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Implant Supported Over Denture By Dr pitzak
This document provides information about implant retained dentures. It discusses why patients may choose implant retained dentures and shows pictures of patients who could benefit from them. It then demonstrates the clinical process of placing two locator attachments on an existing denture, including selecting the correct abutment height, torquing and X-raying the abutments, adding spacers and processing the attachments into the denture. The document identifies the various parts used in the process and provides tips for techniques like adding a lingual relief hole. It also demonstrates how to select replacement males of different retention levels.
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Implant Supported Over Denture By Dr pitzak
- 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 ????
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- 4. Does Your DenturePatient Look Like This?? 4
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- 8. Panorex – Implantsand Locators Dr. Parvis Patient WDS Buena Park 8
- 9. Locators in Place Dr. Parvis Patient WDS Buena Park 9
- 10. Denture with AttachmentsPlaced Dr. Parvis Patient WDS Buena Park 10
- 11. CLINICAL CASE Overdenture – Two Locator Attachments Clinical 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 CASE Overdenture –Two Locator Attachments Torque to 35 Ncm clinically (15 Ncm on the model) 13
- 14. CLINICAL CASE Overdenture – Two Locator Attachments Place white block-out spacer ring Seat metal cap over abutment (may need more with black than one per abutment) processing male Clinical case courtesy of J. Bain, DDS 14
- 15. CLINICAL CASE Overdenture – Two Locator Attachments Inspect for show-through – Ensure clearance! Hot Clinical Tip: Make a vent hole to lingual for acrylic to escape so you do not trap air and create voids in the acrylic! Photos courtesy of J. Bain, DDS 15
- 16. Lingual Acrylic ReliefHole 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 Attachments Paint bonding agent on clean roughened acrylic and add acrylic into receptor sites and on metal housing Photos courtesy of J. Bain, DDS 18
- 19. CLINICAL CASE Overdenture – Two Locator Attachments Seat denture and confirm proper occlusion (tap, tap, bite lightly) Photos courtesy of J. Bain, DDS 19
- 20. CLINICAL CASE Overdenture – Two Locator Attachments Check— • Occlusion • Patient’s manual dexterity Photo courtesy of J. Bain, DDS 20
- 21. CLINICAL CASE Overdenture – Two Locator Attachments Remove denture, fill any voids in acrylic, adjust any excess acrylic and polish denture. Remove the black processing male and insert the 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
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- 23. STUDENT EXERCISE –PARTS INDENTIFICATION Impression Copings Metal Cap Spacer Locator Implant Abutment Locator retentive males Black Processing Male Divergent retentive males Abutment Replicas (Analogs) 23
- 24. PARTS Overdenture – TwoLocator 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 ofAttachments Overdenture Photo 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, WP Locator 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 apart Overdenture – Two Locator Attachments Male Removal Tool •Removes retentive & black Abutment Driver processing male from the metal •The gold-colored end of the cap. Locator Core Tool is used for Male Seating Tool screwing and unscrewing the •Places a new retentive male into Locator Abutments to and the empty metal cap. from implants and replicas. •The male is fixed firmly in the cap when a click is heard. Male Removal Tool Male Seating Tool Abutment Driver 30
- 31. PARTS Overdenture – Two Locator Attachments Male Removal Tool To 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 Attachments To remove the male from the male removal tool: • Screw the tip clockwise completely onto the middle section. This activates the loosening pin inside the tip, 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 Attachments Torque to 35 Ncm clinically (15 Ncm on the model) Abutment driver 35
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- 37. Overdenture – TwoLocator Attachments - CASE Well-fitting denture - DEMONSTRATION CASE • Chairside abutment selection by tissue height • Chairside curing of attachments Denture needing reline • Chairside abutment selection by tissue height • Reline impression over Locator metal housing/black processing male • Laboratory or chairside processing of attachments Needing 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 tissue Tissue 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 Case Overdenture –Two Locator Attachments Clinical case • Seat two Locator abutments Clinical case courtesy of J. Bain, DDS 40
- 41. Demonstration Case Overdenture –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 Attachments Use an appropriate method to mark the locations of the Locator Abutments on the existing denture. Photos courtesy of J. Bain, DDS 43
- 44. Overdenture – TwoLocator 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 ReliefHole 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 Attachments Seat the denture and confirm proper occlusion (tap, tap, bite lightly). Light cure resin or self cure in light occlusion without compression of 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 Attachments Remove the black processing male and insert the 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 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 Attachments Locator Male Processing Package (REF08519-2) 51
- 52. Divergent Angles ofAttachments Overdenture Photo courtesy of Per-Olof Karlsson, Sweden Photo courtesy of J. Bain, DDS Use 10–20 divergent retentive males 52
- 53. Divergent Retentive Males Locator®Extended Range Male Processing Package (8540-2) 53
- 54. Case Overdenture – Two Locator Attachments Well-fitting denture • Chairside abutment selection by tissue height • Chairside curing of attachments Denture 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 Attachments Well-fitting denture • Chairside abutment selection by tissue height • Chairside curing of attachments Denture needing reline • Chairside abutment selection by tissue height • Reline impression over Locator metal housing/black processing male • Laboratory or chairside processing of attachments Needing new denture • Chairside abutment selection by tissue height. Proceed • as before. • Impressions and completion of denture. • Chairside processing of attachments. 56
- 57. Overdenture – Makinga Stent - Case Case 57
- 58. Case Overdenture – Makinga Stent Before 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 denture 2. A new denture 3. A wax try-in that goes unprocessed 58
- 59. Case Overdenture – Makinga Stent 59
- 60. Case Overdenture – Makinga Stent Lang Pressure Pot 60
- 61. Case Overdenture – Makinga Stent 61
- 62. ADVANTAGES OF DOINGIMPLANTS 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 greatVacations! Roatan – Bay Islands - Honduras 64
- 65. Winners eat welleach night 65
- 66. Winners have timefor relaxation 66
- 67. Don’t just bean Average doctor ―ONE OF THE CROWD‖ Be an Experienced doctor – Be a WINNER! 67
- 68.
- 70. Winners have timefor relaxation 70
- 71. Eat well eachnight 71
- 72. Travel - Roatan– Bay Islands - Honduras 72
- 73. Sea Turtle 73
- 74.
- 75.
- 76. Jacks 76
- 77. Tarpon 77
- 78. Turtle 78
- 79.
Editor's Notes
- #12 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.
- #13 Here we see Dr. Bain hand-tightening the abutments using the Locator Abutment Driver.
- #15 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.
- #16 The area of contact is identified and marked with an indelible pencil
- #18 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,
- #19 Then Paint Triad VLC Bonding Agent Onto Housings, then Brush on Light-Cured Gel.
- #20 Then we’re going to seat the denture.
- #22 Dr. Bain is now going to is remove the black processing male.
- #28 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.
- #36 After hand tightening, Dr. Bain will utilize the torque wrench and tighten the abutments to 35 Ncm.
- #41 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.
- #42 Here we see Dr. Bain hand-tightening the abutments using the Locator Abutment Driver.
- #44 The area of contact is identified and marked with an indelible pencil
- #48 Then we’re going to seat the denture.
- #50 Dr. Bain is now going to is remove the black processing male.
- #53 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.