Minimal Invasive Modality for Full Rehabilitation
of Edentulous Mandible with One-Piece Implants in
Elderly Patients; A Case Report
Dental Clinic Henri Diederich, UK
Submission: March 28, 2018; Published: April 11, 2018
*Corresponding author: Henri Diederich, Dental Clinic Henri Diederich, Luxembourg, UK, Tel: +352621144664; Email: [email protected]
How to cite this article: Henri D. Minimal Invasive Modality for Full Rehabilitation of Edentulous Mandible with One-Piece Implants in Elderly Patients; A Case
Report. Adv Dent & Oral Health. 2018; 8(3): 555737. DOI: 10.19080/ADOH.2018.08.555737
One-piece implants encourage the use of minimally invasive surgical techniques in restoring edentulous spaces with minimal postoperative
discomfort and excellent implant survival rate.
The compressive one-piece implant can be used for multiple unit restorations with immediate loading in the upper and lower jaws. It can
also be used in combination with a conventional implant and it can be placed flapless.
The presented case reports offering a treatment modality and procedure of mandibular rehabilitation involving the functional restoration of
a mandibular fully edentulous patient with minimal invasive surgical technique with one-piece implant in elderly patients.
The use of conventional implants in the rehabilitation of
edentulous space has been discussed extensively in the literature
[1-4]. However, conventional implant systems may be limited or
inapplicable in restoring some edentulous spaces due to various
anatomical reasons. One of such reason is insufficient space
between adjacent edentulous teeth for the use of a conventional
implant which makes implant placement impossible [4,5-7]. In
these situations, an alternative implant system for the restoration
of such cases is required.
The One-Piece implants help in restoring edentulous spaces
that previously cannot be restored with conventional implants; it
also encourages the use of minimally invasive surgical techniques
which encourage maximum tissue preservation [8,9].
One-Piece implant offers a unique monobloc design that
integrates both implant and superstructure, for a quick, simple
one-stage procedure. Implants are specifically engineered for use
in narrow ridges and tight spaces . They are time effective
as they eliminate the need for second stage surgery, mucosal
healing period, and decrease patient exposure to additional pain
and discomfort. The innovative geometries and advanced surface
morphology of the implant offer high initial stability [11,12]. One
Piece implants are less invasive and can be immediately loaded in
case of good bone quality, or progressively loaded in case of less
than ideal bone quality.
One Piece implant provides simple treatment sequence at
lower cost and it offers the possibility to treat elderly people
for example with minimal invasive implant placement (Flapless
implant surgery) technique.
Flapless implant placement technique otherwise called
minimally invasive procedure can be performed free hand, by
using guided surgery or custom fabricated surgical guides made
of casts taken at the first patient visit. This procedure, when
applicable, provides patients and doctors with another treatment
approach. Several clinical papers reported excellent short- and
long-term survival rates (of about 98.7% at 2 years) for implants
placed using flapless or minimally invasive approaches with the
option of delivering immediately a pre-fabricated temporary
In term of implant prosthodontics, technical complexity is
minimized with One-Piece implants by reducing the number of
components required, which also means that less treatment time
is required. Patients benefit from having implants placed flapless
and loaded immediately [14-16].
The following case report describes procedures where One-
Piece implants were used to rehabilitate severely atrophied
edentulous mandible in an elderly patient.
Patient is a 91-year-old patient with an ill-fitted removable
prosthesis who was not happy with her prosthesis and wanted
an improved treatment modality in the mandible. Patient’s family
was afraid of implant placement because of the age of the patient.
Following complete medical examination, patient was found to
be in a good health & after clinical examination; the possibility of
implants treatment was discussed (Figure 1).
At the first appointment, A CBCT radiograph was taken to
check if there was enough bone for implant placement, found to
be satisfactory, as follows;
a) Duplication of the mandibular complete denture was
encountered utilizing a radio-opaque material to construct
radiographic stents for the patient.
b) Patient was imaged using cone beam computed
tomography scans (CBCT scans) through a cone beam CT
machine (CBCT, i-CAT Vision)*. Each patient was instructed to
bite on a piece of cotton to achieve adequate jaw separation.
Finally, the resultant image was obtained as a DICOM file.
c) The images were processed using specialized image
processing software (Blue Sky implant software)**.
d) Virtual implants were placed in the planned positions
of available bone. Then, a solid block was modelled & guiding holes denoting the implant direction were opened into the
a. The surgical stent was sterilized chemically*** to be
used during surgery.
b. The patient was instructed to take a prophylactic
antibiotic preoperatively**** and to rinse with
chlorohexidine mouth wash***** four hours before
*Imaging Sciences International, Hatfield, Pa, USA.
a) The sterile box of the implant*** was unwrapped, and
then the inner vial was also opened & the implant osteotomy
was washed thoroughly using sterile saline solution.
b) The sterile implant was introduced into its site by
screwing it using moderate finger pressure [self-tapping]
once resistance was felt, the ratchet wrench was adapted to
the abutment and the screwing process was continued.
one-piece implants of 3,5mm diameter and 14mm length
were inserted flapless in positions 31, 32, 41 and 42 with a torque
of 50N. One Piece implants (Figure 3) are machined in grade 23
titanium with a hydroxyapatite/beta tricalcium phosphate surface
(HA/BTCP), the implant can be used to create single restorations in
situations where high primary stability is achieved on placement.
The axial implants are generally intended for the anterior
part of the mandible or the maxilla where there is sufficient bone
height. They allow bi-cortical or even tricortical anchorage and
provide good stability, even in medium-dense bone.
*Listerine mouthwash, USA
**Ubestesin, 3M ESPE, Germany.
***ROOTT Compressive Dental Implant, TRATE AG,
a) After the implant placement, an addition silicone
impression was taken, and bite registration was made in the
b) After completing Try-in stage and receiving the final
prosthesis from the laboratory, bar was cemented, and the
lower prosthesis was delivered. (Figure 4 & 5) Then, a postoperative
Panoramic radiograph was made to verify accurate
treatment plan (Figure 6).
The patient was seen for follow-up and oral hygiene measures
as well as measuring patient’s satisfaction every single week for
the first three months, then every 6 months for the following 5
years of assessment.
One-Piece implants facilitate oral rehabilitation and accelerate
tooth replacement procedure [8,17]. The implant permits
minimally invasive surgical techniques with a simpler treatment
sequence at lower costs .
When compared to conventional implants, One Piece implants
are cost-effective, they eliminate the need for cover screws, healing
abutments, subsequent separate implant attachments or separate
implant abutments [12,17].
In the above cases, One Piece implants (TRATE.AG, ROOTT.ch,
compressive implants) were used. These are single component
implants with a compression thread. The special compressive
thread produces compression when inserted into the cancellous
bone, thereby creating a layer of cortical bone around the implant
which allows immediate loading with high primary stability.
The abutment direction on the implant can be adjusted up to
15°relative to the implant axis.
The compressive One-Piece implant can be used to restore
single crowns and anterior cemented bridges, or multiple unit
restorations with immediate loading in the upper and lower jaws
with adequate bone tissue. It can also be used in combination with
a conventional implant and it allows flap and flapless placement.
The implants insertion is like that of crestal implants, with a
recommended minimum torque of 35 N/cm.
The presented case reports show the functional restoration of
an edentulous patient with minimal invasive surgical technique
with One Piece implant in elderly patients. Rehabilitation of
seemingly difficult edentulous cases was achieved within a short
period of time.