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IMPLANT RETAINED DENTURES
• Dr. Larry Pitzak, D.D.S. , Western Dental Services Quality Management
• Office 714-571-3168
• Fax 714-571-3698
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IMPLANT RETAINED DENTURES
WHY DO IMPLANT RETAINED
DENTURES ????
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Does Your Denture Patient Look Like This??
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Testimonial
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Panorex – Implants and Locators Dr. Parvis Patient WDS Buena Park
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Locators in Place Dr. Parvis Patient WDS Buena Park
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Denture with Attachments Placed Dr. Parvis Patient WDS Buena Park
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CLINICAL CASEOverdenture – Two Locator Attachments
Clinical case• Seat two Locator abutments
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Clinical case courtesy of J. Bain, DDS
CLINICAL CASEOverdenture – Two Locator Attachments
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Clinical case courtesy of J. Bain, DDS
Hand tighten with the Abutment Driver andTake a verification x-ray.
CLINICAL CASEOverdenture – Two Locator Attachments
Torque to 35 Ncm clinically (15 Ncm on the model)
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CLINICAL CASEOverdenture – Two Locator Attachments
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Clinical case courtesy of J. Bain, DDS
Place white block-out spacer ring over abutment (may need more than one per abutment)
Seat metal cap with black processing male
CLINICAL CASEOverdenture – Two Locator Attachments
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Photos courtesy of J. Bain, DDS
Inspect for show-through – Ensure clearance!
Hot Clinical Tip:
Make a vent hole to lingual for acrylic to escape so you do not trap air and create voids in the acrylic!
Lingual Acrylic Relief Hole
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Over denture – Two Locator Attachments - CASE
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Photos courtesy of J. Bain, DDS
Clean receptor sites with alcohol
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Photos courtesy of J. Bain, DDS
Paint bonding agent on clean roughened acrylic and add acrylic into receptor sites and on metal housing
CLINICAL CASEOverdenture – Two Locator Attachments
CLINICAL CASEOverdenture – Two Locator Attachments
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Photos courtesy of J. Bain, DDS
Seat denture and confirm proper occlusion (tap, tap, bite lightly)
CLINICAL CASEOverdenture – Two Locator Attachments
Check— • Occlusion• Patient’s manual dexterity
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Photo courtesy of J. Bain, DDS
CLINICAL CASEOverdenture – Two Locator Attachments
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Photo courtesy of J. Bain, DDS
Remove denture, fill any voids in acrylic, adjust any excess acrylic and polish denture. Remove the black processing male and insert the selected retentive male into the metal housing.*** It is often best to start with the lightest force retentive male !
Take Out Parts
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STUDENT EXERCISE – PARTS INDENTIFICATION
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Locator Implant Abutment
Locator retentive males
Divergent retentive males Abutment Replicas (Analogs)
Impression Copings
Spacer
Metal Cap
BlackProcessing Male
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PARTSOverdenture – Two Locator Attachments
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PARTS Overdenture – Two Locator Attachments
• Metal Cap• Block Out Spacer
Metal Cap• Black Processing Male• • Locator Abutment
PARTS Black Processing male and retentive males
• The black processing male is replaced with the appropriate retentive male after processing the metal cap into the denture.
• Always start with the least retentive male and progress up for each attachment.
10–20° divergence
8515 8524 8527 8529 8547 8548 8915Processing 5 lbs 3 lbs 1.5 lbs 3–4 lbs .5 lbs 2 lbs
Divergent Angles of AttachmentsOverdenture
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Photo courtesy of J. Bain, DDSPhoto courtesy of Per-Olof Karlsson, Sweden
Use 10–20° divergent retentive males
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PARTS Overdenture – Two Locator Attachments
• Mandible: 2 or more implants• Multiple collar heights for variable tissue levels:
0 to 6 mm depending on platform• Available in NP, RP, WP
Locator Abutments
Different Collar Heights – Measure
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Collar Height
The Locator Abutment is selected to be 1.5mm above the tissue height.
Locator Core Tool –Three Parts that come apartOverdenture – Two Locator Attachments
Male Removal Tool •Removes retentive & black processing male from the metal cap.Male Seating Tool•Places a new retentive male into the empty metal cap.•The male is fixed firmly in the cap when a click is heard.
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Male Removal Tool Male Seating Tool Abutment Driver
Abutment Driver•The gold-colored end of the Locator Core Tool is used for screwing and unscrewing the Locator Abutments to and from implants and replicas.
Male Removal ToolTo remove a retentive male or black processing male from the metal
cap: • Insert the tip into the cap/male assembly and push straight into the
bottom of the male. • Then tilt the tool so that the sharp edge of the tip will grab hold of
the male and pull it out of the metal cap.
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PARTS Overdenture – Two Locator Attachments
PARTS Overdenture – Two Locator Attachments
To remove the male from the male removal tool:• Screw the tip clockwise completely onto the middle section. This activates the loosening pin inside the tip, which releases the male.
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PARTS Male Seating Tool
• Used to insert a retentive male or black processing male into the metal cap
Locator Abutment Driver - PARTS
Machine Screw Driver
Locator Abutment Driver
PARTS Overdenture – Two Locator Attachments
Torque to 35 Ncm clinically (15 Ncm on the model)
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Abutment driver
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Please put everything back
Overdenture – Two Locator Attachments - CASE
Well-fitting denture - DEMONSTRATION CASE• Chairside abutment selection by tissue height• Chairside curing of attachments
Denture needing reline• Chairside abutment selection by tissue height• Reline impression over Locator metal housing/black processing male• Laboratory or chairside processing of attachments
Needing new denture• Chairside abutment selection by tissue height• Abutment level impression with impression coping• Laboratory or chairside processing of attachments
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Tissue Depth = Collar HeightAvailable in 0-6 mm.
DEMONSTRATION CASEOverdenture – Two Locator Attachments
Correct measurement of tissue depth for collar will ensure that the abutment is 1.5 mm above the tissue
Different Collar Heights – Measure
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Collar Height
The Locator Abutment is selected to be 1.5mm above the tissue height.
Demonstration Case Overdenture – Two Locator Attachments
Clinical case• Seat two Locator abutments
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Clinical case courtesy of J. Bain, DDS
Demonstration CaseOverdenture – Two Locator Attachments
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Clinical case courtesy of J. Bain, DDS
Hand tighten with the Abutment Driver andTake a verification x-ray.
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DEMONSTRATION CASEOverdenture – Two Locator Attachments
• Place a white block-out spacer ring on each abutment.
• The spacer ring is used to block out the area surrounding the abutment. More than one spacer may be necessary.
• Place the metal cap with the black processing males onto the Locator Abutments.
DEMONSTRATION CASEOverdenture – Two Locator Attachments
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Photos courtesy of J. Bain, DDS
Use an appropriate method to mark the locations of the Locator
Abutments on the existing denture.
Overdenture – Two Locator Attachments - CASE
• Hollow out the existing denture base in the marked areas for the locator attachments.
• Most dentists place a hole in the lingual area to allow excess acrylic to escape and the denture to seat fully.
• Try the denture back in to make sure you have clearance and that the denture seats without rocking on the locator abutment and is tissue borne only.
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Lingual Acrylic Relief Hole
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DEMONSTRATION CASEOverdenture – Two Locator Attachments
• Apply suitable bonding agent onto the metal caps and on the hollowed out receptor sites. Light cure.
• Fill the receptor sites with prosthetic resin.
or
• Use self-curing resin.
• HOT CLINICAL TIP
Best to place and cure one attachment at a time.
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DEMONSTRATION CASEOverdenture – Two Locator Attachments
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Photos courtesy of J. Bain, DDS
Seat the denture and confirm proper occlusion (tap, tap, bite lightly).Light cure resin or self cure in light occlusion without compression of the soft tissue.
Demonstration Case Overdenture – Two Locator Attachments
• Once the resin has cured, remove the denture from the mouth and discard the white block-out spacers.
• Fill in any acrylic voids, remove any excess acrylic and polish the denture.
DEMONSTRATION CASEOverdenture – Two Locator Attachments
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Photo courtesy of J. Bain, DDS
Remove the black processing male and insert the selected retentive male into the metal housing.*** It is often best to start with the lightest force retentive male !
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DEMONSTRATION CASEOverdenture – Two Locator Attachments
• Select replacement males by considering preferred retention and angle of implant divergence.
• Remove the black processing males from the metal housing using the male removal tool or sickle.
• 6 lbs. of retention per arch total is recommended (two 3.0 lb males, four 1.5 lb males, etc). But always best to start at the lowest level of retention.
10–20° divergence
8515 8524 8527 8529 8547 8548 8915Processing 5 lbs 3 lbs 1.5 lbs 3–4 lbs .5 lbs 2 lbs
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Locator Male Processing Package
(REF08519-2)
DEMONSTRATION CASEOverdenture – Two Locator Attachments
Divergent Angles of AttachmentsOverdenture
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Photo courtesy of J. Bain, DDSPhoto courtesy of Per-Olof Karlsson, Sweden
Use 10–20° divergent retentive males
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Locator® Extended Range Male Processing Package
(8540-2)
Divergent Retentive Males
CaseOverdenture – Two Locator Attachments
Well-fitting denture• Chairside abutment selection by tissue height• Chairside curing of attachments
Denture needing reline – Locator abutments present or only Implant is in place
• Key factor is to get the denture to the well-fitting denture stage first
• Only implants in place – reline denture first to a well fitting denture• Chairside abutment selection by tissue height and proceed as before
• Patient has abutments and denture with attachments and needs reline• Order new metal caps, black processing and retentive/divergent males.• Remove existing metal caps with retentive males from patients denture – check for adequate clearance
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• Place the new metal caps with the black processing males onto the Locator Abutments.
• Take an impression and pick up the metal cap with the black processing males in the impression.
• Remove the metal cap with the black processing males from the impression. You will be left with space to indicate location of attachments.
• Pour the impression – send to lab.• Reline comes back from lab - Check
clearance – place white block out spacer then metal cap with black processing male chairside and proceed as shown in the last section
Case Overdenture – Two Locator Attachments
Case Overdenture – Two Locator Attachments
Well-fitting denture• Chairside abutment selection by tissue height• Chairside curing of attachments
Denture needing reline• Chairside abutment selection by tissue height• Reline impression over Locator metal housing/black processing male• Laboratory or chairside processing of attachments
Needing new denture • Chairside abutment selection by tissue height. Proceed • as before. • Impressions and completion of denture.• Chairside processing of attachments.
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5757
Overdenture – Making a Stent - Case
Case
5858
CaseOverdenture – Making a Stent
Before implant placement in the fully edentulous patient,it is required to have defined the proper tooth position.
This can be accomplished by:1. An existing denture 2. A new denture3. A wax try-in that goes unprocessed
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CaseOverdenture – Making a Stent
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CaseOverdenture – Making a Stent
Lang Pressure Pot
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CaseOverdenture – Making a Stent
ADVANTAGES OF DOING IMPLANTS AT WDS
• PATIENT SATISFACTION
• DOCTOR SATISFACTION
• LEARN – EXPERIENCE
• MENTOR HELP
• INCREASE PRODUCTION
• WIN-WIN
DOCTORS
If you Never start a case
you will Never gain the Experience to Learn.
If you do not Learn you will Never gain Experience.
He who has the Most Experience WINS!
Winners take great Vacations! Roatan – Bay Islands - Honduras
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Winners eat well each night
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Winners have time for relaxation
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Don’t just be an Average doctor “ONE OF THE CROWD”
Be an Experienced doctor – Be a WINNER!
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Winners have time for relaxation
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Eat well each night
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Travel - Roatan – Bay Islands - Honduras
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Sea Turtle
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300 lb Grouper
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Clownfish in Anemone
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Jacks
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Tarpon
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Turtle
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Please put everything back
