Is smaller better?

Mini implants can take much of the time, pain and cost out of replacing missing teeth. Stars such as England rugby international Matt Dawson have already benefited but some experts still have their doubts about the procedure.

For professional rugby players, losing the odd tooth is an occupational hazard. When England scrum half Matt Dawson had a front tooth smashed out in the World Cup final last November, replacing the incisor was a relatively simple procedure, which took just an hour in the dentist's chair.

There are around 14 million people in the UK with one or more missing teeth. Until recently, patients had a choice between dentures or costly and painful implants.

Dawson is one of the first patients in the UK to have benefited from a technique developed in America. A handful of dentists in this country are now offering mini implants, which they say are smaller, cheaper and easier to fit than previous versions.

When a traditional implant is fitted, the surgeon cuts through the gum and peels it away, exposing the bone. A hole about 3.5mm wide is then drilled to accommodate the implant. Once it is inserted, the gum is stitched back over it and left to heal for up to six months before the tooth can be attached.

For some patients, the procedure is even more complicated. If the bone is too thin to accommodate a standard implant, they may need a bone graft, during which a piece is transferred from another part of their mouth or sometimes from their hip. The bone is then left to "bed in" for another four months before the implant can be put in place.

Tariq Idris, a dental surgeon and consultant lecturer at the University of Manchester, says: "It's a common procedure and fairly unpleasant and can take a year to complete."

With the mini implant technique, developed by American dental surgeon Dr Victor Sendax, a puncture hole is made in the gum, which makes an opening in the surface of the bone. Then a titanium screw, around 2.5mm wide, is inserted into the opening and used as a root. The tooth fits over the top of it.

Dr Idris, who has clinics in Chester and London offering mini implants, says they're not for everyone but that they have some clear advantages: "The technique is appealing because it means the implant can be placed without the normal complex surgery. There's no need for an incision and consequently no stitches and much less discomfort. This differs from the traditional implant procedure, which can often result in pain, bruising and swelling.

"I have now placed more than 100 of these implants and they have been very successful. They need careful planning but offer some patients an appealing alternative to dentures."

Another advantage is the cost. Dr Idris says: "Mini implants take less time to insert, which is the major cost factor in any procedure. One tooth can cost up to £1,500 compared with £2,220 for a traditional implant. If someone needs a bone graft, they could end up paying another £1,500, so a single tooth could cost nearly £4,000."

However, Professor Mark Thomason, an expert in prosthodontics at the University of Newcastle, cautions that mini implants were designed as a temporary way of holding single dentures or small bridges in place. "Mini implants have a role but it's difficult to say how successful they will be in the long term because there isn't an enormous amount of data on the subject," he warns. "I'm sure they have their place but it's not something I could get desperately excited about because there are more predictable ways of solving the same problems."

He says that there may also be potential difficulties with the technique. "Mini implants can be placed without having to expose all the bone. The problem is that they can make the dentist's job a bit more difficult because you can't see what you're drilling into - in other words, you can be drilling blind," he says.

"If you lift the tissues out of the way, you can see the physical shape of the bone and you can see if there are any cavities, and orientation is easier."

Dr Idris agrees there is a need for more research. "I don't know if we can say that they will last as long as traditional implants because there isn't as much data [about them], but there are several studies going on at the moment which suggest that 97 per cent of implants have lasted more than four years," he says.

He argues that installing mini implants is reasonably simple: "We always take an X-ray beforehand to make sure that there are no cavities or infection beneath the gum. It's a bit like keyhole surgery and is fairly straightforward, although you need to make sure you know where the bone is before putting the implant in."

 

A success story

Abby Clarke had a mini implant to fill a gap in her front teeth last month. The 17 year old is studying for her A-levels and lives in Chipstead, Surrey.

"When my baby teeth fell out, all my adult teeth came through except one. I was left with a gap at the front, which made me feel self-conscious.

I had braces when I was younger in an attempt to close the gap but that didn't work so I had a bridge fitted. This didn't work either, as it was slightly darker than my normal teeth and didn't look real. It was also attached to the main front tooth and, over time, my gum became inflamed and uncomfortable.

After seeing some pictures of me taken at my sister's wedding, I decided the bridge looked awful and that it was time to do something about it. When I went to see Tariq, we discussed all the options and he suggested that a mini implant might be better than a normal one as it would mean he didn't have to drill down into the bone.

When I went to have the treatment done, I had a local anaesthetic and was sedated because I'm not that keen on dental treatment - I don't like the idea of pain.

Tariq inserted a little screw into the gum and the implant was fitted over the top. The whole procedure only took about an hour-and-a-half. I couldn't feel anything at the time and the next day it only ached a little.

I was really pleased with the results. The new tooth is a lot more realistic and it's the right colour. I think it looks a lot better and I feel a lot more confident when I smile now."

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