I had a hard time figuring out how to start this case blog. Its an interesting story. A patient of mine, who was one of the first multiple crowns over the top of mini implants that I did, referred to me a friend of his. 
The patient of mine was a boxer and was missing teeth on each opposing side.
I knew I was in for a challenge, but to my surprise the case turned out well. Lots of help from Jon at First Impression Dental Lab and getting his bite as correct as possible made the difference in this case. I do not envy anyone who has to get someones bite established that has no frame of reference and has teeth on the opposite sides!
Although we did not do as many crowns and mini implants as planned, the case worked out well for the patient. Most important to him is that he no longer has to wear partial dentures. 
The case has been in function over just over a year (9-25-09) and hopefully I can track the case for several years. One year post op pan is shown. I told him if he did not return for the follow up exams every year…I would find him and knock out the rest of his teeth! Somehow I don't think I would win that boxing match, but he seems like a nice enough guy and will return without threat of bodily harm.
The Main Event
Now to the real case. Our new patient, intrigued with implants to replace his missing back upper teeth, saw a prominent and well qualified dentist in his home town of Asheville NC.
A CT scan (3D – xray) was taken and a very impressive treatment plan was created for our patient. Bi lateral sinus lifts, bone grafting, PRP(Platelet Rich Plasma), implants, custom zirconium abutments, and zirconium crowns. The treatment plan could not have been any better. The one thing that stopped this case dead in its tracks was that it was not affordable to the patient. As I tell my patients there is only one treatment plan in the end that is right….its the one the patient understands the pros and cons of and can afford. Apparently he noticed my boxer buddy's new teeth and they got to talking about mini implants…one thing led to another and he ended up coming to my office for a alternative treatment plan.
Why minis? Both mini implants and conventional implants are constructed from medical grade titanium alloy. Mini implants have been researched and used widely now for over 10 years all over the world. Conventional dental implants now have more than 30 years of data, and many dentists will only use these larger implants. I believe that now is the time for a paradigm shift as I have been working with this alternative. I have no quarrel with others who are uncomfortable with mini implants, but I am ready for a change in thinking and treatment planning for patients that otherwise could not have implant supported teeth.
After studying his CT scan I told Tim that I though he had enough bone on the palatal slope of his upper jaw to place mini implants and skirt around the sinus pneumatization (dropping down of the sinus balloon to where the bone used to be).
The mini implants could support a set of fixed crowns. Tim was not ready to get rid of the existing bridgework he had on his remaining upper teeth just yet. We did discuss that when that time comes we ccould extract the remaining upper teeth, place additional mini implants and fabricate a full arch bridge. This wwould also give us the benefit of cross arch stabilization. Another challenge to the case was the hyper eruption of the last molar on the lower right side. The space between the arches had gotten so small I cautioned Tim that we may not be able to get porcelain on the top of the last tooth.
The mini implants were placed, impression made and on this case I tried a modified ridge lap design where there will be a 1mm space from the lingual so Tim can use a electric toothbrush to keep the implants clean. I know that most dentists who place crowns over mini implants like having the ridge lap design tight to the tissue on both the cheek side as well as the roof of the mouth or tongue side. I think with having a 1mm space I know the implants can be kept clean. 
Minis in place
1mm gap being show from lingual 
Occlusion being established…the bridge will be sent back to the lab to final polish the metal.
Pan x-ray with crowns in place. I will have the patient come back in 1 month, 3 months and then 1 year to see how the soft tissue reacts to the 1mm space and how he is keeping thing clean. The post will get updated with new pictures at those times.
Paresh B Patel DDS Mini Dental Implant Dentist
General Dentist Mooresville NC
