Successful Dentures Part II - Removable Prosthodontics

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Implant Supported Overdentures 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 Overdenture Attachments Overdenture Attachments 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 Overdenture Attachments 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. Overdenture Attachments 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. Implant Placement Implant Placement 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
Page 1 and 2: Secrets to Successful Dentures Part
Page 3 and 4: Anatomy in Relation to Complete
Page 5 and 6: Anatomy in Relation to Complete
Page 7 and 8: Mandibular Relations Vertical Dime
Page 9 and 10: Anterior Tooth Selection Shape Ante
Page 11 and 12: Anterior Tooth Arrangement General
Page 13 and 14: General Concepts of Denture Occlusi
Page 15 and 16: Non-Anatomic Occlusion Is ‘Balanc
Page 17: Maxillary Posterior Tooth Arrangeme
Page 21 and 22: Locator Selection Locator Abutment
Page 23 and 24: Direct Pickup Direct Pickup Choose

Successful Dentures Part II - Removable Prosthodontics

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