Successful Dentures Part II - Removable Prosthodontics

Secrets to Successful Dentures 

Part II 

Dalhousie Continuing Education 

Dr. Mark Vallee BSc MS DDS DP FRCDC 

Topics 

Conventional Denture Treatment: 

Trends in removable prosthodontics. 

Anatomy 

Maxillo-Mandibular Relationship 

Vertical Dimension 

Tooth Selection, Arrangement, and Occlusion 

Implant Supported Overdentures: 

Overdenture abutments 

Implant Placement 

Locator Abutments 

Converting a denture into an overdenture. 

Direct Pickup 

Trends in Removable 

Prosthodontics 

Conventional Denture Treatment 

Patient Demographics 

Esthetic Awareness 

Implant treatment 


Average lifespan of patients: 

14 


60 

13 

Percent Edentulous 

18+ yrs old 

50 

Percent Edentulous 

65+ yrs old 

Percent 

12 

11 

40 

10 

1960 1970 1980 1990 

30 

1960 1970 1980 1990 

Trends in tooth loss


Will there be a need for complete dentures in 

2020? 

Complete dentures patients will increase from 

33.6 million adults in 1991 to 37.9 million adults in 

2020. 

The 10% decline in edentulism experienced each 

decade for the past 30 years will be more than 

offset by the 71% increase in the adult population 

older than 55 years. 



Implant Treatment 

An increase in esthetic awareness has prompted 

an increase in patient demand for quality 

removable prosthodontic restorative treatment. 

Out of 33 million edentulous patients only 2-4% have received 

implant treatment 

Estimated 60% of patients are NOT given implants as a 

treatment option 

Implant supported overdentures are now the standard of care for 

the edentulous mandible 

Anatomy 

Anatomy in Relation to Complete 

Dentures 

Edentulous Maxilla 

e 

d 

f 

i 

a 

l 

g 

k 

j 

h 

c 

d 

m 

b 

a. Labial frenum 

b. Buccal frenum 

c. Labial vestibule 

d. Anterior buccal vestibule 

e. Posterior buccal vestibule 

•Retrozygomatic space 

•Coronoid bulge 

f. Hamular notch 

•Pterygomaxillary notch 

g. Fovea palatini 

h. Vibrating line 

i. Residual alveolar ridge 

j. Palatal rugae 

k. Incisive papilla 

l. Median palatine raphe 

m. Maxillary tuberosity







e 

d 

f 

i 

a 

c 

k 

j 

l 

g h 

d 

m 

b 


•Fold of mucous membrane 

•Does not contain muscle 

•Labial notch in denture is 

narrow 


•Overlies levator anguli oris 

•May be moved in an A-P 

direction by the actions of the 

orbicularis oris and buccinator 

e 

d 

f 

i 

a 

c 

k 

j 

l 

g h 

d 

m 

b 

c. Labial vestibule 

•Reflection contains no muscle 

d. Anterior buccal vestibule 

•Overlies buccinator muscle 

whose fibers are downward and 

forward and limit the height and 

thickness of the buccal flange 

e. Posterior buccal vestibule 

•Thickness determined by the 

masseter muscle 

•Coronoid process of the 

mandible encroaches on the 

space during lateral excursions 

•Labial and buccal flanges of the 

denture must contact movable tissues 

in order to make a seal 




e 

d 

f 

i 

a 

l 

g 

k 

j 

h 

c 

d 

m 

b 

f. Hamular notch 

•Pterygomaxillary notch 

•Does not contain any 

muscles or ligaments to 

interfere with the addition 

of pressure with a 

postdam 

g. Fovea palatini 

•2 small pits representing 

mucous gland openings 

•Usually located just 

posterior to the vibrating 

line 




e 

d 

f 

i 

a 

l 

g 

k 

j 

h 

c 

d 

m 

b 

h. Vibrating line 

•Imaginary line across palate 

•Connects the 

pterygomaxillary notches 

Posterior Palatal Seal 

•Area not a line 

•Functions: border seal, prevent food 

impaction beneath, improve retention, 

compensate for shrinkage of denture 

resin 

•Pressure on displaceable mucosa that 

covers palatal glands 

•Anterior border – junction between 

hard and soft palate; ‘blow’ line 

•Posterior border (vibrating line) – 

junction between movable and 

immovable soft palate; ‘ah’ line 







e 

d 

f 

i 

a 

c 

k 

j 

l 

g h 

d 

m 

b 

Denture bearing areas 

i. Residual alveolar ridge 

•Crest is primary stress 

bearing area 

•Fibrous CT least 

displaceable and best 

able to carry the stress of 

mastication 

j. Palatal rugae 

•Secondary stress 

bearing area 

e 

d 

f 

i 

a 

c 

k 

j 

l 

g h 

d 

m 

b 

k. Incisive papilla 

•Guards the incisive 

canal 

•Pressure will interfere 

with the blood and nerve 

supply causing a burning 

sensation 

•Provide relief 

l. Median palatine raphe



Edentulous Mandible 




g 

b 

l 

f 

j 

k 

c 

a 

d 

i 

h 

e 



c. Lingual frenum 

d. Labial vestibule 

e. Buccal vestibule 

f. Residual alveolar ridge 

g. Buccal shelf 

h. Retromolar pad 

i. Pterygomandibular raphe 

j. Mylohyoid ridge 

k. Alveololingual sulcus 

l. Retromylohyoid space 

g 

b 

l 

f 

j 

k 

c 

a 

d 

i 

h 

e 


•Fold of mucous 

membrane 

•Does not contain muscle 


•Overlies depressor 

anguli oris (VII) 

•Movable by the 

buccinator and orbicularis 

oris (VII) resulting in a 

wide notch in the denture 

c. Lingual frenum 

•Overlies genioglossus 

muscle (XII) 







Denture bearing areas 

g 

b 

l 

f 

j 

k 

c 

a 

d 

i 

h 

e 

d. Labial vestibule 

e. Buccal vestibule 

•Entire periphery of denture 

must end in soft tissues 

•Stability of denture must 

come from the maximum use 

of all bony foundations where 

tissues are firmly and closely 

attached to bone 

g 

b 

l 

f 

j 

k 

c 

a 

d 

i 

h 

e 

f. Residual alveolar ridge 

g. Buccal shelf 

•Bounded laterally by the 

external oblique ridge and 

medially by the crest of the 

ridge 

•Attachment of buccinator 

muscle (VII) 

•Buccal flange rests upon 

buccinator and should extend 

as far as the tissues permit 

•Masseter muscle (V3) may 

crowd buccinator forward 

against the denture causing an 

indentation at the DB angle 




g 

b 

l 

f 

j 

k 

c 

a 

d 

i 

h 

e 

h. Retromolar pad 

•Contains: 

•Retromolar gland 

•Pterygomandibular 

raphe 

•Buccinator muscle 

•Temporal tendon 

•Underlying basal bone is 

resistant to resorption 

•Coverage will provide some 

border seal 

i. Pterygomandibular raphe 

•Extends from the pterygoid 

hamulus superiorly to the 

alveolar ridge inferiorly under 

the retromolar gland 




g 

b 

l 

f 

j 

k 

c 

a 

d 

i 

h 

e 

j. Mylohyoid ridge 

•Attachment of mylohyoid 

muscle (V3) which forms the 

muscular floor of the mouth 

•Fibers are almost horizontal in 

front of the hyoid where they join 

those of the opposite side to 

form a raphe 

•At the level of the hyoid they 

pass almost vertically downward 

to insert into the hyoid 

k. Alveololingual sulcus 

•Slopes toward the tongue to 

permit action of the mylohyoid 

•Length of flange distally 

compared to anteriorly is greater 

owing to the changed length and 

direction of the mylohyoid fibers




Panoramic Radiograph 

g 

b 

l 

f 

j 

k 

c 

i 

h 

e 

l. Retromylohyoid space 

•DL extension determined 

by styloglossus (XII) 

•Posterolateral extension 

determined by superior 

pharyngeal constrictor (X) 

and palatoglossus (X) 

•Overextension may 

cause pain on swallowing 

a 

d 

Mandibular Condyle 

Coronoid Process of mandible 

Glenoid Fossa 

Maxillary Tuberosity 

Nasal Septum 

Pterygomaxillary Fissure 

EAM 

Articular Eminence 

Anterior Nasal Spine 

Hard Palate 

Orbit 

Zygomatic Arch 

Maxillo-Mandibular Relationship 

Pharynx 

Lip Lines 

Earlobe 

Mental Foramen 

Mandibular Foramen 

Shadow of tongue 

Styloid Process 

Symphysis 

Mandibular Canal 

External Oblique Ridge 

Cervical Vertebrae 

Hyoid Bone 

Facial Artery Notch 

Maxillary Relations 

Incisal Display 

Dental Midline 

Occlusal Plane Orientation 

Facebow 


Natural Dentition 

Incisal edge of central 

incisor in relation to 

the lip line at rest 

Young woman – 3 mm 

below lip line at rest 

Young man – 2 mm 


Middle age – 1.5 mm 


Elderly (>80) – 0 mm 

below to 2 mm above 

lip line at rest 

Incisal Display at Rest 

Rest After Wax Adjustment 

Maximum Smile After Wax 

Adjustment





Rest After 

Smile After 





Frontal Plane 

Parallel to 

interpupillary line 

Fox Plane 





Sagittal Plane 

Parallel to Camper’s Line 

Inferior border of the ala of 

the nose to the superior 

border of the tragus of the 

ear 

Frankfort horizontal plane 

Orientation to the external 

auditory meatus and 

orbitale 

Cephalometric landmark 

FHP 

CL 

OP

Mandibular Relations 


Centric Relation 


Adjust occlusal plane 

Parallel to maxillary rim 

Clinical assessment of vertical 

dimension 

Anatomic landmarks 

Physiologic rest position 

Pre-extraction records 

Existing prosthesis 

Esthetics 

Phonetics 

Swallowing 

Average occlusal rim 

dimensions 


Anatomic Landmarks 

2/3 up the height of the retromolar pad 


Anatomic Landmarks 

Level with the lower lip 

at rest 


Esthetics 


Phonetics 

‘S’ 

‘F’ 

‘Ch’ 

‘M’


Swallowing 


Average Occlusal Rim Dimensions 

During swallowing 

After swallowing 

Maxillary – 22 mm 

Mandibular – 18 mm 

Tooth Selection 

Anterior Tooth Selection 


Anterior teeth are 

primarily selected to 

satisfy esthetic 

requirements 

Posterior teeth are 

primarily selected to 

satisfy masticatory 

requirements/ 

occlusion 


Guides 

Pre-extraction records 

Photos, diagnostic 

casts, old radiographs 

Existing dentures 

Patient’s facial 

characteristics 

Patient’s gender, 

personality, age 

Arch size and shape 

Patient’s preferences 


Shape 

Square, tapering, 

ovoid 

Size 

Length, width, 

circumference 

Shade


Shape 


Shape 

Dentogenics concept 

Gender 

Male – rugged with square teeth 

and bold central incisors 

Female – pronounced 

curvatures, rounded point angles 

Personality 

Vigorous or delicate – maxillary 

lateral varies more in size, form, 

and position 

Age 

Young – tapered, ovoid, rounded 

teeth 

Middle – somewhere between 

young/old 

Old – square, sharp corners 

Ovoid 

Pronounced gingivo-incisal 

curvature which tends to 

disperse light and create a 

softened appearance 

Square 

Tapering 

Rounded contours which 

taper towards the cervical 

ridge 

Moderate gingivo-incisal 

curvature 

Central incisor is dominant and gingivo-incisal curvature is 

moderate 

Offers maximum light deflection and creates a bold effect 

50 


Size 


Size 

Width of 6 anteriors 

on a curve 

Average 46-56 mm 

Wax rim & ruler 

•Commissure of lips represents distal surface of canine 


Size 


Size 

Major rugae of palate points to canine position 

Exaggerated Smile 

Length 

High smile – 11% 

Reveals total length of 

maxillary anterior teeth and a 

continuous band of gingiva 

Average smile – 69% 

Reveals 75-100% of 

maxillary anterior teeth and 

interproximal gingiva only 

Low smile – 20% 

Displays less than 75% of 

maxillary anterior teeth


Commercial Products 

Size & Shape 


Determine the facial 

outline 

Compare form of face 

to vertical lines 

Square tapering 

Determine the size of 

the maxillary central 

Indicator is 

proportioned in a ratio 

of 16:1 

Width – 9.25 mm 

Length – 11 mm 

Size & Shape 

Length 

Width 

56 


Size & Shape 

Take a picture 

Insert it into a program 


Portrait shade guide 

Shade 

57 


Aim to harmonize 

between color of the 

skin, hair, & eyes 

Guides 

Complexion 

Hair color 

Eye color 

Age 

Personality & activity 

Patient desires 

Need to educate patients 

Shade 

Anterior Tooth Arrangement 

Position has been tentatively established during the 

clinical refinement of the maxillary occlusal rim 

Adequate lip support 

Proper phonetics


General Arrangement 

Considerations 

Anterior teeth are set primarily 

for esthetics not function 

Considering creating 

asymmetry after discussion 

with patient 

Each tooth should appear as 

an individual tooth 

Gingival 1/3 of maxillary 

incisors provide lip support 

Incisal 1/3 of maxillary incisors 

provides esthetics 

Maxillary anterior teeth are set 

on the smile line 

61 

Maxillary Anterior Tooth 

Arrangement 

Central 

Labial surfaces flush with wax rim 

contour 

Long axis slightly distal to 

perpendicular 

Incisal edge is at occlusal plane 

Lateral 

 

Long axis at an angle more distal 

than central 

Incisal edge is slightly above 

occlusal plane 

Canine 

Long axis at a more distal angle 

than lateral 

Cervical is prominent, incisal 

edge looks tucked-in 

Incisal edge is at occlusal plane 

62 


Arrangement 


Arrangement 

• Labial surface of the centrals usually 5-7mm anterior to incisal papilla 


Arrangement 

Golden Proportion 

Ratio of 1.618:1 

Proportion between a 

larger part and a smaller 

part 

Width of the central 

incisor is in the golden 

proportion to the width of 

the lateral incisor 


Arrangement 

Esthetics of natural 

teeth 

Avoid lampshade 

convergence of roots! 

65 

66

Mandibular Anterior Tooth 

Arrangement 

Mandibular Anterior Tooth 

Arrangement 

• Teeth are set over bone 



• 2-3 mm Overjet 

• 0 mm Overbite 

Tooth Selection 

Posterior Tooth Selection 

Goals of Complete Denture 

Occlusion 

Minimize trauma to the 

supporting structures 

Preserve remaining 

structures 

Enhance stability of the 

dentures 

Facilitate esthetics and 

speech 

Restore mastication 

efficiency to a reasonable 

level 

Decrease lateral forces to 

the residual ridges 

Right Working 

Left Working

General Concepts of Denture 

Occlusion 

Occlusal Spectrum 

Common Features 

Functional anatomy is the main 

determinant of denture tooth 

position 

Simultaneous, bilateral posterior 

contact in centric relation 

Centralization of centric occlusal 

forces over the mandibular 

residual ridges 

Buccal-lingually 

Anterior-posteriorly 

Centric Relation 

Anatomic 

Balanced occlusion 

Lingualized 


Non-balanced occlusion 

Non-anatomic (Monoplane) 


Non-balanced occlusion 

Neutrocentric 

Occlusal Spectrum 

Lingualized 

(lingual contact) 

semianatomic 

nonanatomic 

(balancing 

ramp) 


Criteria 

Resorbed or flabby ridges 

Physical condition of the patient 

Patients who clench or brux 

Previous denture occlusion 

Ridge relationship 

Immediate dentures 

Opposing arch 

anatomic 

nonanatomic 


Indications 


Indications 

Anatomic 

Non-anatomic 

Anatomic 

Non-anatomic 

Good residual ridges 

Well coordinated patient 

Previously successful with 

anatomic dentures 

Class I ridge relationship 

Denture opposes natural 

dentition 

When “Lingualized” 

occlusion is desired 

Poor residual ridges 

Poor neuromuscular control 

(Bruxers, CP, etc.) 


monoplane dentures or 

severely worn occlusion on 

previous denture 

Arch discrepancies 

Class II or III or cross-bite 

Good residual ridges 

Poor residual ridges 


Except when opposing natural 

dentition 

Potential poor follow-up


Indications 


Indications 

Anatomic 

Non-anatomic 

Anatomic 

Non-anatomic 

Well coordinated patient 

Poor neuromuscular control 

(Bruxers, CP, etc.) 


anatomic dentures 


monoplane dentures or 

severely worn occlusion on 

previous denture 


Indications 


Indications 

Anatomic 

Non-anatomic 

Anatomic 

Non-anatomic 

Class I ridge relationship 

Arch discrepancies 

› Class II or III or cross-bite 

Denture opposes natural 

dentition 


› Except when opposing natural 

dentition 

Anatomic Occlusion 

Lingualized Occlusion 

Advantages 

Definite point of positive 

intercuspation may be 

developed 

Esthetically similar to natural 

dentition 

Tooth-to-tooth and cusp-tocusp 

balanced occlusion can 

be achieved 

Maintains some shearing 

ability after moderate wear 

Disadvantages 

Difficult to set 

Less adaptable to arch 

relation discrepancies 

Horizontal force 

development due to cusp 

inclinations 

Harmonious balanced 

occlusion is lost with denture 

base settling 

Requires frequent follow-up 

and may require more 

frequent relines to maintain 

proper occlusion 

Indications 

High esthetic demands 

Severe mandibular ridge 

atrophy 

Displaceable supporting 

tissues 

Malocclusion 

Previous successful denture 

with lingualized occlusion 

Advantages 

Good esthetics 

Freedom of non-anatomic 

teeth 

Potential for bilateral balance 

Centralizes vertical forces 

Minimizes tipping forces 

Facilitates bolus penetration 

(mortar and pestle effect)

Non-Anatomic Occlusion 

Is ‘Balance’ Necessary? 

Advantages 

Reduction of horizontal 

forces 

CR can be developed as an 

area instead of a point 

Freedom of movement 

Can develop solid occlusion 

despite arch alignment 

discrepancies 

Easily adapted to situations 

prone to denture base 

shifting 

Easy to set and adjust teeth 

Disadvantages 

No vertical component to aid 

in shearing during 

mastication 

Occlusal adjustment impairs 

efficiency unless spillways 

and cutting edges restored 

Patients may complain of 

lack of positive 

intercuspation position 

Somewhat esthetically 

limited (don’t look like natural 

teeth) 

“Bolus in” 

“Balance out” 

Complete Denture Occlusion 

Investigators have not shown one 

type of denture occlusion to be: 

Superior in function 

Safer to oral structures 

More acceptable to patients 

Neuromuscular control may be 

the single most significant factor 

in the successful manipulation of 

complete dentures under function 

Tongue function and denture 

wearing experience 

Posterior Landmarks 

Landmarks for the Arrangement of Posterior Denture 

Teeth 

Crest of the ridge 

Mandibular posterior teeth 

are centered over the ridge 

Medial/lateral 

Retromolar pad 

Medial/lateral 

Superior/inferior 

2/3 height retromolar pad 

88 

Posterior Landmarks 

Mandibular Posterior Tooth 

Arrangement 

Three landmarks used to determine the plane of occlusion: 

Retromolar pad 

2/3 height retromolar pad 

Incisal edge of the 

mandibular central incisor 

90


Arrangement 


Arrangement 

Horizontal Plane 

Pound’s triangle 

Lingual aspect of mandibular teeth should be positioned within 

a triangle created by drawing 2 lines from the mesial aspect 

of the canine to each side of the retromolar pad 

Horizontal Plane 

Central groove of denture teeth centered over the crest of the 

ridge 

91 

92 


Arrangement 


Arrangement 


Boucher 

Occlusal plane of mandibular arch should be established at ⅔ 

height of the retromolar pad 

Teeth are not set on the ascending area of the mandibular ridge 

or the retromolar pad 

Otherwise the mandibular denture tends to shift forward 


Long axes of the teeth are perpendicular to the occlusal plane 

Marginal ridges of adjacent teeth should be at the same level 

93 

94 


Arrangement 


Arrangement 

Frontal Plane 

Facial view 

Buccal and lingual cusps should contact the occlusal plane 

analyzer 

Frontal Plane 

Lingual view 

Buccal and lingual cusps should contact the occlusal plane 

analyzer 

95 

96

Maxillary Posterior Tooth 

Arrangement 

Maxillary Posterior Tooth 

Arrangement 

Lingual cusps should be 

set over central fossa of 

mandibular teeth 

Teeth should be set up 

to, but not on top of, the 

tuberosity 

Teeth should not extend 

beyond the denture base 

periphery on the facial 

97 

98 

Implant Supported Overdentures 

Conventional Dentures 

Tooth loss increases with age 

the number of edentulous people will continue to increase for 

several decades because of the increase in mean age. 

Complete dentures have been the traditional standard of 

care for edentulous patients for more than a century. 

Complete denture wearers are usually able to wear an 

upper denture without problems, but many struggle with 

the complete lower denture because they are loose. 

Conventional dentures have a bite force of 25% and 20% 

chewing efficiency of natural teeth. 


Dissatisfied 

7.7 % 

Moderately 

Fully Satisfied 

Satisfied 

66.7 % 

25.6 % 

Patient satisfaction also depends upon 

expectations and some patients may have very 

unrealistic expectations. For this reason it is 

important to guide and educate the patient. 


Patients are significantly more satisfied with 2-implant 

overdentures than with new conventional dentures 

regardless of the type of attachment system used 

bar, ball, magnet, locator. 

Implant overdentures increase the bite force to 60% 

of natural teeth. 

Patients find implant overdentures significantly more 

stable, 

their ability to chew various foods are significantly 

easier, 

they are more comfortable 

and speak more easily.


Studies of several populations have shown that ratings of 

quality of life are significantly higher for patients who 

receive 2-implant mandibular overdentures opposing 

complete maxillary conventional dentures than for those 

with conventional dentures. 

People who receive mandibular 2-implant overdentures 

modify their diets which improves their nutritional state. 

Such improvements may have a strong positive impact on 

general health, particularly for senior adults who are 

vulnerable to malnutrition. 

2-implant overdenture are becoming the first choice of 

treatment for the edentulous mandible. 

Overdenture Attachments 

Ball attachments 

Ball and rubber o-rings and/or metal housings 

Used to be the attachment of choice 

Wear quickly, not as retentive 



Bar Attachments 

1-3 bars with 1-3 clips 

Retentive at first, get loose or break over time. 

Hard to adjust and fix 

Not as popular anymore 

Locator 

Lowest vertical height of 3.17mm. 

Self aligning 

Durable 

Up to 40° angle correction 

Retention flexibility 


Fixed Full-arch Restorations 

Can also have a bar with locators cast or tapped into the framework. 

Usually have 3 - 4 locators incorporated. 

Framework can be gold (cast) or titanium (milled). 

Framework must be passively attached to the implants. 

Returns the bite-force of the edentulous to approximately 80% of natural 

teeth. 

Implant supported and retained. 

Returns the bite-force of the edentulous pt close to natural teeth 

Must have enough space for restoration, minimum of 10mm. 

Framework can be gold (cast), titanium or zirconia (milled). 

Prosthesis can be metal-ceramic, or metal-acrylic. 

Framework must be passive. 

Patient must be able to clean underneath framework 

Implant supported and retained.

External-hex and Internal-hex 

External-hex Implants 

More common in the past 

Good for multiple unit restorations 

Rely more on the screw for retention of 

single unit restorations. 

Internal-hex Implants 

More common now 

Good for single tooth restorations 

Can use for multiple unit restorations - 

cement retained or need specific 

abutments. 

Rely more on the connection for 

retention of single unit restorations. 


Md Implants usually placed in position of: 

2 implants - 33, 43 

4 implants - 32, 34, 42, 44 

Mx Implants usually placed in position of: 

4 implants - 13, 23, 16, 26 

6 implants - 13, 23, 15, 25, 17, 27 

Tissue supported, implant retained. 



Parallel to each other 

Perpendicular to the occlusal 

plane 

Same occlusal height 

Equal distance from the 

midline 

Center of the ridge Bu-‐Li 

Too far apart: 

Increased ant-‐post rocking 

22 mm 

17 mm 

One implant is more distal 

Primary rotation point or 

fulcrum when the patient 

occludes posteriorly 

Increase complications 

Wear of the attachment 

Abutment loosening 

Crestal bone loss 

Implant failure 

Prosthesis fracture 

Surgical Guides 

A necessity. 

Allows the clinician to 

have control over the 

prosthetic outcome. 

Should be 

made/designed by the 

DDS not the lab. 

Duplicate the denture or 

wax set-up in orthodontic 

resin 

Drill holes for placement 

Slot from foramen to 

foramen, end at the 

incisal edge 

Panoramic Radiograph






Locator Abutments 

Diameter of Locator 

retention top – 3.85 

mm. 

Available in a variety 

of cuff heights and for 

most implant types 

and sizes. 

1.5 mm of the top 

should be 

supragingival to be 

able to retain the 

overdenture. 

Recommended torque 

is 20-25 Ncm. 

Height mm 1 2 3 4 5 

height mm 

Ø mm

Locator Selection 

Locator Abutment Delivery 

Select the correct Locator Abutment based on the 

level of tissue indicated when using the Abutment 

Depth Gauge. 

Appropriate abutment height keeps the top 1.5 

mm extended above the soft tissue. 

Seat the Locator Abutment using the Locator 

Abutment Driver, part of the Core Tool. 

For final tightening, use the Torque Wrench Bit 

together with a Torque Wrench, or insert a driver 

into the Abutment Driver. 

The recommended seating torque is 20-25 Ncm. 

Next steps 

Make a new denture start to finish 

Initial impression 

Final impression with your choice of implant 

impression 

Wax Rim adjustment 

Wax try-in 

Delivery 

Convert an existing denture into an overdenture 

With a reline impression (indirect approach) 

Direct pickup of Locator housings with a chairside 

reline. 

Implant Impressions 

Open Tray Impression 

Coping 

Locator Pickup 

Impression Coping 

Closed Tray Impression 

Coping 

Fixture Level Impression 

Abutment Level impression 

Firmly attach the Locator Abutment Pick-ups to 

the Locator Abutments. 

Verify to ensure a perfect fit. 

The copings should have stable friction retention.

Converting a denture into an 

overdenture. 

Identify the positions 

of the Locator 

Abutments in the 

denture base. 

Relieve the denture 

base to obtain 

adequate space for 

the impression 

material and the 

Locator Abutment 

Pick-up. 


overdenture. 

Make an impression 

using an elastic 

impression material 

Make a reline if 

needed. 


overdenture. 

Firmly place the 

Locator Abutment 

Replica in the 

impression copings, 

which, if indicated, are 

then repositioned in 

the impression 


overdenture. 

Fabricate a working 

model with the Locator 

Abutment Replica and 

high-quality stone 

material. 

Complete the relining 

and convert the 

existing denture into a 

Locator attachment 

retained overdenture 


overdenture. 

Replace the processing insert with the required 

retentive insert. 

Remove the Locator Insert by using the Insert 

Removal Tool portion of the Locator Core Tool. 

Press a new Locator Insert over the Insert Seating 

Tool, and press the Locator Insert into the housing 


overdenture. 

Five types of Locator 

Inserts are available to 

obtain the required 

retention for the 

prosthesis. 

The inserts come with 

different retentive 

holding force levels: 

Clear 5 Pounds 

Pink 3 Pounds 

Blue 1.5 Pounds 

Green 3-4 Pounds* 

Red 1.5 Pounds* 

(*for angled implants)

Direct Pickup 

Direct Pickup 

Choose, insert, and tighten correct Locator 

abutments 

Place processing ring and locator housing 

with black processing insert on the abutments. 

Identify position and relieve denture base, create vent 

for excess acrylic. 

Apply acrylic and seat denture, allow for adequate 

curing. 

Trim and polish, remove processing ring, and replace 

insert with appropriate retentive insert. 

Locator Core Tool 

Locator Core Tool Use 

Gap 

Loosen the Insert Removal Tool 

a full 3 turns counter clockwise. 

You will see a visible gap. 

To remove an insert from the titanium metal housing; 

simply insert the tip into the insert assembly and push 

straight in to the bottom of the nylon insert. 

Then tilt the tool so that the sharp edge of the tip will 

grab hold of the insert and pull it out of the cap. 

Insert Removal Tool Insert Seating Tool Abutment Driver 

To discard the insert from the new tip on the Locator Core Tool; 

point the tool down and away from you and tighten the 

Insert Removal Tool clockwise back onto the Locator Core Tool. 

This will activate the removal pin and dislodge the insert from 

the tip end of the Insert Removal Tool. 

Separate the Insert Removal Tool section from 

the Locator Core Tool and use the Insert Seating Tool 

end of the remaining two sections to place a 

new insert into the empty titanium metal housing. 

1. Loosen Insert Removal Tool 2. Remove the Insert 

Gap

3. Discard the Insert 

4. Remove the Insert Removal 

Tool 

5. Place a New Insert 

Questions? 

Insert Seating Tool end

Successful Dentures Part II - Removable Prosthodontics

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