implants</ce:simple-para>
</ce:caption>
<tgroup cols="3"><colspec colname="col1" colsep="0"></colspec>
<colspec colname="col2" colsep="0"></colspec>
<colspec colname="col3" colsep="0"></colspec>
<thead><row><entry>Site</entry>
<entry align="center">Cause of tooth loss</entry>
<entry align="center">Number of single teeth replaced</entry>
</row>
</thead>
<tbody><row><entry><ce:italic>Maxilla</ce:italic>
</entry>
<entry align="center"></entry>
<entry align="center"></entry>
</row>
<row><entry>Central incisor</entry>
<entry align="center">Trauma</entry>
<entry align="center">1</entry>
</row>
<row><entry>Lateral incisor</entry>
<entry align="center">Trauma, agenesia</entry>
<entry align="center">14</entry>
</row>
<row><entry>Canine</entry>
<entry align="center">Agenesia</entry>
<entry align="center">2</entry>
</row>
<row><entry>First premolar</entry>
<entry align="center">Caries, periodontal disease</entry>
<entry align="center">8</entry>
</row>
<row><entry>Second premolar</entry>
<entry align="center">Caries, periodontal disease</entry>
<entry align="center">4</entry>
</row>
<row><entry><ce:bold>Total</ce:bold>
</entry>
<entry align="center"></entry>
<entry align="center"><ce:bold>29</ce:bold>
</entry>
</row>
<row><entry><ce:italic>Mandible</ce:italic>
</entry>
<entry align="center"></entry>
<entry align="center"></entry>
</row>
<row><entry>Central incisor</entry>
<entry align="center">Trauma</entry>
<entry align="center">5</entry>
</row>
<row><entry>Lateral incisor</entry>
<entry align="center">Trauma, periodontal disease</entry>
<entry align="center">5</entry>
</row>
<row><entry>Canine</entry>
<entry align="center">Trauma</entry>
<entry align="center">3</entry>
</row>
<row><entry>First premolar</entry>
<entry align="center">Trauma, periodontal disease, caries</entry>
<entry align="center">5</entry>
</row>
<row><entry>Second premolar</entry>
<entry align="center">Trauma, periodontal disease, caries</entry>
<entry align="center">4</entry>
</row>
<row><entry>First molar</entry>
<entry align="center">Caries</entry>
<entry align="center">1</entry>
</row>
<row><entry><ce:bold>Total</ce:bold>
</entry>
<entry align="center"></entry>
<entry align="center"><ce:bold>23</ce:bold>
</entry>
</row>
</tbody>
</tgroup>
</ce:table>
</ce:display>
<ce:display><ce:table id="t0015" colsep="0" rowsep="0" frame="topbot"><ce:label>Table II</ce:label>
<ce:caption><ce:simple-para id="sp0035">Length of mini-implants used for single-tooth replacement (3i Implant Innovations)</ce:simple-para>
</ce:caption>
<tgroup cols="2"><colspec colname="col1" colsep="0"></colspec>
<colspec colname="col2" colsep="0"></colspec>
<thead><row><entry>Length (mm)</entry>
<entry align="center">Number of implants</entry>
</row>
</thead>
<tbody><row><entry>8.5 (MI 085)</entry>
<entry align="center">1</entry>
</row>
<row><entry>10 (MI 100)</entry>
<entry align="center">20</entry>
</row>
<row><entry>13 (MI 130)</entry>
<entry align="center">22</entry>
</row>
<row><entry>15 (MI 150)</entry>
<entry align="center">9</entry>
</row>
</tbody>
</tgroup>
</ce:table>
</ce:display>
<ce:display><ce:table id="t0020" colsep="0" rowsep="0" frame="topbot"><ce:label>Table III</ce:label>
<ce:caption><ce:simple-para id="sp0040">Bone quality at the implant sites<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup>
</ce:cross-ref>
</ce:simple-para>
</ce:caption>
<tgroup cols="2"><colspec colname="col1" colsep="0"></colspec>
<colspec colname="col2" colsep="0"></colspec>
<thead><row><entry>Bone quality</entry>
<entry align="center">Number of implants</entry>
</row>
</thead>
<tbody><row><entry>Type I</entry>
<entry align="center">12</entry>
</row>
<row><entry>Type II</entry>
<entry align="center">22</entry>
</row>
<row><entry>Type III</entry>
<entry align="center">14</entry>
</row>
<row><entry>Type IV</entry>
<entry align="center">4</entry>
</row>
</tbody>
</tgroup>
</ce:table>
</ce:display>
</ce:para>
<ce:para id="p0060">At second stage surgery, the titanium healing cap connection was made. The final restorations were fabricated after conventional procedures for cemented single-tooth restoration with a screw-retained abutment and a cemented crown technique.</ce:para>
<ce:para id="p0065">Gold-machined UCLA abutments (GUCA3, 3i Implant Innovations, Inc) were used. The gold UCLA-type abutments were screwed on top of the implant replicas using waxing posts and wax added directly to the gold cylinders according to standard waxing procedures. The waxed-up cylinders were then invested in a carbon-free phosphate-bonded investment (Ceramicor, Cendres & Métaux SA, Biel-Bienne, France) and cast with a noble alloy (Al Med, Cendres & Métaux SA). A custom-screwed post was fabricated for all the mini-implants (Fig. 2); the custom posts were screwed on top of the implants in the patients’ mouths by using a torque wrench calibrated at 30 N·cm (torque driver CATDO, 3i Implant Innovations, Inc) and a provisional resin crown was temporarily cemented on each post and left in the mouth for a 2-month period (temporary cement: Temp Bond NE, Kerr Italia Sp A, Scafati, Salerno, Italy).<ce:display><ce:figure id="f0015"><ce:label>Fig. 2</ce:label>
<ce:caption><ce:simple-para id="sp0045">Custom-screwed post on top of mini-implant at time of final impression.</ce:simple-para>
</ce:caption>
 <ce:link locator="gr2"></ce:link>
</ce:figure>
</ce:display>
This temporary phase allowed good definition and stability of the peri-implant soft tissues. This also permitted evaluation of the occlusal scheme and to perform the appropriate variations to the occlusal contacts both static and dynamic. In 7 patients where the esthetic aspects were particularly important, mucogingival surgeries were accomplished to improve the appearance of the gingiva. After this initial temporary phase, the custom posts were reprepared in the patients’ mouths to follow the matured gingival morphology; then they were unscrewed, polished by the laboratory technician and repositioned on the implants. Final impressions of the mini-implant posts were accomplished following conventional crown and bridge techniques by using custom trays and polyether material: Impregum F (ESPE Dental-Medizin GmbH & Co KG) was used in the trays and Permadyne L (ESPE Dental-Medizin GmbH & Co KG) in the syringes. Gingival retraction was accomplished with a nonimpregnated retraction cord (Z-Twist Gingi-Plain, Gingi-Pak, Belport Co, Inc, Camarillo, Calif.). For 36 implants, regular porcelain-fused-to-metal final crowns with porcelain occlusal were made (Fig. 3); for the remaining implants, where the esthetic factors were of minor importance, 16 resin gold crowns with gold occlusal were constructed.<ce:display><ce:figure id="f0020"><ce:label>Fig. 3</ce:label>
<ce:caption><ce:simple-para id="sp0050">Porcelain-fused-to-metal crown cemented on custom-screwed post 5 years after mini-implant insertion.</ce:simple-para>
</ce:caption>
 <ce:link locator="gr3"></ce:link>
</ce:figure>
</ce:display>
The occlusal surfaces of the crowns were designed to avoid premature contact during lateral and protrusive movements.</ce:para>
<ce:para id="p0070">All final crowns were cemented with temporary cement (Temp Bond NE, Kerr Italia Sp A). After prosthetic treatment, a follow-up program was designed for all patients; this provided the opportunity to check the patients every 3 months in the first year and every 6 months in the following years. All the patients regularly returned to the office for recall. Five years after the implant insertion, at the last follow-up appointment, all patients were seen and periodontal parameter data were compiled on peri-implant mucosal response (dichotomic records on 4 surfaces): supragingival plaque, gingival inflammation, bleeding on probing, amount of keratinized gingiva around abutment, and probing depth from the gingival margin.</ce:para>
<ce:para id="p0075">All cemented crowns were carefully removed with the GC removal pliers (K.Y. type, GC Corporation, Tokyo, Japan) to avoid damaging the crowns. The custom posts were unscrewed to allow the measurement of the mucosal canal using a periodontal probe to record the length from the marginal gingiva to the head of the implant. Intraoral radiographic examinations were performed using the paralleling technique and an adjusted film-holding device as suggested by previous studies.<ce:cross-refs refid="bib1 bib25"><ce:sup>1,25</ce:sup>
</ce:cross-refs>
 The radiographic films were observed using a 5× magnifying lens to precisely reveal the implant threads and permit the measurement of marginal bone resorption with an accuracy of ±0.3 mm. Occlusal relationships and all complications were recorded.</ce:para>
</ce:section>
<ce:section id="s0015"><ce:section-title id="st0020">Results</ce:section-title>
<ce:para id="p0080">During the 5-year period of this study, 2 implants (10 mm in length) failed at the second surgical phase. These units were placed in the first premolar sites in the upper maxilla (bone quality 4) in a 52-year-old woman. Another implant (13 mm length) placed in the lower left lateral incisor site of a 25-year-old woman was lost 1 month after the custom post was positioned on the implant and the temporary crown was cemented.</ce:para>
<ce:para id="p0085">One patient reported the loosening of the custom-screwed post twice. The post was remade and the problem did not recur. Five patients reported fracture or loosening of the provisional resin crowns. The problem was solved by making an accurate adjustment to the patient’s occlusion. Seven patients reported recurrent loosening of provisionally cemented final crowns all with porcelain occlusal surfaces. This problem was solved by selective equilibration to achieve optimal occlusion and to avoid contact in lateral and protrusive movements.</ce:para>
<ce:para id="p0090">The clinical evaluation of peri-implant mucosa using periodontal indices gave satisfying results for the implant-mucosa interfaces (Table IV).<ce:display><ce:table id="t0025" colsep="0" rowsep="0" frame="topbot"><ce:label>Table IV</ce:label>
<ce:caption><ce:simple-para id="sp0055">Periodontal parameters recorded by dichotomic records (presence or absence)</ce:simple-para>
</ce:caption>
<tgroup cols="2"><colspec colname="col1" colsep="0"></colspec>
<colspec colname="col2" colsep="0"></colspec>
<thead><row><entry>Periodontal indices records</entry>
<entry align="center">Percentage</entry>
</row>
</thead>
<tbody><row><entry>Plaque presence</entry>
<entry align="center">12</entry>
</row>
<row><entry>Gingival inflammation</entry>
<entry align="center">4.5</entry>
</row>
<row><entry>Bleeding on probing</entry>
<entry align="center">6.5</entry>
</row>
<row><entry>Amount of facial keratinized gingiva</entry>
<entry align="center">91</entry>
</row>
<row><entry>Amount of lingual keratinized gingiva</entry>
<entry align="center">94.5</entry>
</row>
</tbody>
</tgroup>
</ce:table>
</ce:display>
Dental plaque was present on 12% of the considered surfaces and gingival inflammation was present on only 4.5%. Keratinized attached gingiva was not present in 9% of buccal surfaces or in 5.5% of lingual surfaces. A mean probing depth of 2.3 mm was recorded, less than reported in some other studies.<ce:cross-refs refid="bib1 bib26 bib27"><ce:sup>1,26,27</ce:sup>
</ce:cross-refs>
 The probing was carefully accomplished and a low percentage of sites (6.5%) had bleeding on probing. The mean marginal bone resorption at the last checkup, measured with the intraoral radiographic examination method previously described from the apical end of the smooth collar of the mini-implant, was 0.8 mm, with a range of 0.5 to 1.1 mm.</ce:para>
</ce:section>
<ce:section id="s0020"><ce:section-title id="st0025">Discussion</ce:section-title>
<ce:para id="p0095">This 5-year retrospective study presents the results from 52 mini-implants for single-tooth replacement inserted in 44 patients from 1992 to 1994. All implants were put in position by the same surgeon and all custom-screwed posts with single cemented crowns were positioned on implants by the same prosthodontist. In this study, the mini-implants used in single-tooth rehabilitation exhibited a 94.2% success rate similar to the results accomplished by regular-sized implants in single-tooth replacement cases.<ce:cross-refs refid="bib1 bib14 bib15 bib16 bib17 bib18 bib19 bib20"><ce:sup>1,14-20</ce:sup>
</ce:cross-refs>
</ce:para>
<ce:para id="p0100">The mini-implant is commonly used in areas of narrow ridge dimension or where prosthetic space is limited.<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup>
</ce:cross-ref>
 This often occurs in the anterior maxillary region, especially in situations of congenitally missing teeth and after orthodontic treatment, wherein the lack of space does not allow use of a regular-sized implant. A space problem frequently results as well in the mandibular incisors and in the maxillary premolar and canine areas. Furthermore, the presence of thin posterior mandibular ridges that would require bone augmentation surgery before the insertion of standard-sized or wide diameter implants. In such situations, insertion of small diameter implants would enable the dentist to rehabilitate the patient without preinstallation surgery.</ce:para>
<ce:para id="p0105">All implants were restored with custom posts and cemented final crowns in anticipation of achieving more natural esthetic results. As previously said, the occlusal scheme had to be carefully equilibrated to avoid prematurities in eccentric movements. All our minor prosthetic problems (fracture of the resin provisional crowns, decementation of provisional resin crowns, decementation of final crowns) were associated with occlusal prematurities. For maxillary canine substitution, we tried to concentrate the lateral guiding movements in the first premolar area. In 1 patient, a 2.9-mm mini-implant was positioned in the first lower right molar site where the thin crestal ridge did not allow the placement of a wider diameter implant. The final restoration in that situation was a regular porcelain-fused-to-metal crown with porcelain occlusal: The crown shape was reduced to the dimension of a mandibular premolar to better control the occlusal contacts of the restoration.</ce:para>
<ce:para id="p0110">Only 1 patient reported the loosening of the custom-screwed post. After closer analysis, the post showed some casting imperfections at the hexagon level. The post was remade and the problem did not recur. It is probable that the internal hexagon pattern of this type of mini-implant reduces the risk of custom-post unscrewing that has been reported by some authors, with relation to standard-sized implant single-tooth restorations.<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup>
</ce:cross-ref>
</ce:para>
</ce:section>
<ce:section id="s0025"><ce:section-title id="st0030">Conclusions</ce:section-title>
<ce:para id="p0115">Within the limits of this study, the following conclusions were drawn:</ce:para>
<ce:para id="p0120"><ce:list id="l0010"><ce:list-item id="o0010"><ce:para id="p0125">A success rate of 94.2% was observed. Failures were related to poor bone quality in the recipient sites and to occlusal problems.</ce:para>
</ce:list-item>
<ce:list-item id="o0015"><ce:para id="p0130">The single-tooth mini-implant restoration can be a valid alternative in many clinical situations in which space problems do not permit the use of standard- or wide-diameter implants.</ce:para>
</ce:list-item>
</ce:list>
</ce:para>
</ce:section>
<ce:section id="s0035"><ce:section-title id="st0035">Supplementary Files</ce:section-title>
<ce:para id="p0135"><ce:float-anchor refid="mmc1"></ce:float-anchor>
</ce:para>
</ce:section>
</ce:sections>
</body>
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<mods version="3.6"><titleInfo lang="en"><title>Clinical evaluation of single-tooth mini-implant restorations: A five-year retrospective study</title>
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<titleInfo type="alternative" lang="en" contentType="CDATA"><title>Clinical evaluation of single-tooth mini-implant restorations: A five-year retrospective study</title>
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<name type="personal"><namePart type="given">Paolo</namePart>
<namePart type="family">Vigolo</namePart>
<namePart type="termsOfAddress">Dr Odont, MScD</namePart>
<affiliation>Vicenza, ItalyaPrivate Practice</affiliation>
<role><roleTerm type="text">author</roleTerm>
</role>
</name>
<name type="personal"><namePart type="given">Andrea</namePart>
<namePart type="family">Givani</namePart>
<namePart type="termsOfAddress">MD, DDS</namePart>
<affiliation>Vicenza, ItalyaPrivate Practice</affiliation>
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<language><languageTerm type="code" authority="iso639-2b">eng</languageTerm>
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<abstract lang="en">Abstract: Statement of Problem: Placement of small diameter implants often provides a solution to space problems in implant restoration. Analysis of the success of this type of implant restoration has not been clearly determined. Purpose: This 5-year retrospective study presents results from 52 mini-implants for single-tooth restorations placed in 44 patients from 1992 to 1994. Material and Methods: Dental records of 44 patients with 52 mini-implants placed during 1992-94 were reviewed. The implants were all placed by the same surgeon and the single-tooth custom screwed posts with cemented crowns were positioned on the implants by the same prosthodontist. Results: The results achieved by the mini-implant rehabilitation were similar to those reported for standard single-tooth implant restoration. Total implant survival rate was 94.2%. Two implants were lost at second stage surgery, and another was lost after temporary loading. Conclusion: The results suggest that single-tooth mini-implant restoration can be a successful treatment alternative to solve both functional and esthetic problems. They may represent the preferred choice in cases where space problems limit the use of standard or wide diameter implants. (J Prosthet Dent 2000;84:50-4.)</abstract>
<note>Reprint requests to: Dr Paolo Vigolo, Via Vecchia Ferriera, 13, 36100 Vicenza, ITALY, Fax Number: (39)444-964545, E-Mail: paolo.vigolo@ntt.it</note>
<note type="content">Section title: Original Articles</note>
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Clinical evaluation of single-tooth mini-implant restorations: A five-year retrospective study

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