The document discusses the benefits of retaining implants in patients with few peri-implant tissues, noting that implant retention can enhance support and stability while maintenance of soft tissues is easier due to the presence of keratinized mucosa. It also stresses the importance of creating a zone of attached keratinized tissue anteriorly for both fixed and removable prostheses.

9.  uch patients will probably derive functional benefit from implant retention.
S
 he implant will enhance support but the primary benefit is improved stability and
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retention,
 n addition maintenance of healthy peri-implant soft tissues will be relatively easy
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because of the wide zone of keratinized attached mucosa.

10. a b

12. Dissatisfied
7.7 %
Moderately
Satisfied Fully Satisfied
25.6 % 66.7 %
Berg E (1998); Smedley TC et al
(1989); Kapur KK et al (1997)

15. Implant Supported Implant Assisted Fixed Edentulous Bridge

18.  To determine whether a two implant mandibular overdenture
(IOD) is an effective treatment alternative to a conventional
complete denture (CD) in diabetic edentulous patients
treated with insulin and/or dietary therapy.
Two implants
• Hader Bar
• 2 clips
• Experienced denture wearers (15 yrs)
• Good ridge height (20 mm)

19.  To determine whether a two implant mandibular overdenture
(IOD) is an effective treatment alternative to a conventional
complete denture (CD) in diabetic edentulous patients
treated with insulin and/or dietary therapy.
Treatment effectiveness was based on improvements in
treatment success rates, masticatory efficiency, food selection
patterns, dietary intake, patient satisfaction, and cost of initial and
maintenance care.

21. It is important to note

23. Implant assisted
overlay denture
Which is the best option from a functional perspective?

25. Study Subjects:
16 Edent. pts. received CD/IOD(2
implants) and CD/LBOD(4 implants
Longitudinal design
Within-subject crossover (2 mo.)
Outcome Measures:
Masticatory time (carrot, cheese,
bread, apple, sausage)
Patient based perceptions – ease of chewing
Results:
Masticatory time not different between
prostheses (all foods)

30. Some patients require the presence of a properly
contoured and extended denture flange in order to
establish proper lip contours.

31. When implants emerge through poorly keratinized
unattached mucosa removable overlay dentures are
recommended because oral hygiene access is easier.

32.  Both these patients have little or no attached keratinized
mucosa
 ral hygiene procedures are much easier to perform when the
O
implants are surrounded by keratinized attached mucosa.
 reating a zone of attached keratinized tissues anteriorly would
C
be beneficial regardless of whether the patient chose
fixed or removable

44.  ote the supereruption of the mandibular teeth.
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 hen these teeth are removed an aggressive alveolectomy needs to be
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performed prior to placement of implants.
 mplants should be placed combatable with the plane of occlusion.
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47. This is an implant assisted type tissue bar design. When posterior occlusal forces are
applied, the denture rotates around the bar. As a result the posterior occlusal forces
are supported by the buccal shelf and retromolar pad. The anterior forces are
supported by the tissue bar. Hence support is shared between the implants and the
denture bearing surfaces. The bar provides retention and stability for the denture.

54. Graft

55. Hader - ERA

59. Note: Implants must parallel to one another

65. Courtesy Dr. S. Esposito

66. A reline impression can be used to secure the
female portion of the “O” ring to the denture base.
Courtesy Dr. S. Esposito

67. Courtesy Dr. S. Esposito

69. After the impression is made abutment analogues or fixture analogues,
as appropriate, are connected to the transfer impression copings and
positioned in the impression.

71. Impression copings are secured to
the fixture analogues imbedded in
the preliminary cast

72. The impression copings are linked together with floss and
Duralay*.

73. The copings, undercuts and relief
areas are blocked out with wax.

74. The master impression tray is
completed in the usual manner. The
guide pins must project 1-2 mm
above the level of the tray.

96. The left implant is slightly more posterior than desired

97. However, the tissue bar portion over the left implant is tapered
to accommodate the positioning of the denture teeth.

100.  Priorto processing the clip housings are
secured to the bar and the rest of the bar
is blocked out with plaster or stone.

103. Using pressure indicating paste (PIP) to eliminate areas of
excessive tissue displacement or undercut areas that may be
traumatized during insertion and removal of the denture.
The most critical undercuts relative to the path of insertion in an
implant retained denture are generally located anteriorly.

104. Pressure Indicating Paste (PIP)
Using pressure indicating paste (PIP) to eliminate areas of
excessive tissue displacement or undercut areas that may be
traumatized during insertion and removal of the denture.
The most critical undercuts relative to the path of insertion in an
implant retained denture are generally located anteriorly.

105. The mylohyoid area is always an area of
concern and must be carefully adjusted.

106. This border is of
proper length but
excessively thick

108. These are anatomic posterior denture teeth

109. These are anatomic posterior denture teeth