Implant Type Over Denture

Monday, October 31, 2011
IMPLANT TYPE OVERDENTURES
A NEW STANDARD OF CARE
Edentulism and Complete Dentures Background of Overdentures Attachments of Overdentures Clinical Consideration
Edentulism and Complete Dentures Background of Overdentures Attachment of Overdentures Clinical Application
16%
16%
48% 44%
14%
1972~2001, 10-12% Edentulism in USA
Higher in everyday smoker
Below poverty line, 2X greater than above line
Higher than those w/o dental insurance
Higher among African Americans
Higher on people with less than high school education
Center of Disease Control and Prevention

Chronic and progressive bone loss for 25 yrs Mandible : Maxilla = 4 : 1

Tallgren, 2003
Chewing?
Chewing? Speaking?
Chewing? Speaking? Smiling?
Chewing? Speaking? Smiling? Nutrition intake?
Chewing? Speaking? Smiling? Nutrition intake? Social function?
Chewing? Speaking? Smiling? Nutrition intake? Social function? Psychological comfort?
Will there be a need for complete dentures in the United States in 2020?
Douglas CW, 2002
Will there be a need for complete dentures in the United States in 2020? Population: 35 million(2000) 38 million(2020)
Douglas CW, 2002
Will there be a need for complete dentures in the United States in 2020? Population: 35 million(2000) 38 million(2020) Denture Needs: 1~2 per person
Douglas CW, 2002
Will there be a need for complete dentures in the United States in 2020? Population: 35 million(2000) 38 million(2020) Denture Needs: 1~2 per person Denture Counts: 56 million(2000) 61.0 million (2020)
Douglas CW, 2002
60% of dentures need to be replaced
56m * 60% = 34m
34m * 8 hrs = 288m hrs
288 mhrs / 0.2m = 1440 hrs
1440 / 8hrs = 180 days
180 / 20 = 9 months
Newly Extracted
8 years
15 years
20 years + Mandibulectomy
Denture stomatitis
Headache
Angular cheilitis
Emotional stress
Epulis fissuratum
Traumatic ulcer
Fenton, 1998
Denture Metal Housing Matrices Patrices Abutment Implant
Ridge Preservation
Cost
Repairability
Ridge Preservation
Support
Cost
Stability
Repairability
Retention
Psychological Comfort
Vertical Height
Following cost
Psychological Comfort
Faster Turnover
Vertical Height
Attachment Wear
Following cost
More visits
Studies suggest that when conventional dentures are replaced with implant retained overdentures , patients enjoy a higher quality of life, greater self-confidence, and a better nutritional state.
Henry K., Q&A on the future of implants, Dental Equipment & Materials, 2006
The McGill Consensus Statement

Conventional denture on the edentulous mandible is no longer the most appropriate prosthodontic treatment. There is now overwhelming evidence that a 2-implant overdenture should become the first choice of treatment for the edentulous mandible.
When I received the denture with solid attachment underneath, I became a different person; I feel wonderful; and I am very happy with myself and how others compliment the way I look."
Safe to go?
Check pt expectation
Interarch distance and space availablity
Imaging data and grafting procedures
What options for Maxilla?
Bar Attachment
Stud Attachment
Magnet Attachment
HADER BAR
CLIPS (RIDERS)
METAL HOUSING
RESILIENCE DESIGN
Cost Rigid Splinting Malalignment Correction More Space Cleansibility Screw Fracture
OVERCONSTRUCTED
BAR BREAKAGE
LOCATOR
ERA
BALL/O-RING
BALL
COMBINATION
STUD SYSTEM
Faster wear-off Cost Friendly minimal Repairability Easy Resilient Connection More Working Space Malalignment Correction Frequent Replacement
MAGNET
VARIOUS SELECTION
Easy to wear Abutment protection No Undercut Limitation Corrosion Poorest stability
Facts about Complete Dentures Background of Overdentures Attachments of Overdentures Clinical Consideration
Why Removable?
100
edentulous arches Fixed: 4-8 implants, 13-17 yrs Overdenture: 2-4 implants 4-15 yrs Annual recalls: Osseointegration, perio indices Subjective evaluation Fixed: 38/45 V.S. Removable: 37/39
Schimitt and Zarb,1998
20
pts with edentulous maxilla Fixed: 8-10 implant, 40 months Bar Retained Overdenture: 5-8 implants, 27 months Check prosthodontic tx outcome, clinical parameters Comparable treatment outcome
Zitzmann, 2000
How much space?

STUD TYPE BAR TYPE
SPACE AVAILABILITY
2.5mm
3.0mm
How Many Implants?
Maxilla
4
implants to eliminate distal cantilever on ant. 2 implants Lewis, 1992 Rigidly splinting implant for 4 yrs
Naert, 1998
4 4
or more implants placed more than 6mm

Stern, 1998
Mandible
2
implants are often sufficient 3 implants if shorter than 8mm
Stern, 1998
Mandible
21
edentulous pts, 74.2 y/o Single implant at Mandible midline Great oral comfort and functionality
Cordioli M., 1997
Where to Place?
Maintenance
Replace Attachments Replace Attachments Replace Attachments Accidental Breakage Accidental Breakage Denture Reline
Which Design?
More favorable with a spread-out implant arrangement than with a concentrated implant arrangement and cantilever restoration.
Poor A-P Spread
Bruxer? Clencher?
Ku, 2002
Preparatory Phase CT Scan: 1000~1500 Graft Procedure: 300~2500
Implant Phase Implant + Abutment: 1500~2000
Denture Phase Attachment: 150~200 Denture: 1500~2500
Maintenance Phase Replacement: 50~100
Questions??

Implant Type Over Denture

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Monday, October 31, 2011