While ill-fitting dentures may not be considered by some as one of the most serious or health- threatening dental conditions, any dental professional who has spent time speaking with a patient living with a poorly fitting denture knows that the resultant discomfort, inconvenience, and embarrassment is often unbearable. After making a considerable investment in a full set of dentures, it is common for the patient to have difficulty eating or speaking, especially lower dentures. The jaw is moving up and down, the tongue is moving, and so does the denture. That is the nature of lower dentures and rare is the patient who tolerates it well. Many patients just opt not to wear one or both dentures, even when they are new, often avoiding social gatherings or eating in public as a result.
Conventional implants are a widely accepted and well known treatment plan for ill fitting dentures, but the prerequisites for this procedure can be inhibiting. A common challenge is that a large portion of denture wearers are elderly patients who have experienced extensive bone loss or ridge resorption (shrinkage). To do conventional implants invasive bone grafting would be necessary prior conventional implant placement. There may be a variety of health conditions which could preclude taken on lengthy involved treatment. In addition, for those who lived on a fixed income the financial burden of conventional implants is simply untenable.
The promising alternative is small diameter implants (SDIs), also referred to as mini dental implants. Based on their ability to provide a sustainable solution to ill-fitting dentures with a minimally invasive procedure and LOWER cost, they are becoming an extremely viable alternative to the conventional implant procedure. The US Food and Drug Administration approved SDIs for intraoral use in 1997. Conventional implants have been approved far longer and evidence supports comparable integration and success between the two different types. Survival rates are comparable to conventional implants and range in the 90th percentile and upwards. All available research appears to support the use of SDIs when indicated.
The amount of bone is one of the most important elements in the decision between conventional or SDI implant usage. SDIs require much less bone and thus increase the likelihood that a patient will have adequate bone to qualify for case selection. Another factor to consider is the health and attitude of the patient. For the elderly, and those with compromised health, the minimally invasive procedure and shortened healing time associated with SDIs is ideal. Because there are no incisions or suturing necessary, the patient will experience minimal postoperative pain and swelling, allowing one to eat comfortably within hours. Adding in the lower cost of SDIs this treatment can be extremely rewarding for the patients giving them a long term denture stabilization solution.
Case study
The patient presented with the main problem of an extremely poor fitting lower denture. He had difficulty with the denture since its initial placement. He complained of an inability to eat solid food, and indicated he suffered from considerable irritation. Food became lodged underneath the denture and his frustration and discomfort was such that he often chose to just not wear the denture at all. At initial exam, it was clear the patient suffered from periodontal disease for many years prior to loss of the teeth because there was considerable amount of bone loss of the alveolar ridge. The proposed treatment plan was to place 4 SDIs in the lower anterior mandible. If initial stability of the implants is adequate the denture can be fitted with the anchors in the denture at that time. More often a healing period of approximately 3 months is necessary to allow the implants to integrate into the bone, and then retrofit the denture with the retention housings. This case was completed in 4 patient visits, consisting of a consultation – examination visit, the surgical placement of the implants, a post operative visit, and 3 months later the denture retrofit. The patient reported complete satisfaction with the procedure, noting that he no longer experienced pain or discomfort and was again able to eat normally.
Summary
While conventional dental implants are a widely accepted treatment for ill fitting dentures, for many this procedure is simply out of reach due to the common challenges of inadequate bone, poor health, and the inability to afford the more expensive procedures when many have struggled to pay for the dentures alone. SDIs have shown to be a viable and reliable alternative that offers the benefits of a minimally invasive procedure and reduced price tag.
The SDI procedure has the potential to improve quality of life in a minimal time frame at an affordable cost.