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Product Focus:
The Hybrid Mini Dental Implant:
A Case Review
M
ini dental implants (MDIs) are beginning to
garner more attention from the dental profes-
sion. Although originally popularized as a
simplified means of stabilizing a lower complete denture,
the MDI is now considered by many to be an alternative
means of replacing missing teeth as fixed restorations.
Such restorations might be single teeth or multiple
splinted teeth.1-3
Under the early guidance of Dr. Victor Sendax,
IMTEC Corporation (now 3M ESPE) laid an early claim
to relevancy in the MDI market by introducing mini im-
plants that were 1.8 mm in diameter in a variety of
lengths. Over the years, their system and selection of
available MDIs has expanded to include mini implants
best suited to maxillary restorations and its softer bone, as
well as MDIs that have collars to accommodate thick,
soft-tissue coverage. Other implant manufacturers have
followed this diversification trend by offering multiple va-
rieties of what are collectively called “MDIs” that typi-
cally have diameters ranging from 1.8 to 2.5 mm,
depending on the manufacturer. The alloy of choice is, as
usual, titanium, combined with trace amounts of other
metals to enhance strength and biocompatibility. Thread
designs are proprietary; however, all resemble, to some
degree, a wood screw, as they are meant to be self-ad-
vancing and self-threading. The self-threading aspect is
responsible for making immediate fixation and immediate
loading a distinct possibility.
Martin B. Goldstein, DMD
Private Practice
Wolcott, CT
Phone: 203.879.4649
E-mail: martyg924@cox.net
Web site: www.drgoldsteinspeaks.com
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Figure 1—3M ESPE's MDI Hybrid 2.9 mm
implants are suitable for fixed and removable
applications.
Using the Hybrid Mini Implant: Case Study
Of particular note, and the subject of this “mini” case
review, is the hybrid implant. The hybrid implant pushes
well beyond the 1.8-mm-diameter mini implant; however,
falls just short of the full-sized root form implant that usu-
ally begins its diameter progression upward from 3 mm.
The hybrid lays claim to a 2.9-mm diameter and is in-
tended to be placed with much the same method and
many of the same tools as its brethren 1.8-mm mini im-
plants. In fact, the hybrid used in this case study (Figure
1), 3M ESPE’s MDI hybrid, features the same prosthetic
head and “o-ball” configuration as does the company’s
“true” mini implants, but adds a recognizable platform
at the base of the prosthetic head as well as a distinctive
thread pattern beneath that base. Dentists will easily rec-
ognize why the MDI is called “hybrid.” Its bottom-half
appearance, for all practical purposes, is like a root-form
implant, whereas the top half looks like a mini implant.
Where would this type of implant be used? In this in-
stance, a 50-year-old male and a long-standing patient de-
cided it was time to replace a missing 2nd bicuspid and, in
doing so, improve his smile. As can be seen in Figures 2
through 5, the maxillary 2nd bicuspid site is easily acces-
sible, as is often the case, and frequently features a broad
Dental Learning / February 2011 1

Figure 2—Radiograph demonstrating ideal placement of the 3M
ESPI MDI Hybrid mesial to the maxillary sinus.
Figure 3—Note the excellent tissue response to the 3M ESPI
MDI Hybrid implant at 3 weeks.
Figure 4—The “pont-abut” resembles a ridge lap pontic featur-
ing a small opening sized to engage the head of the MDI Hybrid.
Figure 5—The “pont-abut” has been secured with a self-curing
resin cement.
2 Dental Learning / February 2011
swath of bone anterior to the maxillary sinus. Such areas
may also display an equally generous patch of highly ker-
atinized tissue, optimizing the healing and tissue adapta-
tion phase. Occlusal loads can be minimized with sufficient
canine guidance in place and judicious adjustments when
testing excursive movements. The hybrid can also be used
in other areas in the arch, such as lateral incisor sites in the
maxilla. I have found it advantageous, however, to employ
hybrid implants in locations that will allow the implant-
retained crown to be exposed to a minimum of occlusal
force. This is a personal preference based upon the nature
of the implant-retained “pontabut,” as it is often called.
As the restoration is essentially a pontic with a small hole
in its ridge lap area and is cemented with a resin cement,
it makes sense to keep the occlusal load light so as not to
overtax this junction.
Placement Technique
The technique used to place the hybrid varies slightly
from that used with the smaller- diameter implants. The
manufacturer’s instructions indicate the use of a dispos-
able tissue punch to remove a small button of soft tissue
over the osteotomy site followed by use of a small, round
carbide bur to create a purchase point for the osteotomy
drill. The osteotomy drill has a 1.7-mm diameter versus
the 1.1-mm diameter of the drill recommended when plac-
ing their 1.8- and 2.4-mm mini implants. (3M ESPE sells
the combination of cutting instruments in kit form.) Place-
ment armamentarium is the same as that for the mini im-
plants. The finger driver begins the process and is replaced
with the thumb wrench when too much force is necessary
to further advance the hybrid. If needed, a torque wrench
can be used to gain final hybrid placement.
Figure 2 shows the 13-mm hybrid at full placement
depth; Figure 3 shows the appearance of the soft tissue 3
weeks postoperatively; Figure 4 shows the nature of the
ridge lap pontabut; and Figure 5 shows the fixed restora-
tion in place following cementation.
Hygiene
Hygiene care for the pontabut restoration is best ac-
complished with floss and a Waterpik (Water Pik, Inc). In
this author’s experience tissue response is excellent, show-
ing no signs of chronic inflammation.
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Advantages
The advantages of the hybrid implant approach are
readily apparent. Aside from the usual benefits of any im-
plant-retained restoration, the reduced cost and time re-
duction come to the forefront as does its ultraconservative
surgical placement. The hybrid can typically be loaded
within weeks of placement (provided initial placement
torque exceeds 30 Ncm) and can also be offered at sub-
stantially less cost than a traditional approach owing to
the reduced fixture cost and number of visits needed to
complete the restoration. To be sure, it is advisable to offer
this service as one of many alternatives appropriate for
your patient.
Conclusion
The world of minimum-diameter, self-advancing im-
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plants would appear to be expanding into multiple appli-
cations as both patients and dentists begin to appreciate
the advantages offered by such systems. General practi-
tioners interested in adding another treatment to the serv-
ices they provide would do well to explore the rapidly
expanding field of mini hybrid implants.
References
1. Christensen GJ. The ‘mini’ implant has arrived. J Am Dent
Assoc. 2006;37:387-390.
2. Christensen GJ. The increased use of small-diameter im-
plants. J Am Dent Assoc. 2009;140:709-712.
3. Shatkin TE, Shatkin S, Oppenheimer BD, et al. Mini dental
implants for the long-term fixed and removable prosthetics:
a retrospective analysis of 2514 implants placed over a five-
year period. Compend Contin Educ Dent. 2007;28:92-99.
Dental Learning / February 2011 3