Implant Supported Over Denture By Dr pitzak
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  • We will now review a clinical case using this method. First Dr. Bain is going to remove the healing abutment, and replace it with the Locator Abutment and hand tighten.
  • Here we see Dr. Bain hand-tightening the abutments using the Locator Abutment Driver.
  • The first step on the abutment side is to place the white block-out spacer over the Locator abutment.Next Dr. Bain will place the metal housing with the black processing male. Note that the black processing male in the titanium housing suspends the attachment in the most vertically removed position, to accommodate for the tissue resilience that will be built in to the retentive attachments substituted after processing.
  • The area of contact is identified and marked with an indelible pencil
  • After that procedure, clean the site with some alcohol. The process is repeated as necessary until a completely passive “soft tissue only” seating of the denture is possible without any interference from the Male Processing Attachment.The metal housing is also thoroughly dried,
  • Then Paint Triad VLC Bonding Agent Onto Housings, then Brush on Light-Cured Gel.
  • Then we’re going to seat the denture.
  • Dr. Bain is now going to is remove the black processing male.
  • The Locator Abutments are installed with a minimum 1.5 mm of the abutment exposed above the soft tissue. For the chairside processing of the attachments, the area of the denture to receive the attachment needs to be relieved to create space for the attachment housing. This is accomplished in several steps.
  • After hand tightening, Dr. Bain will utilize the torque wrench and tighten the abutments to 35 Ncm.
  • We will now review a clinical case using this method. First Dr. Bain is going to remove the healing abutment, and replace it with the Locator Abutment and hand tighten.
  • Here we see Dr. Bain hand-tightening the abutments using the Locator Abutment Driver.
  • The area of contact is identified and marked with an indelible pencil
  • Then we’re going to seat the denture.
  • Dr. Bain is now going to is remove the black processing male.
  • The Locator Abutments are installed with a minimum 1.5 mm of the abutment exposed above the soft tissue. For the chairside processing of the attachments, the area of the denture to receive the attachment needs to be relieved to create space for the attachment housing. This is accomplished in several steps.

Implant Supported Over Denture By Dr pitzak Presentation Transcript

  • 1. IMPLANT RETAINED DENTURES• Dr. Larry Pitzak, D.D.S. , Western Dental Services Quality Management• Office 714-571-3168• Fax 714-571-3698• Lpitzak@westerndental.com 1
  • 2. IMPLANT RETAINED DENTURES WHY DO IMPLANT RETAINED DENTURES ????
  • 3. 3
  • 4. Does Your Denture Patient Look Like This?? 4
  • 5. Testimonial
  • 6. 6
  • 7. 7
  • 8. Panorex – Implants and Locators Dr. Parvis Patient WDS Buena Park 8
  • 9. Locators in Place Dr. Parvis Patient WDS Buena Park 9
  • 10. Denture with Attachments Placed Dr. Parvis Patient WDS Buena Park 10
  • 11. CLINICAL CASE Overdenture – Two Locator AttachmentsClinical case• Seat two Locator abutments Clinical case courtesy of J. Bain, DDS 11
  • 12. CLINICAL CASE Overdenture – Two Locator Attachments Hand tighten with the Abutment Driver and Take a verification x-ray.Clinical case courtesy of J. Bain, DDS 12
  • 13. CLINICAL CASEOverdenture – Two Locator AttachmentsTorque to 35 Ncm clinically (15 Ncm on the model) 13
  • 14. CLINICAL CASE Overdenture – Two Locator AttachmentsPlace white block-out spacer ring Seat metal capover abutment (may need more with blackthan one per abutment) processing male Clinical case courtesy of J. Bain, DDS 14
  • 15. CLINICAL CASE Overdenture – Two Locator AttachmentsInspect for show-through – Ensure clearance!Hot Clinical Tip:Make a vent hole to lingual for acrylic toescape so you do not trap air and create voidsin the acrylic! Photos courtesy of J. Bain, DDS 15
  • 16. Lingual Acrylic Relief Hole 16
  • 17. Over denture – Two Locator Attachments - CASE Clean receptor sites with alcohol Photos courtesy of J. Bain, DDS 17
  • 18. CLINICAL CASE Overdenture – Two Locator AttachmentsPaint bonding agent on cleanroughened acrylic and addacrylic into receptor sites andon metal housing Photos courtesy of J. Bain, DDS 18
  • 19. CLINICAL CASE Overdenture – Two Locator AttachmentsSeat denture and confirm proper occlusion (tap, tap, bite lightly)Photos courtesy of J. Bain, DDS 19
  • 20. CLINICAL CASE Overdenture – Two Locator AttachmentsCheck—• Occlusion• Patient’s manual dexterity Photo courtesy of J. Bain, DDS 20
  • 21. CLINICAL CASE Overdenture – Two Locator AttachmentsRemove denture, fill any voids in acrylic, adjust any excess acrylicand polish denture. Remove the black processing male and insertthe selected retentive male into the metal housing.*** It is often best to start with the lightest force retentive male ! Photo courtesy of J. Bain, DDS 21
  • 22. Take Out Parts 22
  • 23. STUDENT EXERCISE – PARTS INDENTIFICATION Impression CopingsMetal Cap Spacer Locator Implant Abutment Locator retentive malesBlackProcessingMale Divergent retentive males Abutment Replicas (Analogs) 23
  • 24. PARTSOverdenture – Two Locator Attachments 24
  • 25. PARTS Overdenture – Two Locator Attachments• Metal Cap• Block Out Spacer Metal Cap• Black Processing Male•• Locator Abutment 25
  • 26. PARTS Black Processing male and retentive males• The black processing male is replaced with the appropriate retentive male after processing the metal cap into the denture.• Always start with the least retentive male and progress up for each attachment. 8515 8524 8527 8529 8547 8548 8915 Processing 5 lbs 3 lbs 1.5 lbs 3–4 lbs .5 lbs 2 lbs 10–20 divergence
  • 27. Divergent Angles of Attachments OverdenturePhoto courtesy of Per-Olof Karlsson, Sweden Photo courtesy of J. Bain, DDS Use 10–20 divergent retentive males 27
  • 28. PARTS Overdenture – Two Locator Attachments• Mandible: 2 or more implants• Multiple collar heights for variable tissue levels: 0 to 6 mm depending on platform• Available in NP, RP, WPLocator Abutments 28
  • 29. Different Collar Heights – Measure The Locator Abutment is selected to be 1.5mm above the tissue height. Collar Height 29
  • 30. Locator Core Tool –Three Parts that come apartOverdenture – Two Locator AttachmentsMale Removal Tool•Removes retentive & black Abutment Driverprocessing male from the metal •The gold-colored end of thecap. Locator Core Tool is used forMale Seating Tool screwing and unscrewing the•Places a new retentive male into Locator Abutments to andthe empty metal cap. from implants and replicas.•The male is fixed firmly in the capwhen a click is heard. Male Removal Tool Male Seating Tool Abutment Driver 30
  • 31. PARTS Overdenture – Two Locator AttachmentsMale Removal ToolTo remove a retentive male or black processing male from the metal cap:• Insert the tip into the cap/male assembly and push straight into the bottom of the male.• Then tilt the tool so that the sharp edge of the tip will grab hold of the male and pull it out of the metal cap. 31
  • 32. PARTS Overdenture – Two Locator AttachmentsTo remove the male from the male removal tool:• Screw the tip clockwise completely onto the middlesection. This activates the loosening pin inside thetip, which releases the male. 32
  • 33. PARTS Male Seating Tool• Used to insert a retentive male or black processing male into the metal cap
  • 34. Locator Abutment Driver - PARTS Machine Screw Driver Locator Abutment Driver
  • 35. PARTS Overdenture – Two Locator AttachmentsTorque to 35 Ncm clinically (15 Ncm on the model) Abutment driver 35
  • 36. 36
  • 37. Overdenture – Two Locator Attachments - CASEWell-fitting denture - DEMONSTRATION CASE• Chairside abutment selection by tissue height• Chairside curing of attachmentsDenture needing reline• Chairside abutment selection by tissue height• Reline impression over Locator metal housing/black processing male• Laboratory or chairside processing of attachmentsNeeding new denture• Chairside abutment selection by tissue height• Abutment level impression with impression coping• Laboratory or chairside processing of attachments 37
  • 38. DEMONSTRATION CASE Overdenture – Two Locator Attachments Correct measurement of tissue depth for collar will ensure that the abutment is 1.5 mm above the tissueTissue Depth = Collar Height Available in 0-6 mm. 38
  • 39. Different Collar Heights – Measure The Locator Abutment is selected to be 1.5mm above the tissue height. Collar Height 39
  • 40. Demonstration CaseOverdenture – Two Locator AttachmentsClinical case• Seat two Locator abutments Clinical case courtesy of J. Bain, DDS 40
  • 41. Demonstration CaseOverdenture – Two Locator Attachments Hand tighten with the Abutment Driver and Take a verification x-ray. Clinical case courtesy of J. Bain, DDS 41
  • 42. DEMONSTRATION CASE Overdenture – Two Locator Attachments• Place a white block-out spacer ring on each abutment.• The spacer ring is used to block out the area surrounding the abutment. More than one spacer may be necessary.• Place the metal cap with the black processing males onto the Locator Abutments. 42
  • 43. DEMONSTRATION CASE Overdenture – Two Locator AttachmentsUse an appropriate method to mark the locations of the LocatorAbutments on the existing denture.Photos courtesy of J. Bain, DDS 43
  • 44. Overdenture – Two Locator Attachments - CASE• Hollow out the existing denture base in the marked areas for the locator attachments.• Most dentists place a hole in the lingual area to allow excess acrylic to escape and the denture to seat fully.• Try the denture back in to make sure you have clearance and that the denture seats without rocking on the locator abutment and is tissue borne only. 44
  • 45. Lingual Acrylic Relief Hole 45
  • 46. DEMONSTRATION CASE Overdenture – Two Locator Attachments• Apply suitable bonding agent onto the metal caps and on the hollowed out receptor sites. Light cure.• Fill the receptor sites with prosthetic resin. or• Use self-curing resin.• HOT CLINICAL TIP Best to place and cure one attachment at a time. 46
  • 47. DEMONSTRATION CASE Overdenture – Two Locator AttachmentsSeat the denture and confirm proper occlusion (tap, tap, bite lightly).Light cure resin or self cure in light occlusion without compressionof the soft tissue. Photos courtesy of J. Bain, DDS 47
  • 48. Demonstration Case Overdenture – Two Locator Attachments• Once the resin has cured, remove the denture from the mouth and discard the white block-out spacers.• Fill in any acrylic voids, remove any excess acrylic and polish the denture.
  • 49. DEMONSTRATION CASE Overdenture – Two Locator AttachmentsRemove the black processing male and insert the selected retentivemale into the metal housing.*** It is often best to start with the lightest force retentive male ! Photo courtesy of J. Bain, DDS 49
  • 50. DEMONSTRATION CASE Overdenture – Two Locator Attachments• Select replacement males by considering preferred retention and angle of implant divergence.• Remove the black processing males from the metal housing using the male removal tool or sickle.• 6 lbs. of retention per arch total is recommended (two 3.0 lb males, four 1.5 lb males, etc). But always best to start at the lowest level of retention. 10–20 divergence 8515 8524 8527 8529 8547 8548 8915 Processing 5 lbs 3 lbs 1.5 lbs 3–4 lbs .5 lbs 2 lbs 50
  • 51. DEMONSTRATION CASE Overdenture – Two Locator AttachmentsLocator Male Processing Package(REF08519-2) 51
  • 52. Divergent Angles of Attachments OverdenturePhoto courtesy of Per-Olof Karlsson, Sweden Photo courtesy of J. Bain, DDS Use 10–20 divergent retentive males 52
  • 53. Divergent Retentive MalesLocator® Extended Range Male Processing Package(8540-2) 53
  • 54. Case Overdenture – Two Locator AttachmentsWell-fitting denture• Chairside abutment selection by tissue height• Chairside curing of attachmentsDenture needing reline – Locator abutments present or only Implant is in place• Key factor is to get the denture to the well-fitting denture stage first• Only implants in place – reline denture first to a well fitting denture• Chairside abutment selection by tissue height and proceed as before• Patient has abutments and denture with attachments and needs reline• Order new metal caps, black processing and retentive/divergent males.• Remove existing metal caps with retentive males from patients denture – check for adequate clearance 54
  • 55. Case Overdenture – Two Locator Attachments• Place the new metal caps with the black processing males onto the Locator Abutments.• Take an impression and pick up the metal cap with the black processing males in the impression.• Remove the metal cap with the black processing males from the impression. You will be left with space to indicate location of attachments.• Pour the impression – send to lab.• Reline comes back from lab - Check clearance – place white block out spacer then metal cap with black processing male chairside and proceed as shown in the last section 55
  • 56. Case Overdenture – Two Locator AttachmentsWell-fitting denture• Chairside abutment selection by tissue height• Chairside curing of attachmentsDenture needing reline• Chairside abutment selection by tissue height• Reline impression over Locator metal housing/black processing male• Laboratory or chairside processing of attachmentsNeeding new denture• Chairside abutment selection by tissue height. Proceed• as before.• Impressions and completion of denture.• Chairside processing of attachments. 56
  • 57. Overdenture – Making a Stent - Case Case 57
  • 58. CaseOverdenture – Making a StentBefore implant placement in the fully edentulous patient,it is required to have defined the proper tooth position.This can be accomplished by:1. An existing denture2. A new denture3. A wax try-in that goes unprocessed 58
  • 59. CaseOverdenture – Making a Stent 59
  • 60. CaseOverdenture – Making a Stent Lang Pressure Pot 60
  • 61. CaseOverdenture – Making a Stent 61
  • 62. ADVANTAGES OF DOING IMPLANTS AT WDS • PATIENT SATISFACTION • DOCTOR SATISFACTION • LEARN – EXPERIENCE • MENTOR HELP • INCREASE PRODUCTION • WIN-WIN
  • 63. DOCTORS If you Never start a case you will Never gain the Experience to Learn.If you do not Learn you will Never gain Experience. He who has the Most Experience WINS!
  • 64. Winners take great Vacations! Roatan – Bay Islands - Honduras 64
  • 65. Winners eat well each night 65
  • 66. Winners have time for relaxation 66
  • 67. Don’t just be an Average doctor ―ONE OF THE CROWD‖Be an Experienced doctor – Be a WINNER! 67
  • 68. .
  • 69. Winners have time for relaxation 70
  • 70. Eat well each night 71
  • 71. Travel - Roatan – Bay Islands - Honduras 72
  • 72. Sea Turtle 73
  • 73. 300 lb Grouper 74
  • 74. Clownfish in Anemone 75
  • 75. Jacks 76
  • 76. Tarpon 77
  • 77. Turtle 78
  • 78. 79