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Product Focus:

The Hybrid Mini Dental Implant: A Case Review

M

ini dental implants (MDIs) are beginning to garner more attention from the dental profession. Although originally popularized as a simplified means of stabilizing a lower complete denture, the MDI is now considered by many to be an alternative means of replacing missing teeth as fixed restorations. Such restorations might be single teeth or multiple splinted teeth.1-3 Under the early guidance of Dr. Victor Sendax, IMTEC Corporation (now 3M ESPE) laid an early claim to relevancy in the MDI market by introducing mini implants that were 1.8 mm in diameter in a variety of lengths. Over the years, their system and selection of available MDIs has expanded to include mini implants best suited to maxillary restorations and its softer bone, as well as MDIs that have collars to accommodate thick, soft-tissue coverage. Other implant manufacturers have followed this diversification trend by offering multiple varieties of what are collectively called “MDIs” that typically have diameters ranging from 1.8 to 2.5 mm, depending on the manufacturer. The alloy of choice is, as usual, titanium, combined with trace amounts of other metals to enhance strength and biocompatibility. Thread designs are proprietary; however, all resemble, to some degree, a wood screw, as they are meant to be self-advancing and self-threading. The self-threading aspect is responsible for making immediate fixation and immediate loading a distinct possibility.

Figure 1—3M ESPE's MDI Hybrid 2.9 mm implants are suitable for fixed and removable applications.

Using the Hybrid Mini Implant: Case Study
Of particular note, and the subject of this “mini” case review, is the hybrid implant. The hybrid implant pushes well beyond the 1.8-mm-diameter mini implant; however, falls just short of the full-sized root form implant that usually begins its diameter progression upward from 3 mm. The hybrid lays claim to a 2.9-mm diameter and is intended to be placed with much the same method and many of the same tools as its brethren 1.8-mm mini implants. In fact, the hybrid used in this case study (Figure 1), 3M ESPE’s MDI hybrid, features the same prosthetic head and “o-ball” configuration as does the company’s “true” mini implants, but adds a recognizable platform at the base of the prosthetic head as well as a distinctive thread pattern beneath that base. Dentists will easily recognize why the MDI is called “hybrid.” Its bottom-half appearance, for all practical purposes, is like a root-form implant, whereas the top half looks like a mini implant. Where would this type of implant be used? In this instance, a 50-year-old male and a long-standing patient decided it was time to replace a missing 2nd bicuspid and, in doing so, improve his smile. As can be seen in Figures 2 through 5, the maxillary 2nd bicuspid site is easily accessible, as is often the case, and frequently features a broad
Dental Learning / February 2011 1

Martin B. Goldstein, DMD Private Practice Wolcott, CT Phone: 203.879.4649 E-mail: martyg924@cox.net Web site: www.drgoldsteinspeaks.com

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Figure 2—Radiograph demonstrating ideal placement of the 3M ESPI MDI Hybrid mesial to the maxillary sinus.

swath of bone anterior to the maxillary sinus. Such areas may also display an equally generous patch of highly keratinized tissue, optimizing the healing and tissue adaptation phase. Occlusal loads can be minimized with sufficient canine guidance in place and judicious adjustments when testing excursive movements. The hybrid can also be used in other areas in the arch, such as lateral incisor sites in the maxilla. I have found it advantageous, however, to employ hybrid implants in locations that will allow the implantretained crown to be exposed to a minimum of occlusal force. This is a personal preference based upon the nature of the implant-retained “pontabut,” as it is often called. As the restoration is essentially a pontic with a small hole in its ridge lap area and is cemented with a resin cement, it makes sense to keep the occlusal load light so as not to overtax this junction.

Placement Technique
The technique used to place the hybrid varies slightly from that used with the smaller- diameter implants. The manufacturer’s instructions indicate the use of a disposable tissue punch to remove a small button of soft tissue over the osteotomy site followed by use of a small, round carbide bur to create a purchase point for the osteotomy drill. The osteotomy drill has a 1.7-mm diameter versus the 1.1-mm diameter of the drill recommended when placing their 1.8- and 2.4-mm mini implants. (3M ESPE sells the combination of cutting instruments in kit form.) Placement armamentarium is the same as that for the mini implants. The finger driver begins the process and is replaced with the thumb wrench when too much force is necessary to further advance the hybrid. If needed, a torque wrench can be used to gain final hybrid placement. Figure 2 shows the 13-mm hybrid at full placement depth; Figure 3 shows the appearance of the soft tissue 3 weeks postoperatively; Figure 4 shows the nature of the ridge lap pontabut; and Figure 5 shows the fixed restoration in place following cementation.

Figure 3—Note the excellent tissue response to the 3M ESPI MDI Hybrid implant at 3 weeks.

Figure 4—The “pont-abut” resembles a ridge lap pontic featuring a small opening sized to engage the head of the MDI Hybrid.

Hygiene
Hygiene care for the pontabut restoration is best accomplished with floss and a Waterpik (Water Pik, Inc). In this author’s experience tissue response is excellent, showing no signs of chronic inflammation.

Figure 5—The “pont-abut” has been secured with a self-curing resin cement.

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Advantages
The advantages of the hybrid implant approach are readily apparent. Aside from the usual benefits of any implant-retained restoration, the reduced cost and time reduction come to the forefront as does its ultraconservative surgical placement. The hybrid can typically be loaded within weeks of placement (provided initial placement torque exceeds 30 Ncm) and can also be offered at substantially less cost than a traditional approach owing to the reduced fixture cost and number of visits needed to complete the restoration. To be sure, it is advisable to offer this service as one of many alternatives appropriate for your patient.

plants would appear to be expanding into multiple applications as both patients and dentists begin to appreciate the advantages offered by such systems. General practitioners interested in adding another treatment to the services they provide would do well to explore the rapidly expanding field of mini hybrid implants.

References
1. Christensen GJ. The ‘mini’ implant has arrived. J Am Dent Assoc. 2006;37:387-390. 2. Christensen GJ. The increased use of small-diameter implants. J Am Dent Assoc. 2009;140:709-712. 3. Shatkin TE, Shatkin S, Oppenheimer BD, et al. Mini dental implants for the long-term fixed and removable prosthetics: a retrospective analysis of 2514 implants placed over a fiveyear period. Compend Contin Educ Dent. 2007;28:92-99.

Conclusion
The world of minimum-diameter, self-advancing im-

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