Small Diameter Implants by Richard Lipscomb Jr, DDS
Immediate loading doesn’t always mean permanent loading when it comes to small diameter implants (SDIs). Most dental implants, including SDIs, need a period of time to allow for bone integration, which stabilizes dental implants. Minimizing the occlusal forces being applied to SDIs for the first 3 to 4 months is critical to the implant’s success. There are several ways SDIs can be immediately loaded and still have the support of the surrounding hard and soft tissues. In cases where overdentures are retained by SDI, immediate loading with soft reline materials has its benefits.
The SDIs were placed, the inside of the denture was relieved, and soft reline material was used to buffer the occlusal forces around the implant while aiding in the retention of the overdenture. This technique allows the implants to integrate into a less stressful environment (Figure 1).
When SDIs are used in crown and bridge applications to retain crowns, controlling the occlusal forces is essential for the implants’ survival. In this case, an SDI is replacing tooth #7. The implant abutment is inserted with a silicone shim, while a cotton pellet is tucked into the top of the shim. This will allow for a temporary crown for tooth #7 to be fabricated without touching the abutment of the implant (Figure 2).
The provisional crown is fabricated over the shim and cotton pellet. Once the provisional crown is finished and polished, it’s bonded into place with flowable composite at the interproximal contacts (Figure 3).
The cross-sectional view of the provisional crown and its relationship to the shim and cotton pellet are noted. There is a small space between the top of the shim and the crown that was noted. The lateral forces are neutralized by the shim, the occlusal forces are reduced by the space above the shim, and the SDI is free of stress for the next 3 to 4 months.
Like traditionally sized implants, working with SDIs requires precision and stability, but doing it the right way can result in great, esthetic results for patients.7
7. Jackson BJ. Small-diameter implants: a 7-year retrospective study. J Oral Implantol. 2017;43(2):125-129. doi:10.1563/aaid-joi-D-16-00098