short-term evaluation of mini-implant retained removable ... · short-term evaluation of...

215Short-term evaluation of mini-implant retained removable partial denture Chatchai Kunavisarut, Russami Kumpirichaya

Chatchai Kunavisarut, Russami Kumpirichaya M.Sc., Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University.

Short-term evaluation of mini-implant retained removable partial denture

Corresponding Author: Chatchai Kunavisarut Department of Advanced General Dentistry, Mahidol University, Faculty of Dentistry, 6 Yothi Rd., Rajathevi, Bangkok, 10400. Phone: 02-200-7555 Fax: 02-203-6530 E-mail: [email protected] Received: 16 May 2014 Accepted: 26 June 2014

Abstract Objective: Mini-implants have been used for various purposes and the survival rate was not different from regular implants when they were used as a single tooth replacement. An analysis of mini-implant retained removable partial dentures (RPD) was never reported. The purposes of the present study were to evaluate mini-implant (2.8-mm-diameter) retained RPD in the short period and to compare patient satisfaction before and after treatment.

Material and methods: Nine subjects were given 19 mini-implants to support RPDs. All implants were immediately loaded. Assessments made at recall intervals included: Plaque Index (PI), Gingival Index (GI), probing depth, and standardized radiographs. Implant statuses were classified into success, satisfactory survival, compromised survival, and failure. Patients were asked to complete questionnaires before and after treatment to evaluate patients' satisfaction.

Results: Six implants (31.6%) were considered successful, six implants (31.6%) were satisfactory survival, one implant (5.2%) was in a state of compromised survival, and six implants (31.6%) failed to osseointegrate. None of the implants showed signs of peri-implantitis. Clinical parameters demonstrated that there were no correlations between GI, PI and marginal bone loss. Results indicated increased satisfaction in all patients, especially in functional limitation, physical disability and psychological disability domain.

Conclusion: The placement of mini-implant to help support removable partial dentures can improve patient’s satisfaction of the denture in various aspects. However, due to reduced bone to implant contact of mini-implant, the high failure rate was found. Therefore it could not be recommended to be use as a routine procedure.

Key words: mini-implant, removable partial denture, implant quality scale, implant retained denture, reduced diameter implant, implant success

How to cite: Kunavisarut C, Kumpirichaya R. Short-term evaluation of mini- implant retained removable partial denture. M Dent J 2014; 34: 215-24.

Dental Journal Original ArticleMahidol Dental Journal

216 Short-term evaluation of mini-implant retained removable partial denture Chatchai Kunavisarut, Russami Kumpirichaya

M Dent J Volume 34 Number 3 September-December 2014

Introduction The loss of posterior tooth support results in quantitative and qualitative changes of the residual alveolar ridges with reduced masticatory efficiency, loss of the vertical dimension and an increased load to the remaining teeth. Removable partial denture (RPD) is a minimally invasive, low cost treatment commonly used to restore distal extension edentulous patient. The lack of adequate retention, unesthetic retentive clasping, excessive loading to the remaining teeth, inadequate abutments and patient compliance are some problems associated with the use of RPDs.1 The use of fixed implant retained restoration or implant supported fixed partial denture is an alternative treatment option with high success rate and greater patient satisfaction. The use of implant supported fixed partial denture limit the bone resorption as compared to the conventional distal extension RPD.2,3 Although there are multiple benefits of implant restoration, cost is a major factor in the choice of the treatment, especially in developing countries where most of patients cannot afford fixed dental implant restoration. Implant supported removable partial denture is another alternative to alleviate the limitations of RPD. To date, there are few studies on implant supported RPD and most of them are case reports.4-8

Recently, mini-implant has been used as transitional implants to support dentures during the healing phase of implant denture restoration. It is also used as a permanent single implant crown in inadequate space for standard implants and limited bone availability situations.9-14

Although, mini-implants have been used for numerous purposes, to date there are no reports using mini-implant supported removable partial denture. The aim of this study is to evaluate the outcome and success

of mini-implant retained removable partial denture using the ball attachment.

Materials and methods This project was conducted with approval by the Committee on Human Rights Related to Human Experimentation, Mahidol University (MU-IRB No. 2006-08). All participants were informed of risks, benefits and signed an approved informed consent document prior to enrollment. Inclusion criteria 1. Patients with age ranging between 40-70 years. 2. Patients who presented with a distal extension edentulous situations (either bilateral or unilateral distal extension) and had problem with retention of removable partial denture (RPD). 3. Patients had to wear RPDs for a minimum of 1 month before the experiment. 4. Having no serious medical history: uncontrolled diabetes, uncontrolled blood pressure, taking bisphosphonates, irradiation or chemotherapy, congenital or acquired oral defects, long-term intake of steroids, history of heart attack during the last 12 months, or taking anticoagulation. Exclusion criteria 1. Having periodontitis problem (probing depth more than 4 mm in any areas of the mouth) 2. Heavy smokers (more than 10 cigarettes per day) 3. Having bruxism 4. Requiring general anesthesia for surgical and/or restorative procedures Study models of the upper and lower arches and panoramic radiographs were obtained from all subjects to assess the implant site and determine the appropriate length of implants to be used. Only implants with 2.8 mm in diameter were used in this



study. The longest implants that did not damage inferior alveolar canal in the mandible and sinus floor in the maxilla were selected. Implants were placed in strategic positions to improve retention and support of a removable partial denture, mainly first molar region. One or two additional Implants were also placed in premolar regions to provide a triangular or quadrangular support for the dentures if possible (Figure 1). Prophylactic medication (Amoxycillin 1gm, Ibuprofen 400mg) was given 30 minutes prior to implant surgery. A flapless surgery under local anesthesia was performed using a pilot drill of 1.4mm followed by placing a 2.8mm diameter mini-implant ranging from 8-14mm length (RE-MARK MT™, Renew Biocare, Zurich, Switzerland) at or 1 mm above the alveolar crest according to the tissue height. The bone quality was subjectively graded by the surgeon who placed all the mini-implants. The RPDs were relieved on the intaglio surface at the implant site. Ball housings and O-rings were installed on the implants and picked up with chemically activated acrylic resin (Tokuso Curefast, Tokyo, Japan). Standardized intraoral radiographs were taken after surgery. The radiographs (Kodak Ultraspeed size II double

film, Eastman Kodak, Rochester, NY, USA) were taken using a Ritter transdent unit, 28 cm long cone (Ritter, Germany. A paralleling device (Rinn Corporation, Elgin, IL, USA) and individualized bite blocks made of acrylic resin (Tokuso Curefast, Tokyo, Japan) were used for the standardization of the x-ray geometry. Antibiotics (Amoxycillin 500mg) and 0.2 % Chlorhexidine mouthwash were prescribed for a week. Patients were instructed to consume soft diet for 1 week. Followed up visits were conducted at 1 week, 1, 3 and 6 months following loading of mini-implants. All RPDs were checked and adjusted during the follow up period if needed. The implants were clinically evaluated for plaque, gingival index15, pocket depth and implant mobility at 1, 3 and 6 months. Periapical radiographs were also taken with individual positioning jigs at each follow up visit. The marginal bone loss was determined radiographically by comparing marginal bone level after implant placement 1, 3 and 6 months using implant shoulder as reference point on both mesial and distal aspect of the implant. Digital caliper was used for all measurements. The outcome and success of each implant was determined according to the implant quality scale proposed by ICOI consensus conference 2007 (Table 1).16 Patient’s satisfaction before and after treatment was subjectively evaluated using the OHIP-EDENT questionnaire based on a Likert type scale ranging from 0-4.17 Statistical Analysis A descriptive analysis and Fisher’s Exact test were used to describe the relationship of implant status and the clinical parameters. Wilcoxon sign rank test was used to compare patients’ satisfaction before and after treatment.

Figure 1 Mini-implants were placed at the left mandibular first premolar site, the right mandibular canine site and the 1st mandibular molar on both sides.



Table 1 Success criteria for dental implant International Congress of Oral Implantologists (ICOI), Pisa, Italy,

Consensus Conference, 2007 Implant Quality Scale Group Clinical Conditions 1. Success (optimum health) a) No pain or tenderness upon function b) No mobility c) <2 mm radiographic bone loss from initial surgery d) No exudates history 2. Satisfactory survival a) No pain or tenderness upon function b) No mobility c) 2-4 mm radiographic bone loss d) No exudates history 3. Compromised survival a) May have sensitivity on function b) No mobility c) Radiographic bone loss >4 mm (less than ½ of implant body) d) Probing depth >7 mm e) May have exudates history 4. Failure Any of following: (clinical or absolute failure) a) Pain on function b) Mobility c) Radiographic bone loss >1/2 length of implant d) Uncontrolled exudates e) No longer in mouth

Results A total of 19 mini-implants (2.8mm) ranging from 8mm to 14mm in length were placed in nine patients. At six months follow-up, 6 implants (31.6%) failed to osseointegrate (Figure 2). The remaining 13 implants were divided into 3 categories as (a) successful (6 implants 31.6%) (Figure 3), (b) satisfactory survival (6 implants 31.6%) (Figure 4) and (c) compromised survival (1 implant 5.2%) (Figure 5). None of the remaining implants were mobile. Distribution and status of each implant are shown in table 2. The bone loss ranged from 0-5mm with the maximum amount of resorption taking place within the first month of loading. There was no significant difference in marginal bone resorption between the mesial and distal surfaces, plaque index, gingival index and probing depth (Table 3).

Five implants were placed in the maxilla and 14 in the mandible. Table 4 shows the summarized details of the implant status and clinical parameters. We performed the analysis by combining the clinical status of success and satisfactory survival into “success” group and the clinical status of failure and compromised survival into “failure” group. For the clinical parameter we categorized the implant placement location as maxilla (Max) and mandible (Mand) and the implant length as less than 12 mm (< 12 mm) and 12 mm and above (≥ 12 mm). There was no statistical relationship between the implant failure and the site of implant placement location (p= 0.28) and bone quality (p=0.26). There was nearly statistically significant relationship between implant failure and the length of implant less than 12 mm (p=0.05).



Figure 5 Compromised survival implant (>4 mm bone loss)

Figure 2 Mini implant failed to achieve osseointegration

Figure 3 Mini implant achieved osseointegration.

Figure 4 Satisfactory survival implant (2-4 mm bone loss)



Table 2 Distribution of each inplant and its statusPatient tooth Length (mm) Bone quality Implant Status

1 14 10 III Failed

2 37 12 III Failed

3 23 14 III Satisfactory survival

26 8 IV Failed

36 12 III Success

4 46 10 III Failed

34 12 III Satisfactory survival

37 8 III Failed

5 44 12 III Success

47 8 III Success

35 10 III Success

6 44 10 III Compromised survival

14 12 IV Satisfactory survival

7 34 10 III Satisfactory survival

8 36 10 III Success


26 10 IV Failed

9 36 12 III Success


Table 3 Gingival index, plaque index, probing depth and mean marginal bone loss

Gingival index

Plaque index

Probing depth (mm) Mean marginal bone loss (mm)

Buccal Lingual Mesial Distal

1 month 0.77 0.15 2.35 2.08 1.15 ± 1.26 0.92 ± 0.84

3 months 0.54 0.15 2.23 2.15 1.53 ± 1.26 1.44 ± 0.88

6 months 0.39 0.08 2 2.62 1.78 ± 1.43 1.50 ± 0.93

Table 4 Factor associated with implant failure Bone quality Length of implant Arch

III (n = 16)

IV (n = 3)

< 12 (n = 11)

> 12 (n = 8)

Max (n = 6)

Mand (n = 13)

Success (n = 12) 11 1 5 7 3 9

Failure (n = 7) 5 2 6 1 3 4

Fisher exact test (p value)

0.26 0.05 0.28



Plaque and gingival indexes were used to evaluate peri-implant mucosa recorded at 1st week, 1, 3 and 6 months of implant loading. Only 1 patient had level 2 plaque index, 3 patients had level 1 plaque index and remaining 5 patients had 0 plaque index. One patient had grade 3 gingival inflammation, five with grade 2 gingival inflammation, one had grade 1 and two had grade 0 gingival inflammation. However, both the indices gradually decreased with time. The mean probing depth ranged from 2-2.6mm. Two patients had a pocket depth >3mm. According to the results, there was no co-relation between plaque, gingival index and marginal bone loss (Table 3). The OHIP-EDENT questionnaire was used to evaluate patients’ satisfaction on mini-implant retained RPD before and after treatment. A total of 9 questionnaires for functional limitation, handicap, physical pain, psychological discomfort, physical, psychological and social disabilities were evaluated. Patients treated with mini-implant retained RPD showed a significant improvement in functional limitation, physical and psychological disabilities (Table 5). Discussion The purpose of this short-term prospective study was to evaluate the clinical outcome of

mini-implant, ball attachment retained removal partial denture in distal extension patients. The implant quality scale proposed by the International Congress of Oral Implantologists, Pisa, Consensus conference, 2007 was used in this study because it represents quality of health of each implant thus resembles real clinical situation.16 The results showed a 32% early failure rate within six months. Clinical studies have reported more favorable results for small-diameter implants used as single tooth replacement.14,18,19 There were no clinical signs of early infection such as swelling, fistulas, suppuration, mucosal dehiscence, and osteomyelitis in all the failed implants. Furthermore, there was no correlation between plaque and gingival indices and crestal bone resorption. This outcome is similar to the findings of Taylor et al.20and Levy et al.21 Thus, the etiology of failure in this study may be attributed to biomechanical reasons and not from infection. Occlusal overload is one of the plausible etiologies for peri-implant bone loss. Research has indicated that occlusal overload often results in marginal bone loss or de-osseointegration of successfully osseointegrated implants. 22-25

Osseointegrated implants are ankylosed to the surrounding bone and crestal bone around dental implants may act as a fulcrum point when a bending moment is applied, indicating

Table 5 The mean OHIP-EDENT scores pre and post treatment OHIP-EDENT Pre-treatment Post-treatment p value

Functional limitation 6.56 2.44 .012 **

Physical pain 4.22 2.44 .169

Psychological discomfort 1.56 0.56 .098

Physical disability 5.22 1.33 .007 **

Psychological disability 1.33 0.33 .024 **

Social disability 0.89 0.33 .102

Handicap 0.78 0.22 .102 ** Statistically signifi cant p-value < 0.05



that peri-implant tissues could be more susceptible to crestal bone loss by mechanical forces. The cortical bone is known to be least resistant to shear forces, which is significantly increased by bending overload. Therefore if the bending overload increases beyond the threshold of bone homeostasis, it may result in progressive marginal bone loss or even de-osseointegration.26 Several clinical studies have indicated that marginal bone loss around implants has been associated with high occlusal stress on the implants.22,25,27-29 Interestingly, our study found a tendency of the implant length to be related with the implant failure. Even though we did not reach statistical significance, this finding was similar to the finding of orthodontic mini-implant.30

The failure of implants in this study maybe due to the lateral forces arising from the movement of distal extension RPDs that could have affected the osseointegration of implants leading to increased levels of bone loss in a short period of time. A crater-like bone loss was found in most implants, which indicate overload from lateral forces that may exceed bone remodeling capacity leading to uncontrolled vertical bone loss and implant failure.31 Rangert et al.32concluded that lateral forces are primarily involved in implant overload and peri-implant bone resorption more than axial forces. This is further supported by finding using 3D finite-element analysis.33,34

Although the amount of bone-to-implant contact required to withstand occlusal force is not yet known, the surface area of mini-implant (2.8mm diameter) is about 37% less than a regular sized implant (3.8 mm diameter) indicating that a mini-implant would possibly have a less bone-to-implant contact than a regular sized implant. An increase in lateral forces and reduced bone-to-implant contact could be the primary factors for higher failure rate in this study.35,36

To assess patient’s satisfaction, OHIP-EDENT questionnaires were used. All patients reported a significant improvement in the denture retention with the use of mini-implant, ball attachment retained RPDs. The problems of functional limitation, physical disability and psychological disability significantly improved after treatment similar to other studies.37-39 This may imply that implant supported RPDs may alleviate some of the problems associated with the conventional RPDs. Several studies have shown the effectiveness of implant supported RPDs with improved occlusal support and decreased pressure on soft tissue preventing the displacement of distal extension implant-supported RPDs as compared to the conventional RPDs.40 However, the major problem of this study was high level of marginal bone loss, which has not been reported in other studies using standard sized implants.41 The limitation of a small sample size in this study makes it difficult to make a definite conclusion. Further studies with a large sample size and long term evaluation may provide more comprehensive data on mini-implants retained RPDs. In addition, using wider implant or regular size implant to support RPD may decrease the risk of implant failure resulting from biomechanical complications. In Conclusion, the placement of mini-implant to help support removable partial dentures can improve patient’s satisfaction of the denture in various aspects. However, due to reduced bone to implant contact of mini-implant, the high failure rate was found. Therefore it could not be recommended to be use as a routine procedure. Acknowledgement: None Funding: None Competing Interests: None Ethical Approval: MU 2006-008



Reference 1. Wetherell JD, Smales RJ. Partial denture failures: a

long-term clinical survey. J Dent 1980; 8: 333-40. 2. Jacobs R, van Steenberghe D, Nys M., Naert I.

Maxillary bone resorption in patients with mandibular implant supported overdentures or fixed prostheses. J Prosthet Dent 1993; 70: 135-40.

3. Jacobs R, Schotte A, van Steenberghe D, Quirynen M, Naert I. Posterior jaw bone resorption in osseointegrated implant-supported overdentures. Clin Oral Implants Res 1992; 3: 63-70.

4. Keltjens HM, Kayser AF, Hertel R, Battistuzzi PG. Distal extension removable partial dentures supported by implants and residual teeth: considerations and case reports. Int J Oral Maxillofac Implants 1993; 8: 208-13.

5. Halterman SM, Rivers JA, Keith JD, Nelson DR. Implant support for removable partial overdentures: a case report. Implant Dent 1999; 8: 74-8.

6. Mijiritsky E, Karas S. Removable partial denture design involving teeth and implants as an alternative to unsuccessful fixed implant therapy: a case report. Implant Dent 2004; 13: 218-22.

7. Mijiritsky E, Ormianer Z, Klinger A, Mardinger O. Use of dental implants to improve unfavorable removable partial denture design. Compend Contin Educ Dent 2005; 26: 744-6, 748, 750.

8. Mitrani R, Brudvik JS, Phillips KM. Posterior implants for distal extension removable prostheses: a retrospective study. Int J Periodontics Restorative Dent 2003; 23: 353-9.

9. Comfort MB, Chu FC, Chai J, Wat PY, Chow TW. A 5-year prospective study on small diameter screw-shaped oral implants. J Oral Rehabil 2005; 32: 341-5.

10. Giffin KM. Solving the distal extension removable partial denture base movement dilemma: a clinical report. J Prosthet Dent 1996; 76: 347-9.

11. Mazor Z, Steigmann M, Leshem R, Peleg M. Mini-implants to reconstruct missing teeth in severe ridge deficiency and small interdental space: a 5-year case series. Implant Dent 2004; 13: 336-41.

12. Romeo E, Lops D, Amorfini L, Chiapasco M, Ghisolfi M, Vogel G. Clinical and radiographic evaluation of small-diameter (3.3-mm) implants followed for 1-7 years: a longitudinal study. Clin Oral Implants Res 2006; 17: 139-48.

13. Vigolo P, Givani A. Clinical evaluation of single-tooth mini-implant restorations: a five-year retrospective study. J Prosthet Dent 2000; 84: 50-4.

14. Vigolo P, Givani A, Majzoub Z, Cordioli G. Clinical evaluation of small-diameter implants in single-tooth and multiple-implant restorations: a 7-year retrospective study. Int J Oral Maxillofac Implants 2004; 19: 703-9.

15. Loe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol 1967; 38: Suppl-6.

16. Misch CE, Perel ML, Wang HL, Sammartino G, Galindo-Moreno P, Trisi P, et al. Implant success, survival, and failure: the International Congress of Oral Implantologists (ICOI) Pisa Consensus Conference. Implant Dent 2008; 17: 5-15.

17. Allen F, Locker D. A modified short version of the oral health impact profile for assessing health-related quality of life in edentulous adults. Int J Prosthodont 2002; 15: 446-50.

18. Polizzi G, Fabbro S, Furri M, Hermann I, Squarzoni S. Clinical application of narrow Branemark System implants for single-tooth restorations. Int J Oral Maxillofac Implants 1999; 14: 496-503.

19. Bulard RA, Vance JB. Multi-clinic evaluation using mini-dental implants for long-term denture stabilization: a preliminary biometric evaluation. Compend Contin Educ Dent 2005; 26: 892-7.

20. Taylor RC, McGlumphy EA, Tatakis DN, Beck FM. Radiographic and clinical evaluation of single-tooth Biolok implants: a 5-year study. Int J Oral Maxillofac Implants 2004; 19: 849-54.

21. Levy D, Deporter DA, Pharoah M, Tomlinson G. A comparison of radiographic bone height and probing attachment level measurements adjacent to porous-coated dental implants in humans. Int J Oral Maxillofac Implants 1997; 12: 541-6.

22. Quirynen M, Naert I, van Steenberghe D, Dekeyser C, Callens A. Periodontal aspects of osseointegrated fixtures supporting a partial bridge. An up to 6-years retrospective study. J Clin Periodontol 1992; 19: 118-26.

23. Cox JF, Zarb GA. The longitudinal clinical efficacy of osseointegrated dental implants: a 3-year report. Int J Oral Maxillofac Implants 1987; 2: 91-100.

24. Adell R, Lekholm U, Rockler B, Branemark PI. A 15-year study of osseointegrated implants in the treatment of the edentulous jaw. Int J Oral Surg 1981; 10: 387-416.



25. Ahlqvist J, Borg K, Gunne J, Nilson H, Olsson M, Astrand P. Osseointegrated implants in edentulous jaws: a 2-year longitudinal study. Int J Oral Maxillofac Implants 1990; 5: 155-63.

26. Oh TJ, Yoon J, Misch CE, Wang HL. The causes of early implant bone loss: myth or science? J Periodontol 2002; 73: 322-33.

27. Jemt T, Lekholm U, Adell R. Osseointegrated implants in the treatment of partially edentulous patients: a preliminary study on 876 consecutively placed fixtures. Int J Oral Maxillofac Implants 1989; 4: 211-7.

28. Lindquist LW, Rockler B, Carlsson GE. Bone resorption around fixtures in edentulous patients treated with mandibular fixed tissue-integrated prostheses. J Prosthet Dent 1988; 59: 59-63.

29. Naert I, Quirynen M, van Steenberghe D, Darius P. A study of 589 consecutive implants supporting complete fixed prostheses. Part II: Prosthetic aspects. J Prosthet Dent 1992; 68: 949-56.

30. Pithon MM, Figueiredo DS, Oliveira DD. Mechanical evaluation of orthodontic mini-implants of different lengths. J Oral Maxillofac Surg 2013; 71: 479-86.

31. Duyck J, Ronold HJ, Van Oosterwyck H, Naert I, Vander Sloten J, Ellingsen JE. The influence of static and dynamic loading on marginal bone reactions around osseointegrated implants: an animal experimental study. Clin Oral Implants Res 2001; 12: 207-18.

32. Rangert B, Krogh PH, Langer B, Van Roekel N. Bending overload and implant fracture: a retrospective clinical analysis. Int J Oral Maxillofac Implants 1995; 10: 326-34.

33. Barbier L, Schepers E. Adaptive bone remodeling around oral implants under axial and nonaxial loading conditions in the dog mandible. Int J Oral Maxillofac Implants 1997; 12: 215-23.

34. Kitamura E, Stegaroiu R, Nomura S, Miyakawa O. Biomechanical aspects of marginal bone resorption around osseointegrated implants: considerations based on a three-dimensional finite element analysis. Clin Oral Implants Res 2004; 15: 401-12.

35. Bourauel C, Aitlahrach M, Heinemann F, Hasan I. Biomechanical finite element analysis of small diameter and short dental implants: extensive study of commercial implants. Biomed Tech (Berl) 2012; 57: 21-32.

36. Sakka S, Baroudi K, Nassani MZ. Factors associated with early and late failure of dental implants. J Investig Clin Dent 2012; 3: 258-61.

37. Ohkubo C, Kobayashi M, Suzuki Y, Hosoi T. Effect of implant support on distal-extension removable partial dentures: in vivo assessment. Int J Oral Maxillofac Implants 2008; 23: 1095-101.

38. Shahmiri RA, Atieh MA. Mandibular Kennedy Class I implant-tooth-borne removable partial denture: a systematic review. J Oral Rehabil 2010; 37: 225-34.

39. Scepanovic M, Calvo-Guirado JL, Markovic A, Delgardo-Ruiz R, Todorovic A, Millicic B, et al. A 1-year prospective cohort study on mandibular overdentures retained by mini dental implants. Eur J Oral Implantol 2012; 5: 367-79.

40. de Freitas RF, de Carvalho DK, da Fonte Porto CA, Barbosa GA, Ferreira MA. Mandibular implant- supported removable partial denture with distal extension: a systematic review. J Oral Rehabil 2012; 39: 791-8.

41. Albrektsson T, Buser D, Sennerby L. On crestal/marginal bone loss around dental implants. Int J Periodontics Restorative Dent 2013; 33: 9-11.

short-term evaluation of mini-implant retained removable ... · short-term evaluation of...

Documents