4 Core Concepts of Mandibular Implant Overdentures

One of the most satisfying services I can provide a patient is stabilizing their complete denture with implants.  I’ve done many of these and I’d like to share with you my thoughts on how I use them successfully.

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(1) Implant-Retained, Tissue-Supported

This is a critical concept!  The implants are offering retention that is far superior to suction and gooey adhesives, no question about that.  But the prosthesis is still supported by the soft tissue.  That means traditional denture concepts must be respected.  A good implant overdenture always begins with a stable, well-fitting complete denture.  Preferably I will make a brand new CD for the patient that I will fit for implant attachments.  However if I have to use the patients existing denture I will at least consider a new chair-side reline before beginning treatment.  If the CD does not fit well then there will be unexpected forces acting on the implant attachments which will compromise retention.

(2) Implant Location and Number

The standard of care is a minimum of two in the mandible.  The mandibular implants are placed between the mental foramina due to the high quality of bone that is found there.  It’s best to place them close together, roughly in the lateral incisor areas, rather than spread out in the canine areas.  Why? Because the first option is better at resisting anterior-posterior rocking of the prosthesis.

The placement on the left will better resist A-P rocking of the denture.

Alternatively you can place a third implant in between the first two for additional retention.  I’ll do this if the patient’s force factors are high (bruxer, strong bite, etc.)

Implant placement for an overdenture retained by three implants. The healing abutments are still in place.

Can you place more implants than three?  Sure.  But once you start getting to four and five implants, you’ll probably be leaning more towards a fixed, implant-supported prosthesis.

Two Locator abutments for an implant overdenture.

(3) Attachment Selection

There are O-rings, Hader clips, bars, and all sorts of mechanisms for making your overdenture click and snap into place.  Personally, my method of choice is the Locator attachment.  It’s simple to use and quite effective.  I’ll use a bar if the implants have a severe angle discrepancy (greater than 20 degrees between implants) that would prohibit seating of the Locators.  In that case, a bar would zero out the angles and provide a clean slate for other attachments to connect to.  For more information on Locators, check out my next post.

(4) Delivery

You could take impressions and send everything to the lab for fabrication, but I think it’s better to do this procedure chair-side.  Not only will it save you money, but you will be able to get a dynamic fit.  A lab doesn’t have the benefit of muscled attachments, lips, and functional movement; all they have is a model.  It’s super easy to pick up Locators chair-side.  I’ll show you how in my next post.

 

 

 

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9 Comments

  1. Ryan says:

    Really looking forward to your next article. I need to see a well laid out, step by step explanation for this procedure.

  2. Aaron says:

    Chris, this a cool article. I am in my 3rd year of dental school in Oklahoma and I just had an exam over this very topic. We watch a video produced by University of Michigan called the 2 implant supported denture that goes into more detail about the implants and bone heights. I just wanted to comment on this, since I just had it in school.

    • Chris says:

      Thanks, Aaron! I’m going to be posting two more articles on this topic in the next week. They’ll show more of a step-by-step of how to use Locator attachments with implant overdentures.

  3. Pingback: Locator Attachments for Implant Overdentures: Part 1 | The Curious Dentist

  4. Pingback: Locator Attachments for Implant Overdentures: Part 2 | The Curious Dentist

  5. Pingback: Locator Attachments for Implant Overdentures: Part 3 | The Curious Dentist

  6. Alaa says:

    very informative Article,
    about the location of implants supported lower over-denture, you mentioned that “2 implants in lateral area is favorable to resist the rocking of the denture”, it’s interesting information but is it based on scientific evidence?
    thanks

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