Objective: The aim of this study was to assess the final insertion torque values achieved using site-specific drilling protocols for a novel mini implant system for removable complete overdentures. Anatomical and technical factors influencing final insertion torque were recorded and analyzed.Material and Methods: Participants were randomized to two surgical protocol groups (flapped or flapless) and all received four mini implants (Straumann ® mini implant system; Straumann AG) in the anterior mandible, using a 1.6 mm needle drill and a 2.2 mm pilot drill for the implant bed site preparation. The final insertion torque was recorded as the main outcome variable during surgery. Bone type, radiographical bone density, ridge form, implant length, and the drilling protocol were considered as independent variables. Descriptive statistics, generalized estimating equations (GEE) regression, and heatmap charts were used for data analyses.Results: A total of 296 mini implants were placed in 74 patients (mean age = 64.1 ± 8.0; 64.9% female) using flapless (n = 37) or flapped (n = 37) surgeries. Mean final insertion torque was 55.8 ± 18.4 Ncm (10.5% > 35 Ncm, 48.9% between 35 and 65 Ncm, and 40.6% > 65 Ncm). The needle drill was used in only 43.9% of the implant bed sites. Higher final torque values were observed for higher bone densities (bone type I > II > III, and D1-D2 > D3-D4), highly resorbed ridge forms (5-6 > 3-4), flapped surgeries, and male patients. However, regression models showed that the likelihood of achieving optimal insertion torque (≥35 and ≤65 Ncm) was higher for females (OR = 2.14; 95%CI = 1.14-4.01; p = 0.018), ridge forms 3-4 (OR = 2.87; 95%CI = 1.05-7.85; p = 0.040), and flapless surgeries (OR = 1.96; 95% CI = 1.09-3.51; p = 0.024).Conclusions: Sufficient primary stability for immediate loading was achieved for the majority of the mini implants placed. Surgical implant bed preparation should be sitespecific to achieve optimal primary stability for immediate loading while avoiding excessive insertion torque.

ObjectiveTo report the 1‐year implant survival/success and peri‐implant outcomes of mandibular overdentures retained by four titanium‐zirconium mini implants (Straumann® Mini Implant System), and to assess how surgery and loading protocols influence these outcomes.Materials and MethodsA 2 × 2 factorial randomized clinical trial (RCT) tested the combined effects of two loading protocols (immediate or delayed) and two surgical approaches (flapless or flapped) on the success/survival of the mini implants, and peri‐implant parameters (plaque, bleeding, sulcus depth, gingival position, and marginal bone loss). Outcomes were assessed up to 1‐year after loading, and generalized estimating equations (GEEs) were used to analyze longitudinal and within‐patient clustered data.ResultsTwo hundred and ninety‐six implants were placed in 74 patients. The implant survival/success rates after 1 year were 100%, and no major biological complications were observed. After 1‐year, descriptive data suggest no noticeable changes in plaque scores, whilst a reduction in bleeding scores at the 6‐month and 1‐year follow‐ups compared to baseline. Good longitudinal stability was observed for the probing depth and gingival margin height measures. Overall mean marginal bone loss was 0.68 (±0.68) mm after 3 months and 0.89 (±0.75) mm after 1‐year. The flapless protocol showed better results on soft tissue stability and health but a slightly higher risk for marginal bone loss.ConclusionThe results of this RCT suggest that mandibular overdentures retained by this novel mini implant system represent a safe and predictable treatment option as confirmed by implant survival/success and peri‐implant outcomes, even when flapless surgery and immediate loading protocols are adopted.

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Background Several complete denture wearers have major complaints and may be benefitted from implant treatment. However, the factors that shape the demand for and utilization of implants need further investigation. Objective The aim was to evaluate edentulous patient's willingness to accept or refuse the offer and provision of implant‐retained treatment. Methods As part of a clinical trial, edentulous subjects were offered a mandibular overdenture retained by four mini‐implants opposing a conventional maxillary denture. Treatment was offered without any financial costs for the patients. Patients' level of interest in receiving treatment was assessed using a 5‐point Likert scale, and they were asked to respond to a list of reasons that led to their decision to accept or refuse implants. Those who refused implants received conventional prosthodontic interventions as required, and those who accepted implant treatment underwent surgical planning and implant placement. Results Of 175 eligible subjects, 147 accepted the offer of treatment and were invited to take part in the study (69.4% women, mean age 67.4 ± 10.0 years). Overall, 111 patients (75.5%) expressed a positive intention to undergo implant treatment at the initial contact. Implant treatment was performed for 56.3% (9/16) of those who answered ‘probably yes’ about their level of interest in implant treatment on the Likert scale, and 69.6% (64/92) of ‘certainly yes’ (p < .001). Older subjects were less likely to receive implants (OR = 0.93; p = .036), whilst those with a positive intention towards implants (OR = 3.15; p = .001), those previously treated by the dental team (OR = 7.89; p < .001), and who actively demanded implants (OR = 18.1; p < .001) were more likely to accept treatment. Improved chewing was the most common reason for accepting implants, whilst fear of surgery was the most reported reason for refusal. Conclusion Refusal of implants was high among edentate patients even when financial costs were removed. Patients' initial attitude towards acceptance is a key factor in the demand for and uptake of implant therapy.