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IMPLANT RETAINED DENTURES•   Dr. Larry Pitzak, D.D.S. , Western Dental Services Quality Management•   Office 714-571-3168•...
IMPLANT RETAINED DENTURES   WHY DO IMPLANT RETAINED        DENTURES ????
3
Does Your Denture Patient Look Like This??                                             4
Testimonial
6
7
Panorex – Implants and Locators Dr. Parvis Patient WDS Buena Park                                                         ...
Locators in Place   Dr. Parvis Patient WDS Buena Park                                                        9
Denture with Attachments Placed Dr. Parvis Patient WDS Buena Park                                                         ...
CLINICAL CASE          Overdenture – Two Locator AttachmentsClinical case• Seat two Locator abutments  Clinical case court...
CLINICAL CASE        Overdenture – Two Locator Attachments                            Hand tighten with the Abutment Drive...
CLINICAL CASEOverdenture – Two Locator AttachmentsTorque to 35 Ncm clinically (15 Ncm on the model)                       ...
CLINICAL CASE          Overdenture – Two Locator AttachmentsPlace white block-out spacer ring          Seat metal capover ...
CLINICAL CASE            Overdenture – Two Locator AttachmentsInspect for show-through – Ensure clearance!Hot Clinical Tip...
Lingual Acrylic Relief Hole                              16
Over denture – Two Locator Attachments - CASE                           Clean receptor sites with alcohol  Photos courtesy...
CLINICAL CASE          Overdenture – Two Locator AttachmentsPaint bonding agent on cleanroughened acrylic and addacrylic i...
CLINICAL CASE        Overdenture – Two Locator AttachmentsSeat denture and confirm proper occlusion (tap, tap, bite lightl...
CLINICAL CASE           Overdenture – Two Locator AttachmentsCheck—• Occlusion• Patient’s manual dexterity   Photo courtes...
CLINICAL CASE         Overdenture – Two Locator AttachmentsRemove denture, fill any voids in acrylic, adjust any excess ac...
Take Out Parts                 22
STUDENT EXERCISE – PARTS INDENTIFICATION                                     Impression CopingsMetal Cap  Spacer          ...
PARTSOverdenture – Two Locator Attachments                                        24
PARTS    Overdenture – Two Locator Attachments•                  Metal Cap•            Block Out Spacer                   ...
PARTS     Black Processing male and retentive males• The black processing male is replaced with the appropriate retentive ...
Divergent Angles of Attachments                           OverdenturePhoto courtesy of Per-Olof Karlsson, Sweden        Ph...
PARTS       Overdenture – Two Locator Attachments• Mandible: 2 or more implants• Multiple collar heights for variable tiss...
Different Collar Heights – Measure  The Locator Abutment is selected to be 1.5mm above the tissue height.         Collar H...
Locator Core Tool –Three Parts that come apartOverdenture – Two Locator AttachmentsMale Removal Tool•Removes retentive & b...
PARTS       Overdenture – Two Locator AttachmentsMale Removal ToolTo remove a retentive male or black processing male from...
PARTS       Overdenture – Two Locator AttachmentsTo remove the male from the male removal tool:• Screw the tip clockwise c...
PARTS                    Male Seating Tool• Used to insert a retentive male or black processing male into the  metal cap
Locator Abutment Driver - PARTS    Machine Screw Driver    Locator Abutment Driver
PARTS       Overdenture – Two Locator AttachmentsTorque to 35 Ncm clinically (15 Ncm on the model)                        ...
36
Overdenture – Two Locator Attachments - CASEWell-fitting denture - DEMONSTRATION CASE• Chairside abutment selection by tis...
DEMONSTRATION CASE    Overdenture – Two Locator Attachments     Correct measurement of tissue depth for collar will ensure...
Different Collar Heights – Measure  The Locator Abutment is selected to be 1.5mm above the tissue height.         Collar H...
Demonstration CaseOverdenture – Two Locator AttachmentsClinical case• Seat two Locator abutments  Clinical case courtesy o...
Demonstration CaseOverdenture – Two Locator Attachments                              Hand tighten with the Abutment Driver...
DEMONSTRATION CASE       Overdenture – Two Locator Attachments• Place a white block-out spacer ring on each  abutment.• Th...
DEMONSTRATION CASE        Overdenture – Two Locator AttachmentsUse an appropriate method to mark   the locations of the Lo...
Overdenture – Two Locator Attachments - CASE• Hollow out the existing denture base in the  marked areas for the locator at...
Lingual Acrylic Relief Hole                              45
DEMONSTRATION CASE       Overdenture – Two Locator Attachments• Apply suitable bonding agent onto  the metal caps and on t...
DEMONSTRATION CASE          Overdenture – Two Locator AttachmentsSeat the denture and confirm proper occlusion (tap, tap, ...
Demonstration Case         Overdenture – Two Locator Attachments•   Once the resin has cured, remove    the denture from t...
DEMONSTRATION CASE         Overdenture – Two Locator AttachmentsRemove the black processing male and insert the selected r...
DEMONSTRATION CASE          Overdenture – Two Locator Attachments• Select replacement males by considering preferred  rete...
DEMONSTRATION CASE     Overdenture – Two Locator AttachmentsLocator Male Processing Package(REF08519-2)                   ...
Divergent Angles of Attachments                           OverdenturePhoto courtesy of Per-Olof Karlsson, Sweden        Ph...
Divergent Retentive MalesLocator® Extended Range Male Processing Package(8540-2)                                          ...
Case       Overdenture – Two Locator AttachmentsWell-fitting denture• Chairside abutment selection by tissue height• Chair...
Case       Overdenture – Two Locator Attachments• Place the new metal caps with the  black processing males onto the  Loca...
Case         Overdenture – Two Locator AttachmentsWell-fitting denture• Chairside abutment selection by tissue height• Cha...
Overdenture – Making a Stent - Case                       Case                                      57
CaseOverdenture – Making a StentBefore implant placement in the fully edentulous patient,it is required to have defined th...
CaseOverdenture – Making a Stent                               59
CaseOverdenture – Making a Stent                               Lang Pressure Pot                                          ...
CaseOverdenture – Making a Stent                               61
ADVANTAGES OF DOING IMPLANTS AT WDS          • PATIENT SATISFACTION          • DOCTOR SATISFACTION             •   LEARN –...
DOCTORS             If you Never start a case   you will Never gain the Experience to Learn.If you do not Learn you will N...
Winners take great Vacations! Roatan – Bay Islands - Honduras                                   64
Winners eat well each night                              65
Winners have time for relaxation                                   66
Don’t just be an Average doctor        ―ONE OF THE CROWD‖Be an Experienced doctor – Be a WINNER!                          ...
.
Winners have time for relaxation                                   70
Eat well each night                      71
Travel - Roatan – Bay Islands - Honduras                                           72
Sea Turtle             73
300 lb Grouper                 74
Clownfish in Anemone                       75
Jacks        76
Tarpon         77
Turtle         78
79
 Implant Supported Over Denture By Dr pitzak
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Implant Supported Over Denture By Dr pitzak

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Implant Supported Over Denture By Dr pitzak

  1. 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. 2. IMPLANT RETAINED DENTURES WHY DO IMPLANT RETAINED DENTURES ????
  3. 3. 3
  4. 4. Does Your Denture Patient Look Like This?? 4
  5. 5. Testimonial
  6. 6. 6
  7. 7. 7
  8. 8. Panorex – Implants and Locators Dr. Parvis Patient WDS Buena Park 8
  9. 9. Locators in Place Dr. Parvis Patient WDS Buena Park 9
  10. 10. Denture with Attachments Placed Dr. Parvis Patient WDS Buena Park 10
  11. 11. CLINICAL CASE Overdenture – Two Locator AttachmentsClinical case• Seat two Locator abutments Clinical case courtesy of J. Bain, DDS 11
  12. 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. 13. CLINICAL CASEOverdenture – Two Locator AttachmentsTorque to 35 Ncm clinically (15 Ncm on the model) 13
  14. 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. 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. 16. Lingual Acrylic Relief Hole 16
  17. 17. Over denture – Two Locator Attachments - CASE Clean receptor sites with alcohol Photos courtesy of J. Bain, DDS 17
  18. 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. 19. CLINICAL CASE Overdenture – Two Locator AttachmentsSeat denture and confirm proper occlusion (tap, tap, bite lightly)Photos courtesy of J. Bain, DDS 19
  20. 20. CLINICAL CASE Overdenture – Two Locator AttachmentsCheck—• Occlusion• Patient’s manual dexterity Photo courtesy of J. Bain, DDS 20
  21. 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. 22. Take Out Parts 22
  23. 23. STUDENT EXERCISE – PARTS INDENTIFICATION Impression CopingsMetal Cap Spacer Locator Implant Abutment Locator retentive malesBlackProcessingMale Divergent retentive males Abutment Replicas (Analogs) 23
  24. 24. PARTSOverdenture – Two Locator Attachments 24
  25. 25. PARTS Overdenture – Two Locator Attachments• Metal Cap• Block Out Spacer Metal Cap• Black Processing Male•• Locator Abutment 25
  26. 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. 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. 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. 29. Different Collar Heights – Measure The Locator Abutment is selected to be 1.5mm above the tissue height. Collar Height 29
  30. 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. 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. 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. 33. PARTS Male Seating Tool• Used to insert a retentive male or black processing male into the metal cap
  34. 34. Locator Abutment Driver - PARTS Machine Screw Driver Locator Abutment Driver
  35. 35. PARTS Overdenture – Two Locator AttachmentsTorque to 35 Ncm clinically (15 Ncm on the model) Abutment driver 35
  36. 36. 36
  37. 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. 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. 39. Different Collar Heights – Measure The Locator Abutment is selected to be 1.5mm above the tissue height. Collar Height 39
  40. 40. Demonstration CaseOverdenture – Two Locator AttachmentsClinical case• Seat two Locator abutments Clinical case courtesy of J. Bain, DDS 40
  41. 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. 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. 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. 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. 45. Lingual Acrylic Relief Hole 45
  46. 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. 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. 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. 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. 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. 51. DEMONSTRATION CASE Overdenture – Two Locator AttachmentsLocator Male Processing Package(REF08519-2) 51
  52. 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. 53. Divergent Retentive MalesLocator® Extended Range Male Processing Package(8540-2) 53
  54. 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. 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. 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. 57. Overdenture – Making a Stent - Case Case 57
  58. 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. 59. CaseOverdenture – Making a Stent 59
  60. 60. CaseOverdenture – Making a Stent Lang Pressure Pot 60
  61. 61. CaseOverdenture – Making a Stent 61
  62. 62. ADVANTAGES OF DOING IMPLANTS AT WDS • PATIENT SATISFACTION • DOCTOR SATISFACTION • LEARN – EXPERIENCE • MENTOR HELP • INCREASE PRODUCTION • WIN-WIN
  63. 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. 64. Winners take great Vacations! Roatan – Bay Islands - Honduras 64
  65. 65. Winners eat well each night 65
  66. 66. Winners have time for relaxation 66
  67. 67. Don’t just be an Average doctor ―ONE OF THE CROWD‖Be an Experienced doctor – Be a WINNER! 67
  68. 68. .
  69. 69. Winners have time for relaxation 70
  70. 70. Eat well each night 71
  71. 71. Travel - Roatan – Bay Islands - Honduras 72
  72. 72. Sea Turtle 73
  73. 73. 300 lb Grouper 74
  74. 74. Clownfish in Anemone 75
  75. 75. Jacks 76
  76. 76. Tarpon 77
  77. 77. Turtle 78
  78. 78. 79

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