Implants and rp ds

1. Implants and RPD’s
John Beumer III DDS, MS
Ting Ling Chang DDS
Robert Faulkner DDS
Division of Advanced Prosthodontics, UCLA
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2. Implants
have
been
used
under
following
circumstances
in
conjunc1on
with
RPD’s.
• In
extension
base
RPD’s
(Kennedy
Class
I
and
II)
to
supplement
the
support,
stability
and
reten1on
provided
by
the
exis1ng
den11on.
• Implants
with
ques1onable
anchorage
and
configura1ons
with
unfavorable
biomechanics
• Unan1cipated
implant
failures
in
key
loca1ons
• Replacement
for
a
key
natural
tooth
abutment
• As
a
supplement
when
the
exis1ng
den11on
cannot
provide
sufficient
support,
stability
and
reten1on
for
the
removable
prosthesis
Implants and RPD’s

3. In
extension
base
RPD’s
(Kennedy
Class
I
and
II)
to
supplement
the
support,
stability
and
reten1on
provided
by
the
exis1ng
den11on.
Position and lengths
• Implant site most favored – 1st molar position
• Lengths vary but in recent times some clinicians have
reported successful outcomes when using implants as
short as 6 mm in length (Gates et al, 2012).

4. In
extension
base
RPD’s
(Kennedy
Class
I
and
II)
to
supplement
the
support,
stability
and
reten1on
provided
by
the
exis1ng
den11on.
Prosthodon1c
issues
• Resilient
aNachments
• Provide
both
reten1on
and
stability
with
less
risk
of
implant
overload
(Cho,
et
al
2002)
• Cover
the
retromolar
pad
and
the
buccal
shelf
• Provides
ample
support
• RPD
should
be
designed
with
guide
planes,
proximal
plates
and
posi1ve
rests
on
natural
tooth
abutments

5. In
extension
base
RPD’s
(Kennedy
Class
I
and
II)
to
supplement
the
support,
stability
and
reten1on
provided
by
the
exis1ng
den11on.
Complica1ons
(Gates,
et
al,
2012)
• Peri-­‐implan11s
• Loosening
abutments
• Wear
aNachments
• Occasional
implant
loss

6. Implants
with
ques1onable
anchorage
and
configura1ons
with
unfavorable
biomechanics
Why
overlay
RDP?
– GraXed
implant
sites
– Unfavorable
crown
implant
ra1os
– Linear
configura1on
– Bracing
(cross
arch
stabiliza1on

7. Implants
with
ques1onable
anchorage
and
configura1ons
with
unfavorable
biomechanics
• Implant
connec1ng
bar
designed
to
be
implant
assisted
• Note
posi1ve
cingulum
rest
was
placed
on
the
canine
an
a
pothole
rest
on
the
lateral
inicsor

8. Implants
with
ques1onable
anchorage
and
configura1ons
with
unfavorable
biomechanics
• Defini1ve
prosthesis

9. Unan1cipated
implant
failures
in
key
loca1ons
• Two
implants
were
lost
on
each
side
and
the
pa1ent
chose
not
to
undergo
addi1onal
surgery
• Posi1ve
cingulum
rests
were
placed
on
each
central
(the
central
incisors
were
splinted)
and
the
posterior
molars
• The
aNachments
were
resilient
and
were
primarily
used
for
reten1on
so
as
to
avoid
placement
of
retainers
anteriorly

10. Defini1ve
prosthesis
– Note:
The
aNachments
were
designed
to
be
engaged
on
the
same
plane
as
the
path
of
inser1on
of
the
RPD
framework
Unan1cipated
implant
failures
in
key
loca1ons

11. • Implant
supported
removable
par1al
dentures

12. Replacement
for
a
key
natural
tooth
abutment
• On
some
occasions
a
key
abutment
tooth
on
one
side
of
the
arch
used
to
support
and
retain
a
removable
par1al
denture
is
lost.
• If
the
remaining
teeth
on
that
side
of
the
arch
are
not
suitable
abutments
for
a
removable
par1al
denture
the
authors
have
replaced
the
tooth
with
an
implant/s.

13. Replacement
for
a
key
natural
tooth
abutment
• Note
the
use
of
resilient
aNachment

14. Replacement
for
a
key
natural
tooth
abutment
l Note
the
use
of
resilient
aNachments

15. As
a
supplement
when
the
exis1ng
den11on
cannot
provide
sufficient
support,
stability
and
reten1on
for
the
removable
prosthesis
• Remaining
maxillary
molars
compromised
periodontally
• Large
RPD
obturator
• Note
the
rests
on
the
bar

16. Overlay Removable Partial Dentures
Note:
• Anterior open bite
• Fistulas
• Soft palate defect

17. Overlay Removable Partial Dentures
v Remaining teeth covered with gold copings.
v Tooth tissue junction should be covered with metal as
opposed to acrylic resin
v Implants placed in posterior quadrant.

18. Design of the metal framework
Note
that
the
tooth
1ssue
junc1on
of
all
overlaid
teeth
are
covered
with
metal
as
opposed
to
acrylic
resin.
The
resin
is
porous
and
if
you
cover
these
areas
with
this
material
you
will
increase
the
risk
of
gingival
caries
Note
the
metal
occlusal
surfaces
overlaying
the
implant
connec1ng
bar.
This
was
done
to
accommodate
for
the
lack
of
space
between
the
implant
connec1ng
bar
and
the
opposing
natural
den11on.

19. Definitive prosthesis.
Overlay Removable Partial Dentures

20. Overlay
RPD’s

21. Defini1ve
prosthesis

22. As
a
supplement
when
the
exis1ng
den11on
cannot
provide
sufficient
support,
stability
and
reten1on
for
the
removable
prosthesis

23. • Implants
were
placed
with
the
aid
of
a
surgical
template
so
they
were
aligned
consistent
with
the
path
of
inser1on
of
the
RPD
As
a
supplement
when
the
exis1ng
den11on
cannot
provide
sufficient
support,
stability
and
reten1on
for
the
removable
prosthesis

24. Defini1ve
prosthesis

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