Mini implants in lower jaw: Less Risky than a regular implant?

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Is  inserting of mini implants to replace lower jaw premolar or molar teeth less risky in terms of lower jaw nerve reaching than a usual implant inserting in the same place?
Are there any risks of lower jaw nerve touching when inserting mini implants?
asked Mar 3, 2012 by Suzi
edited Mar 4, 2012 by ChooseDentalImplants
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1 Answer about Mini implants in lower jaw: Less Risky than a regular implant?

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No, the placement of any implant in the posterior lower jaw still has the same risk.  It is the LENGTH of the implant that is the issue rather than the WIDTH (mini-implants are narrower, not shorter).  Based on this and your previous question you seem to be attracted to mini implants rather than "usual" implants.  Keep in mind that both types of implants are basically the same but mini's are just narrower.  The downside is that mini's do not provide as much surface to bone contact as "full" sized implants and therefore may not provide the same long lasting reliability, especially if you are considering them to replace molar teeth where there is a lot of chewing pressure.  I guess the reason so many people are interested in mini's is lower cost, but lower initial cost may not translate into lower "long term" cost.  As far as a simpler surgery to place mini's when they fail (and given enough time they very likely will) the aggravation and EXTRA surgery to replace them later may be extensive and more expensive.

Dr. David Azar, New York, NY
David E. Azar DDS
New York, NY

(212) 406-3500
answered Mar 4, 2012 by David E. Azar DDS - New York, NY
1)As far as the possible mini implant failure is concerned I would like to explain my vision of this. In case of mini implants to replace a molar teeth three or two mini implants are going to be used, if one fails another probably not.However dentists putting mini implants state that they have 98% cases of successful mini implants, if the patient really takes care of his teeth. Usual implant can fail and if such an implant fails than its replacement is more difficult. So if both kinds of implants can fail I would like to choose a less traumatic type of implant. Am I right in my speculations on this matter?

2) What is the minimum length of a mini implant to be used in the posterior lower jaw?
I believe that many people are interested in mini-implants because there isn't any surgery involved.    While the lower cost is a factor,  it ranks way below the no surgery element for me.

I have read quite a few studies involving mini implants.  It appears that their success rate is actually quite high in the last 5 years.  My dentist said to me (condescendingly)... is 5 years a success?   I replied.. yes it is...if my risk for a bone infection, a  perforated sinus or a nerve injury is almost non-existant. .   And if it fails..I can re-do it what?  About 4 times before it equals the cost of a regular implant.

Lastly, 10 years ago the thought of same day implants was unheard of.  The oral surgeons scoffed and said it wasn't the 'right' way to do it and the implants would never last.  Well, here we are, 10 years later... and immediate loading is now mainstream.

I have to wonder if 5 years from now...after mini-implants have shown the test of time.. if they too won't be accepted into the mainstream of dentistry.    Regular dental implants have been a cash cow for the dental profession.   It's time to think about the needs of the average person who can afford 1K vs. 3K.   It's time to think that 5-10 years might qualify as a success for some people.  Not everyone needs the Mercedes and it's time the dental industry steps up to the plate and offers a Chevy.  

Oh and one more comment... aren't most crowns only guaranteed for something like 5 years?   Why is 5 years acceptable for crowns but not mini implants!
Jane, I think that you are making many generalizations and are not addressing many specific issues.  Immediate loading of implants is ONLY acceptable when there are at least 4 implants (with 6 or 8 even better) placed in strategic sites across an entire arch.  Immediate provisionalization of a single implant is not the same thing, generally a single implant cannot be fully loaded right away, but under some specific circumstances a non-functional provisional crown may be placed.  While the final fully loaded restoration will not be placed for several months. Implants with immediate provisional crowns are shown to have a significantly lower success rate (about 90%) compared to a non provisionalized implant (95-98%).    If crowns are only lasting an average of 5 years I would say that is an abject failure.  Crowns I have placed in long term pts (I am practicing 33 years) have an average life of 15 years.  Standard sized root form implants have been shown to have an average life of 15 years, and since "enhanced" surfaces have been introduced (about 7 years ago) the life expectancy is expected to increase.   I think that mini implants may be a good alternative for specific cases, like an elderly pt who only needs to get some short term retention for a removable denture.  But placing 2 or 3 mini-implants to support a single crown (as was mentioned by Suzi) is not a predictable option, this is an extremely unhygienic situation and is doomed to failure.  And where is the cost savings in that?  As far as  minimal surgery most implants today can be placed with NO or only a small incision.  It is only when extensive grafting is required that a relatively large surgery is done and if that is the case mini implants probably cannot be used any way.  With up to date methods and materials even these procedures can be minimally invasive.  As a whole the profession is striving to find easier, better and longer lasting ways to make implant dentistry more available to more patients.  As you said not everyone needs a Mercedes and there are always alternatives, while the alternatives may cost less they should never have a compromised outcome.  As far as whether 5 years from now mini implants will be accepted in mainstream dentistry, it is possible they will be accepted for certain specific uses, but it is unlikely they will gain the same wide spread acceptance as standard sized implants, they are too thin to support long term loads and will likely have very high rates of fracture...if this occurs the surgery needed to remove them can be extensive and result in excessive damage to the surrounding bone and soft tissue.  Many things have been introduced into dentistry as the "next great hope" only to be forgotten to history.  For right now full size titanium root form endosseous implants have an excellent track record and have revolutionized the way we may serve our patients in a safe, and predictable manner.
Best regards
Dr. David Azar
Oh, by the way I had an implant placed last Tuesday to replace my upper left 1st Molar that had to be extracted 20 years after having root canal therapy a post-core and a crown.  I consider 20 years an excellent success.  I received a full sized (5.0mm) implant and the surgeon placed it with only a small incision.  I had minor discomfort for 12 hours and only took some ibuprofen the night of surgery and have not had to take anything for pain since.  My mouth is very comfortable, there was virtually no swelling and I am eating normal foods on the opposite side of my mouth with no problems.  I am very confident that i will have that implant a very long time, possibly the rest of my life, and I am only 56 years old.
Dr Azar
Thank you for responding.   I am in need of 2-4 implants... 2 upper lateral incisors and 2 lower molars.  I've tried to find legitimate statistics to ease my fear of full implants and I can't find it.  So, the appeal of mini-implants is huge to me.   Yes, they might not last, but my fear of nerve damage trumps the risk of early failure everytime.

I would love for you to give me some actual facts to help lower my anxiety concerning lower jaw implants.   Do you have any statistics available on the percentage of implants (in the lower jaw) that caused permanent nerve damage?   Has this number decreased since dentists started using CT scans to visualize the nerve?

I'm 55 years old and have had extensive work performed on my teeth.  I've had at least 14 root canals and countless crowns.  I've trusted dentists to "do the right thing".   Unfortunately, fixed bridges and crowns with posts have turned out to present problems that have left me with only 3 solutions.... partials, implants or dentures.   

Do I pursue dental implants...knowing that eventually another tooth / root canal will fail and I will be faced with this exact same problem?    When do I throw in the towel and go for dentures?

I don't want dentures... I don't want partials...and I don't want implants.  I want a 'fix' that isn't drastic...and I guess that is why mini-implants appeal to me.
Jane, the fact is very simple, both a mini implant and a "full" sized implant in the posterior mandible HAVE THE SAME RISK of nerve damage.  You must understand that it is not the implant that causes the nerve damage, but the procedure utilized to place the implant.  ANY time a doctor is going to place an implant in an area where there is a risk of nerve damage VERY CAREFUL PLANNING must be done prior to the actual placement.  CT scans can be extremely helpful, but may not always be necessary if the needed information (ie the height of bone above the nerve canal) can be ascertained with a 2dimensional xray, like a panoramic xray.  As I said I am 56, I already had one tooth that had a failed root canal replaced with an implant and I am in the process of having a 2nd one done.  Not only do I believe it is the right treatment for myself, but I have done implants on my father, brother, sister-in-law and countless relatives and friends.  I think that is the highest recommendation I can give!  You should feel confident that when dental implants are done correctly they truly are the "right thing".   As far as legitimate statistics, a look at any well done implant study that investigates long term success shows that titanium, root form implants have very high success rates ranging from about 90 to 98% over 5 years (that is the longest study period I am aware of).  This is the highest success rate for ANY medical replacement device!  The bottom line is you must find a doctor who is well trained, has a lot of experience, and whom you trust.  If you tell me which city you live in, I may be able to recommend someone.
Dr Azar
As for implants although you are very optimistic about their post-insertion period, nevertheless I read very sad stories on this very website written by the people who put the traditional implants. Some of them write that the implants were put into a healthy gum, there is no nerve damage on the X-ray, but they can't sleep because of the regular pain, their dentist can't find the cause of the pain, one dentist even disappeared without any explanation on the case of painful implant. Some people write that implant turned their life into the nightmare with the constant pain even when the nerve is not damaged. Some dentist answer that the cause of the pain may be not proper torque applied. How can it be understood that the cause of the pain is not right twisting force during insertion process and in the result not successful osseointegration. How these problems are to be avoided, if it is possible at all? Why do these problems occur? And, of course, it is not clear why with the abvailability of X-rays and CT scans some dentist damage the nerve. Do they economize on CT scans doing, or CT scans doing is not enough to prevent nerve damage? Is it partly unpredictable, like fortunetelling?

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