A 3-Year Follow-up Study of Overdentures

Retained by MiniDental Implants

Elena Preoteasa, DMD, PhD1/Marina Imre, DMD, PhD2/Cristina Teodora Preoteasa, DMD3
Purpose: This study evaluated overdentures retained by minidental implants (MDIs) as a treatment option
for complete edentulism during a 3-year follow-up period. Materials and Methods: This observational
clinical study included completely edentulous patients who were treated with MDI-retained overdentures.
The MDIs were supplied by the manufacturer. Results: Twenty-three patients received 7 maxillary and 16
mandibular MDI overdentures retained by 110 MDIs. Of the 36 MDIs placed in the maxilla, 8 failed (in two
patients), 2 had compromised survival, 3 displayed satisfactory survival, and 23 were successful. Of the 74
MDIs placed in the mandible, 11 displayed satisfactory survival and 63 were successful. The marginal bone
loss was more pronounced for the MDIs placed mesially (intercalated), in areas of decreased ridge width
and bone density, and with lower values of insertion torque. The overdentures fractured in seven patients; in
4 of them, this corresponded to the implant housing area. Self-reported reasons for patient dissatisfaction
included occasional pain under the overdenture (n = 5) and instability of the maxillary antagonist complete
denture (n = 4). Conclusion: Based on this research, considering its limitations, it is possible to conclude
that survival rates and health status are better for MDI overdentures applied in the mandible than for
those applied in the maxilla. The most severe prosthetic complications encountered were overdenture base
fracture, matrix detachment, and instability of the maxillary antagonist denture. INT J ORAL MAXILLOFAC IMPLANTS
2014;29:11701176. doi: 10.11607/jomi.3222
Key words: denture, edentulous, minidental implants, overdenture

he minidental implant (MDI) overdenture is a relatively recent treatment option for complete edentulism and is indicated especially for patients who
are dissatisfied with their conventional dentures. The
MDIs provide only overdenture retention, not support, as there is an occlusal space between the implant abutment attachment and the overdenture. MDI
overdentures have several benefits compared to other
treatment alternatives. In contrast to the conventional
complete denture, this type of overdenture requires an

1Professor,

Department of Prosthodontics, Faculty of Dental

Medicine, Carol Davila University of Medicine and Pharmacy,
Bucharest, Romania.
2Lecturer, Department of Prosthodontics, Faculty of Dental
Medicine, Carol Davila University of Medicine and Pharmacy,
Bucharest, Romania.
3 PhD Student and Assistant Professor, Department of
Scientific Research Methodology, Faculty of Dental Medicine,
Carol Davila University of Medicine and Pharmacy,
Bucharest, Romania.
Correspondence to: Elena Preoteasa, Department of
Prosthodontics, Faculty of Dental Medicine, Carol Davila
University of Medicine and Pharmacy, Str. Ionel Perlea nr. 12,
sector 1, 010208 Bucharest, Romania.
Email: dr_elena_preoteasa@yahoo.com

additionally relatively simple, minimally invasive surgical intervention, but the attachment system and immediate loading of the MDIs ensure increased retention,
stability, and function, with improvements in patient
satisfaction, comfort, and quality of life.13 Standarddiameter implant-supported prosthetic alternatives
have shown success, but these are not viable solutions
for all edentulous patients. The MDI overdenture may
be a more appropriate treatment alternative for the
edentulous patient with compromised health and/or
a restricted buccolingual dimension of bone. In these
cases, MDI placement requires fewer and less invasive
surgical interventions (eg, avoidance of bone grafting
procedures and decreased clinical time required for
implant placement, especially when a minimally invasive flapless technique is used), promoting a lower
risk of developing complications and shortening the
healing period.4,5 Given the demographic changes in
the population, especially the aging trend, there is an
increasing need for relevant treatment for the medical problems of older patients, complete edentulism
being one of them. The MDI overdenture is one viable
treatment alternative for this condition, which seems
appropriate to this segment of the population, but
scientific evidence regarding clinical outcomes of the
MDI overdenture is relatively limited.6 Therefore, more

2014 by Quintessence Publishing Co Inc.

1170 Volume 29, Number 5, 2014

2014 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Preoteasa et al

information is needed to assess the viability and safety

of this treatment concept.
The purpose of this study was to evaluate the MDI
overdenture as a treatment option for complete edentulism. Treatment outcomes were considered in three
dimensions: MDI status, overdenture status, and patient perception and satisfaction. Data were collected
after a 3-year follow-up period.

MATERIALS AND METHODS

An observational clinical study was conducted and
implemented. Patients with complete edentulism who
requested treatment at the Department of Prosthodontics, Faculty of Dental Medicine, Carol Davila
University of Medicine and Pharmacy, Bucharest, between April and November 2008 were enrolled in the
study. A convenience sample was formed according
to the following eligibility criteria. Completely edentulous patients with conventional complete dentures
who were dissatisfied with this treatment alternative,
or who were untreated but expressed fear and reticence toward conventional dentures, were included.
Excluded were those with severe systemic conditions
(eg, uncontrolled hypertension, diabetes mellitus)
or receiving particular medications (eg, bisphosphonates) because of the risk associated with the surgical procedure of MDI placement and the potential for
these conditions and medications to contribute to a
poor prognosis. The patients were given information
regarding the MDI overdenture, and all chose this
treatment alternative and participation in the study on
a voluntary basis. From each patient, written informed
consent was obtained.
Because the role of the MDIs is to improve retention of a prosthetic device, the overdenture design
aimed to ensure proper support, retention, and stability. In this respect, complete coverage of the support area, including the anatomical and functional
borders, with a complete peripheral seal was chosen.
For maxillary dentures, complete palatal coverage
with a postpalatal seal was used. Registration of the
maxillomandibular relationship aimed to ensure a
correct functional vertical dimension of occlusion in
centric relation. Premature contacts were checked and
eliminated to accomplish the coincidence of centric
relation and centric occlusion and obtain bilateral simultaneous stable occlusal contacts in centric occlusion. Principles of lingualized denture occlusion were
used; ie, the maxillary lingual cusps articulated with
the central fossae of the mandibular occlusal surfaces
in centric working and nonworking mandibular positions. Some of the patients presented with previously
made complete dentures; their quality was analyzed

and the clinician decided either to keep or replace

them. Aspects related to coverage of the support area,
denture retention and stability, correct registration of
maxillomandibular relationships, type of denture occlusion, the correctness of the arrangement of artificial
teeth, material status, and patient perception regarding the denture were evaluated and considered as factors in this decision.
The MDIs used were supplied by IMTEC/3M ESPE.
These were available in four lengths (10 mm, 13 mm,
15 mm, and 18 mm) and three diameters (1.8 mm, 2.1
mm, and 2.4 mm) and used collared balls as attachments. The number of MDIs placed and their locations
and dimensions were chosen based on the individual
features of the patient and the judgment of the dentist
but considered as closely as possible the manufacturers recommendations for this type of implant regarding the minimum number of MDIs that should be
placed (four MDIs in the mandible and six MDIs in the
maxilla). The MDI overdenture was chosen as a treatment option for mandibular or maxillary complete
edentulism. This treatment alternative was indicated
for maxillary edentulism when teeth or fixed prosthetic restorations were present in the anterior mandible
or when patients had a skeletal Class III relationship
with a reverse relation of the edentulous arches.
To ensure a good prognosis, several instructions
were given to the patients. Amoxicillin with clavulanic
acid (Augmentin, SmithKline Beecham) were administered to patients for 5 days, starting 2 hours prior to
implant placement. After the surgical intervention,
patients were informed that they would probably
feel some discomfort and pain that would disappear
in a few days; analgesic drugs were recommended if
necessary. Also, they were advised to eat soft foods
of moderate temperature. The importance of adequate hygiene procedures was highlighted. Patients
were taught how to adequately clean the MDIs and
the overdenture. Additionally, they were advised to
use chlorhexidine products to prevent bacterial and
fungal infections. Chlorhexidine digluconate 0.2%
solution was recommended (twice daily oral rinses)
before surgical implant placement and afterward. For
overdenture cleaning, in addition to traditional mechanical cleaning, chemical cleaners (tablets) were recommended. Also, patients with bruxism or xerostomia
were advised not to wear the overdenture overnight at
least two times per week.
The main outcome of this study was the success
of the MDI overdenture as a treatment option for the
completely edentulous patient. The analysis covered
MDI status, overdenture status, and patients perceptions regarding this treatment alternative. The study
variables, which addressed patient features and treatment specifics, are listed in Table 1.7 Additionally, a
The International Journal of Oral & Maxillofacial Implants 1171

2014 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Preoteasa et al

Table 1

Study Variables

Table 2

Health Status of MDIs Placed

Location

Patients general attributes (age, sex)

Data regarding oral and treatment-related features:
Bone information: bone height,* ridge width, bone density
according to Misch classification7*
Treatment variables: Number and locations of MDIs,
length and diameter of MDIs, implant insertion torque

MDI health status

MDI status:
Implant health, assessed using the previously described
scale
Peri-implant marginal bone loss: registered as the
maximum number of threads devoid of bone on the mesial
and distal implant sides
Implant mobility
Self-reported peri-implant bleeding: spontaneous or during
brushing
Radiolucency at the apical part of the implant

Success

Overdenture status:
Presence of any technical complication that required
repair or maintenance: matrix detachment, overdenture
fracture or relining
Patient perceptions regarding MDI overdenture:
Self-reported reasons for satisfaction/dissatisfaction with
this treatment
Frequency of overdenture wearing
Ease of use of MDI overdenture: overdenture placement
(insertion), removal, and cleaning
*A ssessed

with computed tomography; assessed with a clinical

bone compass; assessed with panoramic radiography;
assessed by clinical evaluation.

health scale for the MDI, derived from that proposed

by the International Congress of Oral Implantology in
Pisa, Italy, at the 2007 Consensus Conference8 and taking into consideration the Albrektsson et al criteria for
implant success,9 was used as follows:
Failure: MDIs that were lost or removed for any reason, MDIs that fractured or presented with mobility,
marginal bone loss exceeding half of the implant
body length, or pain during function
Compromised survival: MDIs still present in the
mouth, without an indication to be removed, but
with either minimal clinical mobility, severe marginal bone loss (less than half of the implant body
length), or sensitivity during function
Satisfactory survival: MDIs displaying no clinical
mobility or sensitivity during function, with moderate bone loss (more than two threads, but less than
half of the implant body length)
Success: MDIs without clinical mobility or sensitivity
during function and marginal bone loss of less than
two threads
Data collection was conducted before and during surgical placement of the MDIs and after surgery;
follow-up appointments were attended weekly during

Maxilla

Mandible

Failed

Compromised survival

Satisfactory survival

11

23

63

the first month postsurgery, at 3 and 6 months, and at

1, 2, and 3 years postsurgery. Clinical and radiographic (panoramic radiography, computed tomography)
methods, together with data obtained through discussions with the patient during recall visits, were used for
evaluations. Panoramic radiographs were indicated at
6 months, 1 year, 2 years, and 3 years.
Statistical analysis was performed with the Statistical Package for the Social Sciences (version 13.0, SPSS
Inc). In addition to descriptive statistics, the chi-square
and Mann-Whitney tests were used for comparison between groups.

RESULTS
Sample Characteristics

Of the 24 completely edentulous patients initially enrolled, 1 was lost during follow-up. Of the remaining 23
patients, 10 were men and 13 were women; the mean
age was 62 years (range, 52 to 76 years). The subjects
were treated with 7 maxillary and 16 mandibular MDI
overdentures. A total of 110 MDIs were placed (36 in
the maxilla and 74 in the mandible). Five or six MDIs
were placed in the maxilla and four to six MDIs were
placed in the mandible.

MDI Status

Of the 110 MDIs placed, 8 failed, for a survival rate

of 92.7%. All MDIs that failed had been placed in the
maxilla. Also, all eight failed MDIs had been placed in
two female patients and failed within 1 to 2 years after their insertion. In one patient, all five MDIs that had
been placed failed, two as a result of MDI fracture. In
the other patient, three of five MDIs placed were lost as
a result of progressive marginal bone loss. The health
status of the MDIs, according to the scale presented,
can be summarized as follows: in addition to the 8
failed MDIs, 2 had compromised survival, 14 showed
satisfactory survival, and 86 were considered successful. Differences in the health status of maxillary and
mandibular MDIs are summarized in Table 2.
The other complications that occurred within
the 102 MDIs still present at the 3-year follow-up

1172 Volume 29, Number 5, 2014

2014 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Preoteasa et al

examination are listed in Table 3. Almost half of the

MDIs registered marginal bone loss > 1 thread and
peri-implant bleeding, which appeared most frequently during brushing. Some of the complications had a
different distribution depending on location (eg, spontaneous peri-implant bleeding was reported only for
MDIs placed in the mandible).
Marginal bone loss was more severe in women, in
patients with a decreased ridge width, in sites with
decreased bone density, around implants with lower
insertion torque values, and in MDIs placed toward the
midline (mesial/intercalated). MDIs with marginal bone
loss of more than one implant thread more frequently
presented with radiolucent lesions at the apical part of
the implant and were more frequently associated with
spontaneous peri-implant bleeding (Table 4).

Overdenture Status

During the 3-year follow-up period, overdenture fractures occurred in seven patients. In the mandible, overdenture fracture sites corresponded more frequently to
the implant housing area (n = 4), but fractures also occurred in regions between implants (n = 2). In the maxilla, only one overdenture fractured in the area between
implants. Overdenture relining was done in five cases.
Two of these were the patients with implant failures.
During the 3-year period, detachment of the corresponding matrices from the overdenture base occurred in eight MDIs; clinical prosthetic procedures
were required to rectify these problems. Five of these
matrices corresponded to mesial MDIs and three to
distal MDIs.

Patient Perceptions and Satisfaction

With respect to patients perceptions of MDI overdenture treatment during the 3-year follow-up period, they
were generally satisfied with the esthetics, retention,
and functionality (mastication, phonation). Patients
complaints were related mainly to occasional pain that
was described as appearing under the overdentures or
related to soft tissue trauma (n = 5). Some patients perceived instability of the maxillary antagonist denture
(n = 4 patients with mandibular MDI overdentures),
which was related to difficulties during mastication.
Treatment satisfaction was linked to the frequency of
overdenture wearing. Twenty patients declared that
they wore the overdenture continuously, whereas only
three stated that they did not wear it while sleeping.
However, the latter patients were not the patients advised to avoid wearing the overdenture during sleep
(ie, those with bruxism or xerostomia). The specific
recommendation regarding nighttime wearing of the
overdentures was generally not followed, with the patients admitting that they followed this advice only for
a short time.

Table 3

Complications of MDIs Placed

Total
(n = 102)

Maxillary
(n = 28)

Mandibular
(n = 74)

Marginal bone loss

12 threads
23 threads
> 3 threads
Total

29
11
5
45

6
4
1
11

23
7
4
34

Apical radiolucency

22

16

36
12
48

13
0
13

23
12
35

Complication

Mobility
Bleeding
During brushing
Spontaneous
Total

Table 4

Relationships between Patientand Implant-Related Factors and

Peri-implant Marginal Bone Loss
Peri-implant marginal
bone loss

Characteristic

< 1 implant > 1 implant

thread
thread
Significance

Patient sex
Female
Male

23 MDIs
34 MDIs

33 MDIs
12 MDIs

Mean patient age (y)

62.04

60.27

NS

Mean bone height (mm)

17.23

18.44

NS

Mean ridge width (mm)

6.23

5.64

Bone density 7
D2
D3
D4

28 MDIs
20 MDIs
9 MDIs

9 MDIs
28 MDIs
8 MDIs

Implant length
10 mm
13 mm

11 MDIs
46 MDIs

15 MDIs
30 MDIs

Implant diameter
1.8 mm
2.10 mm
2.40 mm

0 MDIs
26 MDIs
31 MDIs

3 MDIs
14 MDIs
28 MDIs

32.11

27.67

Implant location
Mesial (intercalated)
Distal

26 MDIs
31 MDIs

33 MDIs
12 MDIs

Apical radiolucency
Absent
Present

52 MDIs
5 MDIs

28 MDIs
17 MDIs

33 MDIs
22 MDIs

21 MDIs
14 MDIs

2 MDIs

10 MDIs

Mean implant torque

(Ncm)

Peri-implant bleeding
Absent
Present during
brushing
Present
spontaneously

P = .001*

P = .013
P = .007*

NS*

P = .003
P = .005*

P < .001*

P = .014*

*Chi-square

test; Mann-Whitney test. NS = not statistically

significant; = assumptions not met to apply the
corresponding statistical test.

The International Journal of Oral & Maxillofacial Implants 1173

2014 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Preoteasa et al

Regarding the ease of use of MDI overdentures,

most patients perceived overdenture insertion as
quite easy. Only six patients reported difficulties with
this procedure. Regarding overdenture removal, most
patients (n = 16) said they perceived it as problematic.
Thus, in general, overdenture removal was perceived
as being more difficult than overdenture insertion.
All patients declared that they perceived cleaning
of the overdenture as easy. All of them stated that they
cleaned the prosthetic device daily, and some patients
(n = 6) reported cleaning their overdenture twice a day.

DISCUSSION
Nowadays the MDI overdenture is more frequently
seen as an optimal treatment option for completely
edentulous patients, as it is extremely well suited to
this population of often elderly persons. These persons may have multiple general diseases that limit
the ability to undergo complex surgical interventions,
they may be less willing to undergo extensive medical procedures, and they may have limited financial
resources. A major advantage of the MDI overdenture
is related to the possibility of immediate loading of the
MDIs, which gives maximum satisfaction to the patient
because function is rapidly regained (ability to chew,
speak, and interact socially).
Regarding the MDIs that are used to stabilize the
dentures, this study presented a survival rate of 92.7%
within a 3-year follow-up period. The published evidence comprises data similar to this, generally presenting MDI survival rates above 90%.5 Elsyad et al
indicated a survival rate of 96% for MDIs placed in the
mandible after a 3-year follow-up period,10 and Griffitts
et al obtained a survival rate of 97.4% for MDIs placed
in the mandible after 13 months.11 In the current study,
MDIs placed in the maxilla presented a lower survival
rate than those placed in the mandible. These results
are concordant with other studies reported in the scientific literature, such as that conducted by Shatkin et
al, who achieved survival rates of 95.1% for mandibular
MDIs and 83.2% for maxillary MDIs within a 2.9-year
follow-up period.12 They also reported that the MDI
survival rate depended on implant location: posterior
maxillary MDIs had a greater chance of being lost than
those placed in the anterior maxilla (posterior 88.9%,
anterior 93.3%), whereas similar survival rates were
seen for anterior and posterior MDIs placed in the mandible (posterior 96.5%, anterior 96%). This differing behavior of MDIs placed in the maxilla and mandible is
likely a consequence of differences in bone features
(eg, bone density). This behavior of MDIs may be similar to that observed with conventional dental implants,
which also have a higher failure rate in the maxilla.13

In the current study, MDI failures occurred only in

the maxilla in two female patients. One of these lost
all five MDIs placed. She had reduced bone density
(D3 and D4 Misch classification) and hypodivergent
facial pattern and had become edentulous only recently (the remaining teeth were the maxillary right
canine and premolars). After overdenture placement,
the patient complained about phonation deficiencies
and perceived some muscular tension and discomfort. Adjustments were made to the overdentures and
a gradual improvement was noticed that led to a satisfying outcome after 3 weeks. Positive results were
experienced for approximately 1 year. Three months
after the 1-year appointment, the patient came to the
dentist citing some discomfort related to overdenture wearing; denture stomatitis was noted at that
time. Treatment was recommended for this condition,
but the patient did not attend follow-up medical appointments. Five months later, she came to the office
claiming that all her MDIs had been progressively lost.
Radiographic exams showed that two of the MDIs had
fractured. The patient stated that she desired only
some overdenture adjustments because she was suspected to have other medical problems (osteoporosis
and hepatic neoplasm). During this visit, the denture
was relined, and an appointment was made to remove
the remaining fractured implants, but the patient
missed this appointment. The other patient lost three
of her five MDIs. She was a highly stressed person
with an unbalanced, mainly vegan, diet that included
many hard foods. In her case, MDI failure was probably related to a slightly increased vertical dimension
of occlusion, which had been chosen because of the
decreased available vertical prosthetic space. When
the problems began to be noticed, adjustments were
made; nevertheless, three implants were lost. After
this, two new MDIs were placed, and a positive status
of the two surviving MDIs at the 3-year follow-up was
noted.
During this study, two MDIs failed because of fractures, both in the apical part of the implant. The authors note that this behavior is similar to that of teeth
and different from that of conventional implants. Conventional dental implants typically present problems
at the connection between the abutment and endosseous implant, most often loosening of the abutment
screw or fracture of the implant in this location. Shatkin
et al also identified MDI fracture as a complication of
MDI overdentures, but they reported that it occurred
infrequently (0.8%) during MDI placement.12 Regarding implant fractures, some aspects need to be clarified. Endosseous dental implants seem to fracture less
frequently when supporting overdentures, compared
to fixed prosthetic devices, as supported by some
clinical evidence.14 In contrast, however, according

1174 Volume 29, Number 5, 2014

2014 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Preoteasa et al

to Snchez-Prez et al15 and Allum et al,16 narrow implants (defined, respectively, as narrower than 4 mm
and 3 mm) have an increased risk of fracture. Taking
these aspects together, studies should be implemented to identify the frequency and types of implant fractures associated with MDI overdentures.
Peri-implant marginal bone loss and matrix detachment were more frequent for the implants located
toward the midline (intercalated), probably indicating that mesially placed implants may be subjected to
higher loads than distal implants. The higher strain on
mesial MDIs may be explained by their increased role
in indirect retention in counteracting tipping forces
and overdenture dislodgment during mastication.
Also, the presence of MDIs may induce movements
of the occlusal and masticatory field anteriorly, which
could explain, in the case of mandibular MDI overdentures, the relatively quick appearance of instability of
the antagonistic maxillary complete denture.
The results of this study indicate that marginal bone
loss around MDIs is not influenced by the implant diameter, a finding supported by other studies.17 When
a patients general health status may prevent complex surgical interventions, small-diameter implants
may be considered as the best options for mandibular
edentulous patients, who often present a decreased
ridge width. However, the authors emphasize that the
current results indicate that a decreased ridge width
appears to have a tendency to a more pronounced
peri-implant marginal bone loss. Also, according to
the current results, although self-reported spontaneous peri-implant bleeding was noted rarely, when
present it may indicate more severe MDI marginal
bone loss.
Several overdenture deficiencies were noted during the 3-year follow-up period. Overdenture fractures were found with a moderate frequency (seven
overdentures fractured) and can be explained by the
increased security in chewing brought about by the
overdentures increased balance and retention, which
favored an increase in muscular activity. The most
common location for overdenture base fractures was
in the housing area; this is probably related to the
relatively thin overdenture base in that region. Overdenture relining is a complication that has been identified in several studies concerning the topic of MDI or
conventional implant overdentures and conventional
dentures.18,19
Patients were generally satisfied with their MDI
overdentures. This might be related to the sample
characteristics and study inclusion criteria, ie, volunteers who were dissatisfied with their complete dentures or who expressed fear and reticence regarding
conventional dentures, with limited financial means,

who were offered access to this treatment option at a

lower cost. Even so, their positive perceptions about
this treatment alternative remained constant over
time, probably related to the increased retention and
comfort associated with the prosthetic device.
The main limitation of this study is its relative small
sample, but it provides data to help dentists to understand the behavior of MDI overdentures and offers hypotheses that might be tested in larger, randomized
controlled clinical trials.

CONCLUSIONS
Based on this research and taking its limitations into
consideration, the following conclusions regarding
minidental implant (MDI) overdenture treatment can
be drawn.
Survival rates and health status were better for MDIs
placed in the mandible than for those placed in the
maxilla, indicating that the MDI overdenture may
be a more suitable treatment option for mandibular
complete edentulism.
Overdenture fracture is a relatively frequent complication that occurred most often in the mandible in
sites corresponding to implant housing areas. Consequently, it may be recommended that dentists
ensure proper thickness of the overdenture base or
reinforce it to prevent this.
In completely edentulous patients, applying an MDI
overdenture in the mandible may have a negative
impact on the stability of a conventional maxillary
denture, and it may be necessary to manage this
side effect (eg, to apply a maxillary MDI overdenture) to ensure patient satisfaction.
The MDI overdenture, like any other medical treatment, has potential complications. In general, these
can be addressed through interventions that have
acceptable moderate biologic, financial, and clinical
costs (eg, prosthetic interventions such as adjustment
or relining of the overdentures acrylic base, repairing
the fractured overdenture, replacement or change of
the matrices of the ball attachments, or insertion of a
new MDI in case of MDI failure).

ACKNOWLEDGMENTS
The authors thank IMTEC, currently part of 3M ESPE, for their
support of this research by providing some of the materials and
minidental implants. The authors reported no conflicts of interest related to this study.

The International Journal of Oral & Maxillofacial Implants 1175

2014 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.

Preoteasa et al

REFERENCES
1. Bulard RA, Vance JB. Multi-clinic evaluation using mini-dental implants for long-term denture stabilization: A preliminary biometric
evaluation. Compend Contin Educ Dent 2005;26:892897.
2. Thomason JM, Kelly SA, Bendkowski A, Ellis JS. Two implantretained overdenturesA review of the literature supporting the
McGill and York consensus statements. J Dent 2012;40:2234.
3. Preoteasa E, Melecanu-Imre M, Preoteasa CT, Marin M, Lerner H.
Aspects of oral morphology as decision factors in mini-implant supported overdenture. Rom J Morphol Embryol 2010;51:309314.
4. Christensen GJ. The increased use of small-diameter implants. J Am
Dent Assoc 2009;140:709712.
5. Sohrabi K, Mushantat A, Esfandiari S, Feine J. How successful are
small-diameter implants? A literature review. Clin Oral Implants Res
2012;23:515525.
6. Gallucci GO, Morton D, Weber HP. Loading protocols for dental
implants in edentulous patients. Int J Oral Maxillofac Implants
2009;24:132146.
7. Misch CE. Bone density: A key determinant for clinical success. In:
Misch CE. Dental Implant Prosthetics. St Louis: Mosby, 2005:130141.
8. Misch CE, Perel ML, Wang HL, et al. Implant success, survival, and
failure: The International Congress of Oral Implantologists (ICOI)
Pisa Consensus Conference. Implant Dent 2008;17:515.
9. Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term
efficacy of currently used dental implants: A review and proposed
criteria of success. Int J Oral Maxillofac Implants 1986;1:1125.
10. Elsyad MA, Gebreel AA, Fouad MM, Elshoukouki AH. The clinical
and radiographic outcome of immediately loaded mini implants
supporting a mandibular overdenture. A 3-year prospective study.
J Oral Rehabil 2011;38:827834.

11. Griffitts TM, Collins CP, Collins PC. Mini dental implants: An adjunct
for retention, stability, and comfort for the edentulous patient. Oral
Surg Oral Med Oral Pathol Oral Radiol Endod 2005;100:e8184.
12. Shatkin TE, Shatkin S, Oppenheimer BD, Oppenheimer AJ. Mini
dental implants for long-term fixed and removable prosthetics:
A retrospective analysis of 2514 implants placed over a five-year
period. Compend Contin Educ Dent 2007;28:9299.
13. Pikner SS, Grndahl K, Jemt T, Friberg B. Marginal bone loss at implants: A retrospective, long-term follow-up of turned Brnemark
System implants. Clin Implant Dent Relat Res 2009;11:1123.
14. Gargallo Albiol J, Satorres-Nieto M, Puyuelo Capablo JL, Snchez
Garcs MA, Pi Urgell J, Gay Escoda C. Endosseous dental implant
fractures: An analysis of 21 cases. Med Oral Patol Oral Cir Bucal
2008;13:e124128.
15. Snchez-Prez A, Moya-Villaescusa MJ, Jornet-Garcia A, Gomez S.
Etiology, risk factors and management of implant fractures. Med
Oral Patol Oral Cir Bucal 2010;15:e504508.
16. Allum SR, Tomlinson RA, Joshi R. The impact of loads on standard
diameter, small diameter and mini implants: A comparative laboratory study. Clin Oral Implants Res 2008;19:553559.
17. Pommer B, Frantal S, Willer J, Posch M, Watzek G, Tepper G. Impact
of dental implant length on early failure rates: A meta-analysis of
observational studies. J Clin Periodontol 2011;38:856863.
18. Bortolini S, Natali A, Franchi M, Coggiola A, Consolo U. Implantretained removable partial dentures: An 8-year retrospective study.
J Prosthodont 2011;20:168172.
19. MacEntee MI, Walton JN, Glick N. A clinical trial of patient satisfaction and prosthodontic needs with ball and bar attachments for
implant-retained complete overdentures: Three-year results.
J Prosthet Dent 2005;93:2837.

1176 Volume 29, Number 5, 2014

2014 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.