Attachment Selection

Overdentures- Ridge evaluation and esthetics Fixed- Ridge evaluation, gingival esthetics Number of implants Anterior-Posterior spread Opposing arch Function Fixed- Rigid, scre! retained Overdenture- "oad bearing or nonload bearing Retention Available space #ost

Patient #onsiderations
Parallel attachments for easier path of insertion "ess attachments $ better Patient dexterit% &%giene $ Stannous Fluoride rinses ' month recall

Anterior(Posterior Spread
A line from the center of the most anterior implant to a line )oining the distal aspects of the t!o most distal implants *ndicates the amount of cantilever that can be reasonabl% placed +suall%, ,-. times the A(P spread

A(P Spread
Actual "ength of #antilever /epends on0 Stress factors Parafunctional &abits #ro!n heights *mplant !idth Number of implants Opposing teeth or denture

#ontrolling Stress

Stress1Force(Area
Force

Stress
Area

2or3ue1
Force x Perpendicular distance from the line of force to the center of rotation

#uspal *nclination

#uspal *nclination

2reatment Plan Options

Fixed Removable

*mplant Supported

Soft 2issue Supported *mplant Retained

2reatment Plan Option 4 "o!er 5dentulous Fixed .-6 *mplants

Prosthetic Options-"o!er .-6 *mplants

&%brid /enture Fixed #ro!n and 7ridge #antilever 48-4.mm

6 *mplants-Fixed *mplant Supported

,' ,, ; ;

,9

,.

,6 ,: ; ;

. *mplants- Fixed *mplant Supported

7 A ; ;

/ 5 ; ;

2reatment Plan Option , "o!er 5dentulous Removable . *mplants

Prosthetic Options- Removable Overdenture-*mplant Supported

<old 7ar !( O Rings /istali=ed O Rings #antilever 48-,8mm <old 7ar !ith &ader #lips /istali=ed 5RA>S #antilever 48-,8mm

# 7 A / 5 A 7

# / 5

2reatment Plan Option ' "o!er 5dentulous Removable 9 *mplants

Prosthetic Options- Removable *mplant and 2issue Supported

<old 7ar !ith O Rings #antilever .-48mm

<old 7ar !ith &ader #lips and 5RA>S #antilever .-48mm

b c d

b a

c d a

2reatment Plan Option 9 "o!er 5dentulous Removable ' *mplants

Prosthetic Options- Removable Overdenture-"o!er *mplant and 2issue Supported

<old 7ar !( ,- O RingsOverdenture No #antilevers

' *mplants- Removable Overdenture *mplant and 2issue Supported

# 7

2reatment Plan Option . "o!er 5dentulous Removable , *mplants

Prosthetic Options Removable Overdenture-"o!er 2issue Supported

<old 7ar !( &ader #lip O Ring on each implant 5RA attachment on each implant

, *mplants-Removable 2issue Supported

2reatment Plans +pper 5dentulous Four Options

2reatment Plan Option 4 +pper 5dentulous Fixed ? *mplants

Prosthetic Options Fixed- +pper *mplant Supported

Fixed #ro!n and 7ridge &%brid /enture No #antilevers Necessar%

? *mplants- Fixed *mplant Supported

: 6 ; 9 '

48 44 ; 4' 49

2reatment Plan Option , +pper 5dentulous Removable ? *mplants

Prosthetic Options- ? *mplants Removable- +pper *mplant Supported

<old 7ar !( O RingsOverdenture <old 7ar !( ' &ader #lips Overdenture- No Palate #antilevers-Optional

? *mplants- Removable *mplant Supported

<old 7ar Overdenture <old 7ar Overdenture !( O Rings !( &ader 7ar ( #lips

: 6 9 '

48 44 4' 49 9 ' 6

48 44 4' 49

Palate

No Palate

2reatment Plan Option ' +pper 5dentulous Removable 6 *mplants

Prosthetic Options Removable- +pper *mplant Supported

<old 7ar !( 9- O Rings and distal to @s 9 and 4' <old 7ar !( &ader #lip- 5RAS distal on @9 and 4'Overdenture-No Palate #antilever .-48mm

6 *mplants- Removable *mplant Supported <old 7ar !( O Rings .-48mm #antilever <old 7ar !( &ader clips and 5RA>s .-48mm #antilever

: . 9

48 4, 4' . 9

48 4, 4'

2reatment Plan Option 9 +pper 5dentulous Removable 9 *mplants

Prosthetic Options Removable- +pper 2issue Supported

<old 7ar !(9 O RingsOverdenture !( No Palate <old 7ar !( &ader #lip and , distali=ed 5RA attachments !( Overdenture- No Palate No #antilever

Arch Form 9 *mplants-2issue Supported

S3uare Arch 2apered Arch

6 9

44 4' .

44 4,

Aaximum contact !ith tissue $ No contact !ith 7ar Attachments are for retention ON"B

2reatment Planning
/esign sensibilit% and flexibilit% in the treatment plan /esign and implant concepts !ill var% Plan ahead for success &ave a disaster plan *n most cases, less attachments are better