| When I first heard of Dr. Clifford’s mini implant bridges through a mutual friend I started exchanging ideas with him via email. I checked out his web site. I found him amiable, honest and willing to share. I traveled to Chico, Ca to see for myself what he was up to. He gave me a personal over the shoulder course carrying one case from start to finish – placing the implants through cementing the denture teeth to acrylic prosthesis. I met and talked to the technician doing his lab work. He graciously recalled several cases and removed the prostheses so I could examine the stability of the implants, the periodontal status and question the patients.
In every case the patients were thrilled with the result of their treatment. They were able to maintain the cleanliness of their mini implant bridges. There was no soft tissue irritation and the implants were solid. In one case where there was only 8 mm of bone beneath the sinus two implants had failed to integrate. Dr. Clifford replaced them with a wider daimeter mini and re-adapted the bridge in a few minutes time. We looked at I-cat scans of several patients both pre and post op and spent a lot of time discussing cases and what he had learned.
I have been placing mini’s since 2001 and it was a leap of faith at that time. My first case was a difficult upper on a retired truck driver with a lot of bone. He had lower natural teeth. Fortunately he didn’t brux or clench and the case was a success. It has been in successful function for eight and a half years.
In the first couple of years of placing I broke off several implants on mandibular insertion until the manufacturer added the collar. I had several failures on the maxilla in bruxers. I have since stopped doing maxillary overdenture cases except in selected cases. Of course the bad reports circulating about the failure of mini’s in the maxilla have scared a lot of dentists off. The lesson here is that I didn’t quit I just kept looking around for a way to do these cases successfully.
The first implant I placed was a ramus frame in 1978. It lasted for over 23 years until the patient passed away. I remember the days where there were only subperiosteals, blades and frames. There was a huge debate in the implant community when first hollow baskets and cylindrical implants were introduced. I have seen one controversy after another in the 30 years that I have been a general dentist placing implants.
If you look at what’s been done in Italy for many years it is a different story. Go to http://www.implamed.it/ and check out the bicortical screw cases (click on the British flag for English) and the Tramonte systems. Spend some time looking at the clinical cases. The Italians have also been doing intra-oral argon welding of titanium for years. This stuff is mind blowing. They have been doing full arch cases on screws for years with clinical success. The Italians don’t understand why American dentist are not immediately loading the majority of their cases. If the implant heads don’t line up they simply bend them to approximate parallelism.
A prosthesis that is fixed and designed to be hygienic and cleanable over implants does not need to adhere to the same standards as fixed over teeth. Implants have no periodontal ligament and there is no cementum to absorb the bacterial toxins. Current all-on-4, 5 or 6 bridges have been maintaining well for years and the space between the prosthesis and soft tissue has been reduced over time from several mm’s to just 1mm currently. Water Piks with Listerine, 0.12% CHX, superfloss, sonicare etc. are keeping the bacteria down to a manageable level so that they are not causing perio. Dr. Clifford’s prosthesis are easily removable with a simple tug of an cleoid. They can be inspected, adjusted, the implants cleaned and the case re-cemented in a short appointment.
There are a number of dentists across the country who are placing porcelain to metal over mini’s as well as composite resin arches over mini’s. Dr. Clifford’s technique is unique in that the lab fees are low and the prosthesis is retrievable and easy to modify. He has not presented the mini implant bridge as a replacement for existing techniques but as an alternative technique to be used when indicated based on the clinical judgment of the practitioner and the needs of the patient.
Dr. Malo of Lisbon, Portugal developed the all-on-4 technique because he wanted to reduce the number of sinus bone grafts in his implant practice. In a very few years his technique has gone from being viewed with suspicion to widely accepted, but not without critics.
In the past ten years mini implants have gone from being a novelty design placed by a few “kooks” to a design whose success in mandibular overdentures can no longer be denied. The 3M purchase or Imtec was a major turning point in the acceptance of mini implants in general along with their enthusiastic promotion by Dr. Gordon Christensen in his update and implant course.
It is entirely possible the Dr. Clifford’s work in developing his mini implant bridge technique will be looked upon as an important step in the evolution of the many uses of this most versatile implant.
I urge the critics or Dr. Clifford to remember that If all objections were first overcome nothing would ever be undertaken. Those who say it can’t be done should never stand in the way of those that are doing it. It is only with the passage of time and the observation of completed cases that the mini implant bridge sage will play out.
Jeffrey S. Miller, DDS, PC
Mesa, AZ |
