CASE STUDY NO. 2
A 50-year-old female presented with a missing tooth No. 12 that was
extracted for unknown reasons more than 10 years ago ( figure 7). The
patient was referred to our office for an implant consultation. Upon review
of a CT scan, it was revealed that at the widest area buccal-lingually there
was 4.09 mm and at the narrowest 3. 8 mm ( figure 8). She was presented
with two treatment options: bone grafting or a narrow-diameter implant.
She opted for the narrow-diameter implant, as it eased several of her
concerns: she was unhappy with a removable appliance, worried about
a block graft for a single tooth, and finances were a burden.
A 1. 8 mm x 14 mm Anew implant (Dentatus) was selected, and a
surgical guide was fabricated for a flapless approach. In this instance,
a healing cap was placed, and the existing flipper was relieved to address financial concerns (figures 9 and 10). A screw-retained crown
was fabricated three months post insertion ( figures 11 and 12). The
patient reported no postoperative discomfort, and the case remains
successful, as shown in the two-year postoperative x-ray ( figure 13).
1. The Oxford Dictionaries word of the
year 2013. Oxford Dictionaries
November 19, 2013. Accessed
September 1, 2017.
2. The top 50 European manufactures of
dental implants (2nd ed.). Published by
Research and Markets. 2013.
3. Dental implants facts and
figures. American Academy of
Implant Dentistry website. http://
May 31, 2017.
4. Christensen G, Child P. The truth
about small diameter implants.
Dentistry Today website. http://www.
diameter-implants. Published May 1,
2010. Accessed September 1, 2017.
5. Froum SJ, Shi Y, Fisselier F, Cho SC, et
al. Long-term retrospective
evaluation of success of narrow-diameter implants in esthetic areas: A
consecutive case series with 3 to 14
years follow-up. Int J Periodontics
Restorative Dent. 2017; 37( 5):629-637.
DMD, is a
graduate of the
School of Dental
general practice residency at North
Shore University Hospital, he continued
working as chief resident and
completed an implant and advanced
prosthetics fellowship. He maintains a
private practice in Manhattan, teaches
at Columbia University, and serves as a
volunteer on medical missions.
Narrow-diameter implants are an
asset to any implant armamen-
tarium. Patients should not be
condemned to life with a removable appliance. These cases are just
two small examples that highlight how we make the impossible a reality
for patients who were previously denied implant treatment.
Many patients think that implants are too expensive. Because fewer
procedures are required for narrow-diameter implants (e.g., no bone
augmentation and fewer follow-up appointments), the cost is almost always
significantly less expensive to the patient, while still preserving the fee for
time and overhead for the practice.
Even when patients do have the financing in place, they are still
cautious and looking for procedures that are significantly less time-consuming and forego surgical procedures. I use narrow-diameter
implants that are conducive to one-stage, flapless surgery because they
require one coring procedure. This allows us to maintain adequate
bone volume and spacing for esthetic results. The unique screw-retained
abutment reduces stress on the implant and provides for easy maintenance of provisional and long-term restorations. Perhaps the biggest
bonus of all is being able to provide a greater number of patients with
the same elevated, predictable level of care that was once denied them.
Narrow-diameter implants allow us to offer implant treatment to
many more patients. It’s time to consider new ways of having an old
discussion—let’s reframe the conversation about implants with patients
who previously declined or were denied implant treatment.
Figure 7: Pre-op panorex
Figure 8: Pre-op CT scan
Figure 9: Implant placement
Figure 10: Implant exposed for
Figure 11: Final restoration
Figure 12: Final crown seating