Immediate Small-Diameter Implants as Abutments for an Overdenture in the Edentulous Atrophic Mandible: Report of Immersion Endoscopic Bone in vivo, and Histologic Bone-Implant Evaluation After 6 Months of Function
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2019
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The aim of this report was to endoscopically evaluate bone quality in vivo in the immediate installation of temporary
small-diameter implants, and again after 6 months of function, through an attachments system for overdenture, in the atrophic mandible
of a patient. We also histologically evaluated bone-implant interaction in these temporary small-diameter implants, once the success of
the osseointegration of the submerged implants was guaranteed. A patient received a total of 6 implants in the atrophic mandible, two of
which were immediately loaded with a provisional prosthesis, and four were left to heal in a submerged way. Further, an immersion
endoscopic evaluation was performed during bone drilling, and this showed a compact bone structure with limited vascularization and
predominantly cortical structure.This immediate loading protocol involving an overdenture retained by two small-diameter implants of
2.9 mm in the atrophic mandible proved to be successful after 6 months of loading. Clinical and histologic osseointegration was consistently
achieved for both of the retrieved immediately loaded implants. This modality allows the patient to be restored with a stable, functional,
and aesthetic prosthesis during the osseointegration period of submerged implants and soft-tissue healing, before the removal of the
provisional implants. The histological evaluation of bone-implant contact found that the space between the implant threads closer to the
surface was filled with woven bone and lamellar bone, but the tissue in contact with the cervical portion of the implants was compatible
with cortical bone organization. Also, the newly formed bone has a regular cell distribution and characteristics of advanced maturation
after 6 months of function in the atrophic mandible. Anchored overdentures in 2 to 4 small-diameter implants (2.9 mm) for edentulous
patients with severe atrophy of the mandible with cortical bone would be a minimally invasive alternative.