Chapter 1 Sendax Hybrid Mini Dental Implant Applications
Combining Natural Tooth Abutments with Conventional and Mini Dental Implants
1. Ultra-small diameter MDIs will slip into minimal-width islands and columns of bone, allowing MDI insertions to proceed even in sites where standard-width conventional implants might be considered too bulky and consequently contraindicated as too risky without major grafting.
2. Minimally invasive starter drill openings through bony cortices and into medullary bone, for only one third to one half of the implant length, means that direct drill encroachment should never occur on any vulnerable adjacent tissues, including mandibular neurovascular canal, mental foramen, inferior border of mandible, adjacent tooth roots, lingual, labial, and buccal cortical bone plates, floor of maxillary sinus, floor of nasal cavity, and posterior wall of maxillary tuberosity.
3. Auto-advancement of the MDI, driven slowly into medullary bone with finger and thumb wrench rotations and compressive pressure until biting into denser bone apically, helps stabilize the MDI but does not require overt penetration of any cortical wall. Additional gradual force can be marshaled by using a ratchet wrench or an adjustable torque wrench (in Newton-centimeters) to improve the mechanical advantage but not to apply excessive force that might snap the implant or fracture very dense Type 1 basal cortical bone typically found in the mandibular symphysis region.
4. MDI crestal emergence profiles through small islands of keratinized gingival soft tissues attached to crestal bone significantly improve the prognosis for the periimplant environment of the MDIs and, by extension, enhance the predictability of the entire hybridized prosthesis.
7. MDI affordability can play a significant role in patient acceptance of a restorative treatment plan wherein the need for additional implant abutments to render an improved case predictability may tip the balance into a rejection of an entire important rehabilitative program. The MDI can supplement conventional implants in select cases that can be made more readily cost-effective in such a hybrid combination.
The following images (Figures 1-1 to 1-23 and Box 1-1), starting with the first hybrid MDI case, are sequentially designed to impart an orderly instructional basis for implementing hybrid MDI applications and gradually reinforce the learning curve on a pathway to more advanced MDI combinations.