Open Access Maced J Med Sci electronic publication ahead of print, published on March 10, 2018 as https://doi.org/10.3889/oamjms.2018.130 _______________________________________________________________________________________________________________________________ Open Access Maced J Med Sci. 1 ID Design Press, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. https://doi.org/10.3889/oamjms.2018.130 eISSN: 1857-9655 Dental Science - Case Report Therapeutic Challenge in a Severely Atrophic Mandible Edvard Janev 1* , Nadica Janeva 2 , Marija Peeva–Petreska 3 , Kristina Mitic 4 1 Faculty of Dentistry, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia; 2 Department of Prosthodontics, Faculty of Dental Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia; 3 Department of Oral Surgery, Faculty of Dental Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia; 4 Department of Periodontology, Faculty of Dental Medicine, Ss. Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia Citation: Janev E, Janeva N, Peeva–Petreska M, Mitic K. Therapeutic Challenge in a Severely Atrophic Mandible. Open Access Maced J Med Sci. https://doi.org/10.3889/oamjms.2018.130 Keywords: Mini implants; Edentulous mandible; Total prosthesis; Augmentation *Correspondence: Edvard Janev. Faculty of Dentistry, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia. E-mail: edijanev@hotmail.com Received: 06-Dec-2017; Revised: 21-Dec-2017; Accepted: 08-Feb-2018; Online first: 10-Mar-2018 Copyright: © 2018 Edvard Janev, Nadica Janeva, Marija Peeva–Petreska, Kristina Mitic. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) Funding: This research did not receive any financial support Competing Interests: The authors have declared that no competing interests exist Abstract BACKGROUND: After tooth loss, however, severely atrophic residual alveolar ridges are fairly common, especially in patients who have been edentulous for a long period. Anterior area of the mandible is areas where clinicians have greater anatomical limitations. Reduced alveolar bone height very often represents a contraindication to implant therapy, unless a procedure such as a ridge augmentation is performed. CASE REPORT: This study aims to present two separate cases in highly selected edentulous anterior mandibular sites, where one stage, mini implants were used to support total prostheses. Small diameter implants have been used for retention of complete removable mandibular overdentures. This is an excellent option for those who suffer from the inconvenience and embarrassment of loose lower dentures and are tired of having to use sticky pastes and creams to make their dentures stay in place. CONCLUSION: Small diameter implants, when used multiples may offer adequate support for a removable prosthesis and overcome this problem. Introduction The management of the atrophic mandibular ridge has always been a challenge for the clinicians because of inadequate retention and support that the ridge offers to the complete denture prosthesis.When the complete denture patient is unable to tolerate the prosthesis in spite of all efforts from the clinician, the surgical approaches must be resorted to; these include the vestibuloplasties and the bone grafts [1]. The conventional removable total prosthesis has a frequent motion during the act of eating, chewing, swallowing and even talking. According to some statistic data, 50% of patient report those problems and 40% of them are located in the mandible, due to progressive bone resorption (Figure 1). Figure 1: Resorption process in the mandible The new method of treatment and its purposes include the following parameters: Mini Dental Implants (MDI) anchor the existing upper or lower dentures and provide stability. They are suitable to replace single or multiple missing teeth, and the patient can be prepared for fixed porcelain crowns