Michael Tischler, DDS

Before and After Views of Small-Diameter Implants Before. Image of patient with congenitally missing laterals. After. Image of patient with 3-mm one-piece small-diameter implants to replace missing laterals.

HISTORY AND APPROVED USES
Over the past 10 years, there has been a definite increase in smaller-diameter dental implants on the dental market. In the early 1970s, Dr. Victor Sendax first developed the "mini" implant concept. From that point, various companies have evolved to further this "mini" implant market, and now there are really 2 groups of these smaller-sized dental implants. One group can be called the "mini" implant group with diameters of 1.8 mm to 2.5 mm and lengths between 10 mm to 18 mm. The US Food and Drug Administration (FDA) 510(k) approval for these "mini" implants can be found on the FDA Web site, fda.gov. According to the Web site, the FDA has approved certain brands of dental implants of this size "for use as a self-tapping titanium screw for transitional or intrabony longterm applications." They are also indicated, according to the FDA Web site, for "long-term maxillary and mandibular tissue-supported denture stabilization. Multiple implants should be used and may be restored after a period of time or placed in immediate function." This is according to the FDA.

TREATMENT PLANNING FOR MINI AND SMALLER-SIZED DENTAL IMPLANTS
When treatment planning for any sized dental implants, the principles of loading forces must be taken into account. If a dental implant is overloaded, there is a higher likelihood of bone loss being associated with the implant and possible failure. The best way to treatment plan for dental implants is to plan for the placement of dental implants based on the prosthetic end result. These reduced-size dental implants can support both removable and fixed applications. Since these implants have less surface area for the bone to attach to due to their reduced size, the planning for reducing the forces on them becomes even more important.

TREATMENT PLANNING FOR A REMOVABLE PROSTHESIS
When utilizing both mini- and small-diameter implants for a removable denture treatment plan, it must be considered that the implants are not splinted, and the denture will be primarily tissue supported. A clinician should treatment plan for more implants, longer implants, and find the most stable bone possible to reduce loading forces on the im-plants. These factors will help offset the increased instability of a tissue-supported denture with nonsplinted implants. One advantage of nonsplinted implants is the reduced cost and adaptability of the prosthesis if an implant fails. The literature has shown success with both immediate loading and delayed loading of these smaller-sized dental implants. Various attachments are available to secure a denture to the reduced sized implants, and the literature from the available companies will explain the differences.

Clinical Uses of Small-Diameter Implants

Image 1. Small-diameter implant at 1.8 mm to support a mandibular overdenture. Image 2. Panograph of 1.8 mm small-diameter implant to support a mandibular overdenture. Image 3. Panograph of 3 mm one-piece small-diameter implants in function. Image 4. Periapical radiograph of 3 mm one-piece diameter implant.

TREATMENT PLANNING FOR A FIXED PROSTHESIS
Treatment planning for reduced-size implants must follow the same guidelines as treatment planning with regular-sized implants (3.5 mm to 5 mm width). One advantage of the 3-mm smaller diameter implants is the ability to place them closer to adjacent teeth than a regular size implant. The lack of a micro gap between the implant abutment and body allows for this closer proximity, according to the literature. This is ideal for their intended use of replacing maxillary lateral incisors and mandibular centrals and lateral incisors. It is often in these areas that only 5 mm to 6 mm are available between a missing tooth. A CT scan is needed in these situations so that the exact spacing from an axial view can be ascertained. Another reason for a CT scan is to avoid excessive angulations and the need to overprep the abutment on the one-piece implants.

CONCLUSION
The currently available mini dental implants (1.8 mm to 2.5 mm in width) and small-diameter dental implants (3 mm in width) can be used successfully in a variety of clinical situations. It must be emphasized that the reduced surface area of these implants requires correct treatment planning so that loading forces do not cause bone loss or implant failure. The reduced costs of treatment for the patient and less invasive surgery for placement is an advantage when reduced-size implants support a denture. Another advantage is the prosthetic flexibility if an implant fails. These advantages can outweigh the benefits of the stability of a bar overdenture on traditional implants for some people. The use of 3-mm-size implants is ideal for replacing maxillary lateral incisors and mandibular centrals and laterals. Due to the stringent spacing requirements, a CT scan is recommended for placement.

3M ESPE As the world leader in small-diameter implants, the MDI Implant System is clinically proven and FDA accepted for long-term denture stabilization. Clinicians can immediately stabilize loose lower dentures with a 90-minute, often flapless procedure after a 1- or 2-day MDI certification course. It provides multiple retention options and implant designs for both dense and softer bone. The minimally invasive procedure provides immediate results and improves denture patients' quality of life. For more information, call (800) 879-9799 or visit 3mespe.com/mdi.	American Dental Implant The Skinny 2.4 Implant is the 2-piece implant designed and developed for narrow ridge situations. A small-diameter implant should offer uncompromising strength as well as full prosthetic versatility. The Skinny 2.4 offers the benefit of a small diameter while providing the universal restorative platform. There's no learning curve and no need for additional surgical instrumentation. It is offered in microporous and hydroxylapatite surfaces. For more information, call (800) 511-0661 or visit americandentalimplant.com.
AB Dental USA The I6B Thin Implant is a 2-piece one-stage or 2-stage implant. It is appropriate for immediate loading. It can be used with a ball attachment for overdenture cases. The height of the ball attachment can be changed as is required by the gumline of the patient, and its flexibility prevents the regular wear on ball attachments. Abutments are available in straight, angled, and a temporary plastic sleeve. For more information, call (888) 823-5553 or visit ab-dentusa.com.	Hiossen The HM's narrow ridge and denture implants come in 2.5- and 3-mm diameters and 10-, 13-, and 15-mm lengths. HM's unibody and micro threads are designed with masticatory forces in mind and are made from high-quality titanium and RBM treated. All of this ensures that each placement is a success, giving both the practitioner and patient peace of mind. For more information, call (888) 678-0001.
Intra-Lock The Mini Drive-Lock dental implant system is thoughtfully engineered to provide ergonomic efficiency, prosthetic versatility, and tissue compatibility, producing superior patient's denture stability. The implants are profiled for strength, stability, and ease of insertion. They feature patented Drive-Lock technology that optimizes single-motion delivery, from pickup to placement. It is the only mini implant in the world that has the bioactive Ossean surface.	MILO is a one-piece, 3-mm diameter dental implant system. Engineered as a true "convertible" small-diameter implant, it is endowed with qualities that render it ideal for long-term denture stabilization or fixed prosthetic options. Patented Cement-Over Abutments are available in straight, 15°, wide, and plastic castable designs and simply fit over the o-ball assembly, converting the implant from removable to fixed prosthetic options. MILO Implants feature Drive-Lock technology for mountless, efficient placement and have a bioactive Ossean surface. For more information, call (877) 330-0338 or visit intra-lock.com.
Zimmer Dental The versatile ERA Mini Dental Implant System enables the transitional function of a denture during the osseointegration of traditional implants as well as long-term, affordable chairside denture stabilization in as little as one visit. This multidimensional system comprises the ERA Mini Implant, surgical instrumentation, and prosthetic components, including the unique, angulation-correcting, vertically resilient properties of the widely used ERA attachment. For more information, call (800) 854-7019 or visit the the Web site zimmerdental.com.	Simpler Implants The Simpler Toadstool small-diameter implant is unique because it virtually eliminates vertical loading on the implant. Other features include the lowest profile, platform switching, tissue guidance, and HA coating, none of which can be found with any other narrow-diameter implant. When these features are combined, it offers the best chance of successful short- and long-term osseointegration. For more information, call (800) 565-3559.
OCO Biomedical The new 2.2- and 2.5-mm I-Micro offers a more aggressive thread than the competitors' mini-implants and has machined vertical grooves to render the implant antirotational. It can be placed with OCO drivers or with drivers from several other mini-implant systems, incorporating a simple, minimally invasive placement technique. The "micro mini" is a perfect starter implant for placing the 3-mm I-Mini implant, which utilizes the same placement protocol as OCO Biomedical's larger diameter one-piece implant, the ISI Complete.	The 3-mm I-Mini is a true mini dental implant that is placed and performs like OCO's larger-diameter immediate-load implants. You can utilize as much bone as possible by placing a mini with an aggressive thread pattern and OCO's proven auger/bull-nose tip, designed to create a biomechanical lock at the apex and grow bone. It boasts a greater than 99% reported success rate as well as having a simple, minimally invasive placement procedure and surprising load capability. For more information, call (800) 228-0477.
Basic Dental Implants MIDI series implants bridge the gap between mini and conventional implants. Two 1-piece configurations are available: o-ring attachment for denture stabilization and angled abutment for nonremovable prosthodontics. With lengths of 11, 13, and 15 mm and diameters of 3, 3.8, and 4.3 mm, these implants economically accommodate most cases where strength and bone volume are a concern. For more information, call (888) 888-1468.	Implant Direct This broad line of narrow-diameter implants combines the prosthetic versatility of 2-piece implants with the simplicity of application-specific, one-piece implants. Each 3-mm implant is approved by the FDA for permanent clinical use because of its surface area and strength. They are self-tapping for ease of insertion and have mini-threads to minimize bone loss. All-in-one packaging includes abutments, transfers, and, where required, healing collars and cover screws. For more information, call (888) 649-6425 or visit the Web site implantdirect.com.
Bicon The Bicon system has had 3.5-mm implants since 1985. These narrow implants facilitate the restoration of missing maxillary lateral incisors as well as individual mandibular incisors. The sloping shoulder of the implant enhances crestal bone preservation while providing space for the interdental papillae—offering the opportunity for natural-looking gingival aesthetics. For more information, call (800) 88-BICON or visit bicon.com.	Euro Dental Implant EDI brings to North America a superior implant system that has been in proven use for more than 15 years in Europe. The 5 implant lines are simple, compatible, and more predictable at an affordable price. The full range of prosthetic options will save your practice time, effort, and money. Join EDI's profession-leading opinion leaders at a hands-on educational course. For more information, call (877) 321-2424, visit the Web site edimplant.com, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
Dentatus ANEW Implants fit where no others can. They are the only implants with nonhygroscopic, screw-retained restorations for limiting spaces, converging roots, and narrow ridges. They are ideally used for congenitally missing laterals, replacement of lost mandibular incisors, provisionalization during grafting procedures, and to maintain soft-tissue architecture. They are proven in clinical and university settings and are available in 1.8-, 2.2-, and 2.4-mm diameters with thread lengths of 7, 10, and 14 mm.	Atlas Implants are designed for the stabilization, cushioning, and passive retention of partials and complete dentures. With the Tuf-Link silicone reline, dentures are retained without housings, o-rings, or adhesives. Atlas Implants are available in 1.8-, 2.2-, and 2.4-mm diameters with thread lengths of 7, 10, and 14 mm and are FDA indicated for long-term use and for any length of time as decided by the healthcare provider. For more information, call (800) 323-3136 or visit dentatus.com.
Mega'Gen The Intermezzo is a 1-piece implant system with a super RBM surface that has a bendable neck design. Sizes include 1.6, 2, 2.5, and 3.1 mm in various lengths. It minimizes the drilling sequence with one-step insertion. After drilling, according to bone type, fixation can be provided by either a handpiece connector or hand driver. Intermezzo implants can be used in extraction sockets and immediate placement. With a bending neck up to 15°, it provides favorable results in the anterior mandible and maxillary lateral incisors and their restoration. For more information, call (866) 277-5662.	DENTSPLY Tulsa Dental Specialties The internally hexed XiVE D 3.0 allows clinicians to easily and predictably treat maxillary lateral incisor or man-dibular central and lateral in-cisor cases that, due to narrow surgical and restorative spaces, couldn't be treated in the past. And, with prosthetic options like Gingiva Former, Transfer Coping, EstheticBase, Auro-Base, and Telescopic abutments, you can provide your patients with highly aesthetic restorations. For more information, call (800) 662-1202 or visit tulsadentalspecialties.com.
KAT Implants The KAT (Key Assisted Transfer) Implants system is built around a single, low-profile, external locking taper connection platform that allows for use of the same abutments on implants ranging in diameter from 2.5 to 5 mm and in length from 6 to 14 mm. The use of the abutment incorporated key and Pick-Up Abutment impression method allow for an ex-tremely accurate implant level indexing. For more information, call (603) 427-0084 or visit katimplants.com.