Topic

[Diagnostic / Planning]  First MD overdenture locator case? Stage or Immediate?


 

Hey Guys, 

 

Thoughts on 2 or 3 mandibular implants to support complete lower denture. Exo teeth first? or immediate placement? Ball abutments/ removable? What does a ball abutment cost?

 

Dont have CT scan yet. Just panorex.

 

Love to hear your thoughts~


by Mark Kwon at Thu, May 26, 2011 5:11 AM

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Josh Gibson Replied at Mon, May 30, 2011 2:10 AM

thanks Mark and Bernard...



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Mark Kwon Replied at Fri, May 27, 2011 10:41 PM

I agree with dr. Jin. However, here's food for thought. Q. What is pt wanted to upgrade to bar over denture or Allon4 in the future? How would current tx plan affect the future tx? I often get patient who cannot afford fixed solution right now but wishes for future; One of the option we present to these patient is by asking " How many can you afford this year?" ; Often we start with two locators at the md anterior couple years later they come back to get two posterior and upgrade final prosthetic with Allon4 bridge. hmm... Something to think about... And, yes, I almost always do immediate denture and implant placement and locators (whenever I DO removable option =_=;;) mainly due to patient satisfaction. sincerely, - mark



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Bernard Jin Replied at Thu, May 26, 2011 3:20 PM

Hi Cam. Good to see you on the forum! Great question! The general idea is 'the more retention you can provide the patient, the merrier the patient will be' You're correct in stating that most examples show 2 implants and locators. Often, the decision for 2 implants is dictated by patient finances. Two is the minimum # of implants a person should have - if they are expected to have any improved level of denture stability. There was a study conducted at UBC using only implant + locator - but it didn't work too well for the patients (implants had failed from overloading). With 2 implants & locators, the retention falls along a LINE. This would mean that the denture (when loose) would very often rock (fulcrum) along this line. It still provides the patient with much better stability (than if they had no implants) but mostly along one axis. With 3 or more locators, the LINE (connecting the 2 implants) is now replaced with multiple lines (some people call this the A-P and lateral spread). It gives the denture much better stability in the different axises - yielding much better overall retention and stability. Naturally, if placing more than 2 implants, I would recommending flapping the site (to locate the mental foramen) so you can place the implants as lateral as possible. Then with the 3rd implant you can place it between the 2 implants but with an A-P spread that is maximized. As for immediate denture - I recommend a soft tissue conditioner (i.e. not engage the locators) until adequate healing has occurred. You are right about patients objecting to being edentulous - thus the recommendation for tissue conditioning beneath the denture. Hope that helps! Cheers! ~ Bernard



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Cameron Tansey Replied at Thu, May 26, 2011 1:08 PM

Thanks for your input. How do you determine # of implants. Many examples show 2, however the denturist would prefer 3 any advantages/ disadvantages? Assuming good bone quality and support, would an immediate denture be placed the same day or is some healing time required. It is recommended by some to leave edentulous for 4-6 weeks although not sure how many pts would like this. CT



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Mark Kwon Replied at Thu, May 26, 2011 5:23 AM

Thanks for the post. This is a very common question I get. (Although, I am biased towards Allon4 treatment) I think Md overdenture is a great solution for patients looking for more stable removable option. And yes, I would recommend Locator over ball-attachment: They are easier and cheaper (around ~$250 for housing and attachment i think (dont quaote me on this, since I dont do the purchasing ^^) But the biggest advantage of locator attachment, in my opinion, is the low-profile (ie. does not take up much height of the room in the lower denture) Q: immediate or staged approach? Answer: depending on your comfort level. One of the most important technical aspect of any MD full mouth surgery is to achieve two things: 1. Remove enough alveolar bone , so that you can engage better quality bone - ie. basal bone 2. Remove enough alveolar bone to allow enough space for Denture space ; One of the most common problem noobies run into is that you didnt remove enough bone height therefore, denture end up being thin; this also leads to insufficent space for attachment leading to difficulty of picking up the locator and long-term complication of breakage due to weak denture base. According to the panorex, the mental nerve curves high up: locate the foramen and level the bone without damaging the nerve. In my office, this would be done as immediate case. And because bone quality on Md arch is usually very good, I would attach the locator and housing on the same appointment. Hope this helps. sincerely, - mark Kwon