post operative Q&A
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Frequently Asked questions
Q. How much post-op pain should my MDI patients expect? I know this is a relative question but it will be commonly asked. For example, is it comparable to an extraction for this type of implant, or is it usually less painful? Where I may prescribe Hydrocodone 5mg for an extraction, would I also expect the same level of pain control needed here? What is your usual protocol for post-op care?
A. There should be little post-op pain except for the needle injection sites if there is no prior inflammation or infection in the area under treatment. Low-level analgesics are the only usual post-op medicines. Warm saline is also a good idea. I also recommend IMTEC’s ACCESS® curved bristle toothbrushes (specify #1 bristle density for implant patients) for implant after-care treatment. They’re available from the company, and patient reactions to their use have been very positive.
Q. Should I have my MDI patient go without his or her dentures for any period of time after the surgery or treat it more like an immediate denture? If he or she wears it immediately after surgery, should I wait until the next day to remove it or should it come out that same evening?
A. There is no need to let the patient go without his or her prosthesis at any time unless the prosthesis itself is causing iatrogenic pressure ulcers or other comparable problems that you cannot resolve chair side.
Q. Dr. Sendax, I can’t say enough good things that the MDI system has done for my patients. The system works! I do need your input concerning a patient, however. I placed twelve MDI’s in her mouth, six up and six down. I placed three MDI’s distal to her lower existing teeth (cuspid to cuspid) on each ridge. No implants are in the mandibular canals or the mental foramen. However, the patient complains of cold sensitivity from the middle implant on the left side. I spoke with the late Dr. Charles English about this and he said that he had not seen this problem before. Have you? Please let me know if you can figure out what might be causing this phenomenon.
A. Doctor, thanks for your gracious comments about the MDI system. I must say though that I have never encountered the apparent cold sensitivity you describe. If natural teeth were present in the area of interest I could understand such a temperature reaction, but with only MDI’s in the affected region it is difficult to draw any inference from what you describe. I suppose if the implant is in close proximity to some neurologic focus it could conceivably transmit cold sensitivity, but admittedly that’s strictly hypothetical. I’ll reflect on it and if I can think of something else I’ll get back to you. In the interim, keep up the good work!
Q. Please discuss what I can expect as far as mobility is concerned.
A. Good question. Mobility (looseness) of mini-implants occurs typically in the first few weeks following insertion, and is almost always associated with over-instrumentation of bone at time of drilling procedure (osteotomy). Once the simple learning curve is mastered for bone site preparation, subsequent mobility is rarely encountered if self-tapping bone-to-implant integration is accomplished at the outset. Steady bone stability is then routinely encountered.
Moreover, mobile implants have been encountered in my clinical trials in only a single instance over a four-year period. It occurred when the mini-implant was placed in an extremely osteoporotic bone site where quantity and quality of osseous resource was low.
Q. I have now placed thirty-seven MDIs. I have had a total of five become mobile, two in the past two weeks in the same patient . I realize every case is different but what would be the main reasons for that to happen? I believe in one case where both came loose, it was a lower full denture; I don’t think I had the patient’s existing denture seated all the way down to the ridge when I attached the O-Rings. I also think the metal housings were in contact with the inside of his denture, so all of the occlusal forces were on the implants, with no tissue bearing areas. One of the other three that came loose was a 13mm MDI that I was not able to screw all the way down. Some threads were exposed, which I try not to have happen even if I have to change the length or type of implant. So maybe it was too heavy.
Also, with lower overdentures, do you usually place more than two mini’s? Do you always try to use their existing denture so long as the base is thick enough to accommodate the O- Rings? I find myself using the micro metal housings more than the regular housings that come with the implants. My best results have been with a new denture over four mini’s. Comments please.
A. Thanks for the update, even with some negative reports (re: loosening and exfoliations). Best advice I can give you about using a patient’s existing denture is that these cases must be relined with a hard or soft liner for stability preferably before picking up O-Ring encapsulations. In fact, it may be best to simply remove the existing hard acrylic overlying the MDIs, provide sufficient relief (clearance) and then reline the entire denture including the MDIs with soft liner to avoid over stressing them from lateral traumatic contacts, especially if you have some reservations about the integration of the MDIs at this stage. Defer O-Ring loading pickups until your confidence level is adequate.
As to length of the MDIs, we always recommend not over screwing into dense Type 1 bone, and to either use a shorter implant or try to deepen your starter drilling by pecking away a little more of the apical bone to get a better take. Also you can use only two MDIs if the bony integration is solid and secure, but clearly three or four gives you a better margin for error or exfoliation. In short bite, limited interarch space situations the micro O-Rings are indeed a better bet and that’s why we offer them as an option.
Q. When using two square heads at an angle, how do you keep bacteria from the v-shaped area?
A. With an ACCESS toothbrush.
Q. What can I tell my patients to expect as far as recovery time after MDI placement?
A. There is no significant recovery time after insertion since it is a minimally invasive procedure. Most typical reaction is a little gum soreness for a few days from the minimal Novocaine injections. These MDI’s go into immediate function and, depending on the type of tooth replacements that go on top of the mini implants, your patients should function immediately after placement with few side effects.
Q. Dr. Sendax, I have placed three IMTEC MDI implants, all 15mm on lower left, as a support for a five- unit bridge between #17 and #21 as transitional prosthesis. Two months post-insertion radiograph shows at least 2mm bone loss around the three MDI implants. They are not mobile, but I am concerned that I may not be able to use these as supporting posts under the new bridge. The patient did not have any pain or infection following the surgery.
I have placed conventional implants in the past and followed good surgical protocol. The patient in this case cannot have a permanent replacement until after the first of the year. So we have a couple of months before the final bridge. I will evaluate the bone level at that time. How much bone loss will it take to load the stress under the bridge? What could be done to prevent such bone loss? I realize that these MDI’s are not intended to be used as bridge abutments. However, in this case it was not used as a terminal abutment, rather support of the bridge. Also, the patient is a heavy smoker. Comments, please.
A. Doctor, when you said your patient is a smoker it reminded me that smoking is a real potential negative for both bone and soft tissues around implants and natural teeth. You might very well be encountering this very significant factor in the bone loss you describe around your MDI’s. Try to get the patient to break this.
As to bone loss levels, we do not typically see significant bone loss around MDI sites unless there have been recent extractions, soft and hard tissue inflammation or infection. Also, check your occlusion carefully to avoid traumatic deflective contacts during excursive movements and centric. A remarkably “steady state” of bone is more routinely observed. Also, we do indeed consider these integrated MDI’s usable as ongoing bridge abutments, once convincingly integrated with bone. Once your own comfort level with the procedure is a reality then you should be in a position to ethically recommend this procedure for longer-term fixed bridge applications.