September18, Unitedkingdom  2021 


Abstract Volume: 3 Issue: 3 ISSN:

Minimal invasive treatment option in the atrophied mandible

 Dr. Jimoh Olubanwo Agbaje BDS, DMD, FMCDS, MMI, PhD1, Dr. Henri Diederich* 2.

1. OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, Catholic University Leuven, Belgium

2. Dr. Henri Diederich, 114 av de la Faiencerie, L- 1511 Luxembourg

Corresponding Author: Dr. Henri Diederich

Copy Right: © 2021 Dr. Henri Diederich. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.  

Received Date: August 17, 2021

Published date: September 01, 2021

: Flapless surgery, Immediate loading, One piece implant, edentulous patient, Rehabilitation

Minimal invasive treatment option in the atrophied mandible


The absence of teeth has a negative impact on chewing performance and the swallowing threshold of edentulous patient.

Poor masticatory function decreases oral health quality of life and people concerned are usually unhappy. Rehabilitation of an edentulous jaw within short time improves patient masticatory function and general quality of life1.

This article aims to introduce a new implant system which allows in a very short time (about 2 weeks) to improve patients quality of life.

The implants used are a new generation of implants from the company TRATE /Switzerland) and the range of implants are called ROOTT M implants. The Implant system consists of several types of components specifically developed for different locations in the jaw2.

Implants characteristics:

There are one-piece implants, so called since no other components are needed except a fixation screw for attachment to prosthesis. These implants are a single component 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 absence of intrinsic micro gaps helps avoid peri -implantitis over time. The abutment direction on the implant can be adjusted up to 15 ° relative to the implant axis. The length of the implants ranges from 08 to 20 mm and thickness from 3mm to 5 mm. The implants have a resorbable blast media surface1-4.

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 similar to that of crestal implants, with a recommended minimum torque of 35 N/cm.

Single piece implants (Compressive M) 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.

-Available systems

The one-piece implant offers a unique monobloc design that integrates both implant and superstructure, for a quick, simple one-stage procedure or two stage procedure.  The advantage of the one-piece implant (by ROOTT) is that there is no connection between the implant body and the abutment. There is no risk of screw loosening or a screw fracture. There is also no ‘pumping effect’ that may induce bone loss around the implant neck.

The monobloc implant (Compressive M by ROOTT) has a tissue level connection instead of a bone level connection. This tissue level connection ensures that even if there is a pumping effect it will not induce bone resorption since it is far from the bone level.

Implants are specifically engineered for use in narrow ridges and tight spaces5. The implant body is tapered, it ensures a high implant stability which encourages an immediate loading process.

The ROOTT Implant system consists of several types of components specifically developed for different locations in the jaw2, 4, 6.

The  implant system incorporates the whole range of treatment procedures and it encourages early loading which ensures that patient edentulism can be taken care of immediately with the restoration of function and aesthetics within a few days7.

The ROOTT system incorporates ranges of treatment options for management of edentulism, and it is a alternative to extensive surgical procedures in situations where there is substantial bone resorption3, 4, 6, 7.

-Presenting the problem of these people in general elderly people but beginning from 38-98

Mastication comfort in a atrophied mandible is a major problem for all concerned. Poor chewing function negatively impacted the oral health quality of life and prolonged edentulism often results in dimensional changes in bone and soft tissue. The severity of these changes depends on the duration of the edentulism and the patient's systemic and oral well-being1, 8.

Due to the complete loss of teeth, the individual loses various functions such as chewing and talking. There is of course also an aesthetic aspect. For these reasons, the patient tries to look for a solution. The insertion of a new prosthesis can therefore play an important role in improving chewing and oral health quality of life in the edentulous patients (young and elderly)8.

The occlusal force decreases under the influence of several factors. In the elderly, this is often a result of tooth loss, lack of a dental prosthesis, masticatory muscle sarcopenia, poor periodontal condition and orofacial pain9, 10.

The advantage of flapless and immediate loading

One-piece implants facilitate oral rehabilitation and accelerate tooth replacement procedure11, 12. The implant permits minimally invasive surgical techniques with a simpler treatment sequence at lower costs13. 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 abutments11, 13.

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 prosthesis14, 15.

Case report

Patient is a 66 years old man who lost his remaining teeth in the mandible due to chronic periodontitis (see Panoramic radiograph below). He presented at the clinic with a reason to get fixed teeth in the mandible. A clinical examination of the mouth showed a partial edentulous lower arch with resorbed ridge and periodontally compromised teeth (33 and 34). Radiographic examination using an orthopantomogram showed a partial edentulous lower jaw with moderate vertical bone resorption in the front and severe vertical resorption in the premolar and molar region (Figure 1).

Treatment Plan: From a prosthetic point of view, the patient desired a fixed prosthetic solution. In the lower jaw a flapless immediate loading treatment with a bar for overdenture retention was proposed. The patient agreed to this treatment plan.

After an implant placement, bite registration was done. Then transfer copings were screwed on the implants in the mandible and an impression was taken with silicone immediately after the surgery.


The one-piece implant (Compressive M ROOTT) is an implant for immediate loading , or for delayed load in case of weak insertion torque. One-piece implants are time efficient since there is no need for a second stage surgery, mucosal healing period which decreases patient exposure to additional pain and discomfort. The innovative geometries and advanced surface morphology of the implant offer high initial stability13, 16.

The one-piece implant provides a simple treatment sequence at a lower cost and it offers the possibility to treat elderly patients (but also younger) with a minimal invasive implant placement (Flapless implant surgery) technique.  The 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.

One-piece implants make the rehabilitation of edentulous cases possible within a short period of time as seen in the case above.


1.  Ester Fonteyne, Carine Matthys, Laura Bruneel, Laurence Becue, Hugo De Bruyn, and Kristiane Van Lierde. “Articulation, oral function, and quality of life in patients treated with implant  overdentures in the mandible: A prospective study”. Clin Implant Dent Relat Res. 3, 388-399. 23-6-2021.

2.  Agbaje JO, Diederich H. “Use of cortically fixed at once implants for the treatment of atrophic and extreme athrophic jaws”. Africa journal of Dentistry and Implantology 2018;43-50

3.  Agbaje JO, Diederich H. “Minimal Invasive Modality for Full Rehabilitation of Edentulous Mandible with One-Piece Implants in Elderly Patients; A Case Report”. Adv Dent & Oral Health 2018;8:001-006

4.  Agbaje JO, Diederich H. “Minimal Invasive Concept for the Rehabilitation of Edentulous Jaw with One-piece Implants”. International Journal of Case Reports & Short Reviews 2018;4:028-030

5.  Wu AY, Hsu JT, Chee W, Lin YT, Fuh LJ, Huang HL. “Biomechanical evaluation of one-piece and two-piece small-diameter dental implants: In-vitro experimental and three-dimensional finite element analyses”. J Formos Med Assoc 2016;115:794-800

6.  Agbaje JO, Meeus J, Vrielinc L, Diederich H. “Rehabilitation of Atrophic Maxilla using  Pterygoid Implants: Case Reports”. Modern Approaches in Dentistry and Oral Health Care 2018;1:1-6

7.  Henri Diederich, Alexandre Junqueira Marques, and Léo Guimarães Soares. “Immediate Loading of an Atrophied Maxilla Using the Principles of Cortically Fixed Titanium Hybrid Plates”. Advances in Dentistry & Oral Health (ADOH) 3(3), 001-003. 2017.

8.  Figueredo OMC, , Câmara-Souza MB, Carletti TM, and odrigues Garcia RCM. “Chewing ability and oral health-related quality of life in frail elders after new complete dentures insertion: A paired controlled clinical trial. Special care in dentistry. American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry” 40(2), 168-174. 2020.

9.  Taylor TD. “Fixed implant rehabilitation for the edentulous maxilla”. Int J Oral Maxillofac Implants 1991;6:329-337

10.  Rungcharassaeng K, Kan JY. “Aesthetic implant management of multiple adjacent failing anterior maxillary teeth”. Pract Proced Aesthet Dent 2004;16:365-369

11.  Wang QN, Li M, Qiu J, Zhang XZ, Wu ZQ, Chen DL, Xu JM, Tang CB. [“Application of one-piece implant-supported detachable telescope retained fixed bridge in edentulous cases”]. Shanghai Kou Qiang Yi Xue 2015;24:702-707

12.  Lauritano D, Grassi R, di SD, Lucchese A, Petruzzi M. “Successful mandible rehabilitation of lower incisors with one-piece implants”. J Med Case Rep 2014;8:406. doi: 10.1186/1752-1947-8-406.:406-408

13. Rajput N, K P S, G R, S C C, Mohammed J. “Minimally invasive transmucosal insertion and immediate provisonalization of one-piece implant in partially edentulous posterior mandible”. J Clin Diagn Res 2013;7:2070-2073

14.  Barrachina-Diez JM, Tashkandi E, Stampf S, Att W. “Long-term outcome of one-piece implants. Part II: Prosthetic outcomes. A systematic literature review with meta-analysis”. Int J Oral Maxillofac Implants 2013;28:1470-1482

15.  Pozzi A, Polizzi G, Moy PK. “Guided surgery with tooth-supported templates for single missing teeth: A critical review”. Eur J Oral Implantol 2016;9 Suppl 1:S135-53.:S135-S153

16.  Jung RE, Grohmann P, Sailer I, Steinhart YN, Feher A, Hammerle C, Strub JR, Kohal R. “Evaluation of a one-piece ceramic implant used for single-tooth replacement and three-unit fixed partial dentures: a prospective cohort clinical trial”. Clin Oral Implants Res 2016;27:751-761Five days after the try-in an appointment for prosthesis delivery was given. The patient was reviewed after 2 weeks. Thereafter, the patient was scheduled for follow-up at 3 months and then every 6 months

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