Direct procedure for connecting a mandibular implant-retained overdenture

with ball attachments

Corinne Taddei, DDS, PhD,a Michel Metz, DDS,b Etienne Waltman, DDS, PhD,c and
Oliver Etienne, DDSd
Louis Pasteur University, School of Dentistry, Strasbourg, France

mplant-supported overdentures retained by attachments are now an established treatment method.1,2

The mandible is well suited for implant-retained overdentures, particularly when the implants can be placed
in the canine regions. Among available retention systems, ball attachments have been proven to be reliable.3-5 The ball attachment consists of a spherical
patrix that is usually screwed into the implant assembly.
The matrix fits over the patrix and provides retention by
means of spring-action arms or an interchangeable elastic ring. The connection between the matrix and the
denture can be achieved by indirect or direct method.
The indirect technique consists of recording the dentures soft tissue support as well as positioning the implants in relation to the denture, so that the connection
of the matrix and the reline procedure can be completed
in the laboratory. This method has the potential advantages of reduced chair time and the use of a single
denture base acrylic resin. However, the recording and
transferring of the implants position with analogs may
introduce some misfit. Moreover, the patient is without
the prosthesis during this time. The direct technique for
locating a ball attachment intraorally is simple, economic, quick, and allows the patient to retain the prosthesis. If relining of the prosthesis is indicated, the
reline should be completed as a preliminary step. Few
connection procedures have been proposed in the literature.6,7 This article describes a clinical procedure for
a direct connection between a complete mandibular
overdenture and 2 supra-implant nonsplinted attachments, using a rubber dam to prevent the acrylic resin
from entering into the undercut areas located under
the head of the implant or under the patrix portion of
the attachment. This method prevents compression of
the gingival peri-implant soft tissue, and allows the denture to be seated completely on the supporting surface.

2.

3.

4.

5.

6.

7.

8.

9.

between the intaglio surface of the denture and the

attachment system with a low-viscosity silicone
material (Pressure Spot Indicator; Coltene/
Whaledent Inc, Cuyahoga Falls, Ohio). Remove disclosed interferences with a bur.
Place the matrix on the patrix (Fig. 1, A). Place the
denture, coated with the low-viscosity silicone, intraorally, and evaluate for contacts with the matrix
attachment system. Carefully relieve undesirable
contacts observed in the denture.
Remove the matrix and position a piece of perforated
elastic material, approximately 1 cm2, cut from an examination glove, around the patrix connector. Place
an elastic band 1 mm high, cut from an irrigation
tube (15249; W&H GmbH, Burmoos, Austria), under the ball (Fig. 1, B).
Perforate the lingual portion of the denture opposite
the attachments so that most of the excess acrylic
resin can escape.
Reposition the matrix (Fig. 2, A) and coat the prosthetic housings with white auto-polymerizing acrylic
resin (Tab 2000; Kerr Italia SpA, Salerno, Italy). Use
white acrylic resin so that the excess will be easily
detected.
Place the denture with firm finger pressure and then
ask the patient to occlude until polymerization is
complete (Fig. 2, B).
Remove the denture and carefully remove the excess
acrylic resin from the intaglio and outer surfaces of
the denture.
Remove the elastic bands as well as the glove material,
and remove approximately 1 mm of acrylic resin adjacent to the matrix with a bur, to prevent impingement on the gingival peri-implant soft tissue.
Polish the denture and insert. Provide the patient
with instructions on insertion, removal, and maintenance of the prosthesis.

PROCEDURE
1. Screw the patrices (AdVent; Zimmer Dental, Rungis,
France) into the implants and disclose interferences
a

Associate Professor.
Lecturer.
c
Associate Professor.
d
Assistant Professor.
J Prosthet Dent 2004;92:403-4.
b

OCTOBER 2004

REFERENCES
1. Feine JS, de Grandmont P, Boudrias P, Brien N, LaMarche C, Tache R, Lund
JP. Within-subject comparisons of implant-supported mandibular prostheses: choice of prosthesis. J Dent Res 1994;73:1105-11.
2. Mericske-Stern R, Steinlin Schaffner T, Marti P, Geering AH. Peri-implant
mucosal aspects of ITI implants supporting overdentures. A five-year longitudinal study. Clin Oral Implants Res 1994;5:9-18.
3. Preiskel HW. Overdentures made easy: a guide to implant and root supported prostheses. Chicago: Quintessence; 1996. p. 189-232.

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TADDEI ET AL

Fig. 1. A, Patrix screwed into implants. B, Latex (from an examination glove) positioned as rubber dam around ball attachment.
Upper left inset, Perforate latex with dental explorer; upper right inset, cutting elastic band from irrigation tube.

Fig. 2. A, Left: 1-mm elastic band (irrigation tubing) fills undercut area. Matrix is positioned on band (right). B, Denture held in
position with finger pressure. Excess resin escapes through palatal perforation. Patient is subsequently asked to close in
maximum intercuspation position.

4. Donatsky O, Hillerup S. Non-submerged osseointegrated dental implants

with ball attachments supporting overdentures in patients with mandibular
alveolar ridge atrophy. A short-term follow-up. Clin Oral Implants Res
1996;7:170-4.
5. Payne AG, Solomons YF. The prosthodontic maintenance requirements of
mandibular mucosa-and implant-supported overdentures: a review of the
literature. Int J Prosthodont 2000;13:238-43.
6. Dominici JT, Kinderknecht KE, Patella-Clark E. Clinical procedure for stabilizing and connecting O-ring attachments to a mandibular implant overdenture. J Prosthet Dent 1996;76:330-3.
7. Sadig WM. Special technique for attachment incorporation with an implant
overdenture. J Prosthet Dent 2003;89:93-6.
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FACULTE DE CHIRURGIE DENTAIRE
4, RUE KIRSCHLEGER, 67000 STRASBOURG
FRANCE
FAX:33 390 24 39 00
E-MAIL: corinne.taddei@chru-strasbourg.fr

404

0022-3913/$30.00
Copyright 2004 by The Editorial Council of The Journal of Prosthetic
Dentistry

doi:10.1016/j.prosdent.2004.07.011

VOLUME 92 NUMBER 4