The implant retained denture

What are implant retained dentures or locator denture?

Implant retained dentures are a type of overdenture that you can take in and out to clean and attaches to dental implants. It differs from the bar overdenture in that the implants attach directly to the denture instead of to an intermediary bar.

Implant and Tissue Supported Overdenture or Implant retained overdenture

Implant and Tissue Supported Overdenture is a patient removable prosthesis that gets support from both dental implants and patient tissue. I prefer the term implant retained denture. It has either a bar or studs on the implants.  Requires fewer implants than any other option.  Ensure if bar with clips only one as multiple inadvertently creates a supported prosthesis.

For mandible 2 with bar is best and clip with intimate contact OR 2 individual and want lateral throat form

Best location for 2 implant mand OD is in lateral incisor area with short attachments

Some reinforce acrylic with metal mesh to reduce acrylic fractures. 4 is minimum in maxilla with no palatal coverage but full tuberosity coverage. JOMI 2007 Cavallaro Tarnow   2 implants then denture works just like traditional denture.

Minimum requirement vertically is about 10mm with an ideal breakdown of 2mm for tissue, 2mm for denture acrylic base, 3mm for denture teeth, and 3.35mm for a locator.  For horizontal space constraints a Micro-ERA is 4.43mm so 8mm total is minimum, that leaves 2mm acrylic both sides. For a locator overdenture you need about 9mm vertical and horizontal, but would like to see 10-12mm Lee 2006 JPD Sadowsky 2007 JPD

Reference

How do we measure vertical space for a locator denture?

To measure the space available we have 3 main options

1. Make radiographic template (code 6190) and have them wear during CBCT
2. Measure existing/new denture or area with boley gauge, this method is the least diagnostic.
3. Matrix capture of denture teeth, if not doing CBCT then this is best method.

CBCT option 

This is a double scan technique.  One in which they are first scanned wearing the prosthesis and then the prosthesis is scanned by itself.

1. If patient is edentulous then make a duplicate of the finished temporary prosthesis with to wear as a radiographic template.
2. If patient has some teeth remaining do same thing, just remove the teeth that are still present from the duplicated finished temporary prosthesis
3. To make the radiographic template use 1:3 ratio barium sulfate powder (Hypaque Sodium by Amersham Health) OR
4. #6 round but to 1/2 depth around the lingual flange and fill with gp and polish off with rubber OR
5. Add radioopaque glass beads
6. Can mark attached tissue like seen in A Technique to Identify Attached Gingiva During Virtual Implant Planning
7. Patient wears during CBCT and besides reading bone levels can measure space available.

Matrix option

1. Once have approved wax baseplates can just remove from mounted models and measure.
2. There is several much more complex Aug 10ways to do this but I don’t see how they are a whole lot more informative.

Implant retained denture dental code = Locator denture dental code

This would be a locator or ERA retained denture.  These would be dentures that are retained by implants (actually some type of abutments), but are supported by tissue as well as the implants.

D5862 per each Precision attachment (set of male and female components reported as one precision attachment) (so locator or ERA)

D5110 or D5120 denture might be easier to use but D5863 or D5865 Complete Overdenture is the correct code.

Attachment options for implant retained dentures are found in the link.

Treatment planning of the implant overdenture

Implant retained overdenture is very similar to denture and a fixed detachable provisional

 Implant overdenture procedure in a step by step format

Steps for the initial impression for the implant overdenture

1. Measure depth from implant platform to most coronal aspect of surrounding gingival tissue for depth locators
2. Take alginate impression

Steps for the final impressions for the implant overdenture

1. Seat locator abutments to specified torque
2. Place implant impression copings
3. Clear thermoplastic tray by Massad or custom tray
4. Paint tray with PVS adhesive
5. Rigid PVS on palate, tissue areas, and directly over implant copings to act as stops.
6. Trim most away most material except for solid stops on palate, tissue both sides, and on copings.  Leave just enough for positive seat of copings, do not come up sides.
7. Med PVS on periphery and light inside border mold.
8. Ask for processed denture base with metal subframe mesh support (probably? some say rather no and let acrylic break before implant does) with holes to pick up locators exactly.
9. Also want wax rim with central SR Phonares set in wax
10. Follow denture thread instructions from here

Steps if picking up overdenture intra-orally

1. Place locator block out spacer ring and then titanium cap with black processing male (1 at a time? 2 at a time? just not all)
2. Ensure locators with metal housing not hitting
3. GC fit check
4. Adjust as needed and then place undercuts with #8 bur
5. Place vent hole to palatal or lingual
6. Refine occlusion now
7. Adhesive painted on denture area
8. Petroleum jelly in areas don’t want maybe
9. Block out undercuts on implant (if any) with silicone like fit check or Fit Test C&B VOCO
10. Place resin in hole and seat denture  self cure or LC if can
11. Have the patient feel their masseter with their hands as they close and then clench and repeat until they can tell when the muscle is starting to clench.  Tell them you want them to close but not clench at all when doing your reline.
12. Remove and fill small voids with LC resin
13. Remove processing male insert and place appropriate strength

Implant retained denture loading and other instructions

Early loading of the implant overdenture is anytime we load between 48 hours and 3 months. Loading lower unsplinted implants at 1 week has same results as at 6 weeks with 14mm implants and a flapless surgery. While still healing recommend a soft diet and removal at night with thorough oral hygiene instructions. Should fabricate a night guard for removable overdentures in order to protect abutments from any para-functional activity.

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