Auxiliary Implants

Auxiliary implants (synonyms: temporary implants, provisional implants, mini-implants, IPI for English : Immediate Provisional Implants) serve as anchoring elements for orthodontic appliances or for provisional dentures during postoperative healing phases and – unlike permanent implants – are inserted only temporarily (temporarily inserted). Auxiliary implants differ from permanent implants (permanently placed artificial tooth roots) in terms of their smaller diameter (1 to 3.5 mm), length, only one-piece construction and method of use. Like these, they are usually made of titanium.

Auxiliary implants in prosthetics

Due to their small diameter, auxiliary implants find a place between permanent implants during their healing phase of several months and are inserted (placed) simultaneously with them. While osseointegration (direct bone-implant contact, ankylotic (fused) healing) is the goal for definitive implants and they must therefore not be loaded during the osseointegration phase, this gap-free healing into the bone is not the primary goal for auxiliary implants. They bear, limited in time from the outset, the load of temporary dentures. If they become loose prematurely during their functional phase, they can be replaced by new ones elsewhere. If they survive the wearing period without loosening, they can be removed again without any problems. Narrow single-tooth gaps, as can occur particularly in the lower anterior region, are usually difficult or impossible to restore even with small definitive implant systems. In such problematic cases, a small-diameter mini-implant, for example, can be used for permanent restoration. However, a prerequisite for this is successful ankylotic (fused) osseous healing. During this three-month osseointegration phase, there must be no contact between the provisional crown and the antagonists (teeth of the opposing jaw).

Auxiliary implants in orthodontics

Following the physical law actio = reactio, according to which every force triggers a counterforce, individual teeth or even groups of teeth can only be moved orthodontically if the necessary forces are counteracted by appropriate anchorage. Unfortunately, not only the teeth that are to be orthodontically repositioned are moved in the process. Rather, this also applies to teeth that are only to be used for anchoring the counterforces. To avoid this effect of so-called anchorage loss, mini-screws, the most commonly used orthodontic auxiliary implants, can be placed as anchorage elements between the natural tooth roots or behind the tooth rows. The possibilities of orthodontic treatment are limited when the number of teeth is reduced or periodontal disease (damage to the tooth supporting apparatus) is present. If in such cases auxiliary implants can be used for anchorage, the orthodontic treatment is only made possible by them. Furthermore, auxiliary implants are an alternative for the so-called headgear, an external arch that uses the neck or back of the head as an abutment and is therefore associated with considerable restrictions in terms of esthetics and wearing comfort. This in turn can have an unfavorable effect on patient cooperation and jeopardize the success of the treatment. The same applies to the wearing of a facial mask. Auxiliary implants are an elegant alternative and are effective around the clock, regardless of the wearer’s compliance (cooperation). If, depending on the indication, a particularly stable bony anchorage is required, such as in the case of palatal implants, the situation is accommodated by implants of larger diameter (3.5 mm) and more length (4 to 10 mm), as well as by a roughened titanium surface in the implant area surrounded by bone.

Indications (areas of application)

  • For stabilization of fixed provisional (transitionally worn) dentures until placement of definitive (permanent) dentures.
  • For immediate postoperative load capacity
  • To relieve definitive implants in their healing phase of several months.
  • For the relief of bone and soft tissue after surgical reconstruction (augmentation) and other pre-prosthetic interventions (to improve the bone and soft tissue situation before provision of dentures).
  • Patient request for fixed provisional restoration.
  • Patients with gag reflex caused by wearing removable dentures.
  • As a permanent implant in narrow mandibular anterior gaps.
  • As an orthodontic anchoring element.

Contraindications

Before surgery

  • Information about the surgical procedure, complications, alternative treatment options and behavior after the procedure.
  • Clarification of possible surgical risks such as diabetes, cardiovascular problems and others
  • .

The surgical procedure

I. Insertion

Under local anesthesia (local anesthetic), the planned insertion site (“insertion site”) is first marked with a pilot drill without a mucosal incision. A pilot followed by an extension drill creates an undersized bone cavity (narrower than the implant diameter). Then, by carefully screwing in a tap, the marginal bone is compacted, preparing it to receive the auxiliary implant. This is screwed into the implant bed with tactile sensitivity. Due to the bone compaction, the auxiliary implant achieves a very high primary stability (firm seating even without bony healing). The auxiliary implant is loaded with the temporary denture immediately after insertion. II. removal

Removal of an auxiliary implant takes place at the same time as insertion of the final denture or after completion of the orthodontic tooth position corrections. Depending on its size and surface roughness, the implant can be removed more or less easily under local anesthesia. Due to the only small bone or mucosal defect, wound healing usually proceeds quickly and painlessly.

After the operation

  • Control of the wound healing process

Possible complications

  • Allergy / hypersensitivity to the anesthetic.
  • Hematomas (bruises)
  • Swelling
  • Post-bleeding
  • Wound healing disorders
  • Premature loosening of the auxiliary implant