implant type over denture

8/3/2019 Implant Type Over Denture

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Monday, October 31, 2011



IMPLANT TYPE OVERDENTURES

A NEW STANDARD OF CARE




Edentulism and Complete Dentures

Background of Overdentures

Attachments of Overdentures

Clinical Consideration




14%

16%

16%

48 %44 %




1972~2001,10-12% Edentulism in

USA

Below poverty line,2X greater than above

line

Higher among AfricanAmericans

Higher on people withless than high school

education

Higher than those w/odental insurance

Higher in everydaysmoker

Center of Disease Control and Prevention




Chronic and progressive bone loss for 25 yrsMandible : Maxilla = 4 : 1

Tallgren, 2003Monday, October 31, 2011


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Chewing?




Chewing?

Speaking?




Chewing?

Speaking?

Smiling?




Chewing?

Speaking?

Smiling?

Nutrition intake?




Chewing?

Speaking?

Smiling?

Nutrition intake?

Social function?




Chewing?

Speaking?

Smiling?

Nutrition intake?

Social function?

Psychological comfort?




Will there be a need for complete denturesin the United States in 2020?

Douglas CW, 2002





Population: 35 million(2000) 38 million(2020)

Douglas CW, 2002






Denture Needs: 1~2 per person

Douglas CW, 2002






Denture Needs: 1~2 per person

Denture Counts: 56 million(2000) 61.0 million (2020)

Douglas CW, 2002




60% of dentures need to be replaced




56m * 60% = 34m

34m * 8 hrs = 288m hrs

288 mhrs / 0.2m = 1440 hrs

1440 / 8hrs = 180 days

180 / 20 = 9 months




Newly Extracted 8 years

15 years20 years +Mandibulectomy




Denture

stomatitis

Angular cheilitis

Epulisfissuratum

Traumaticulcer

Emotionalstress

Headache



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Fenton, 1998




Patrices

Matrices

Abutment

Implant

Denture

Metal Housing




RidgePreservation

Cost

Repairability




RidgePreservation

Retention

StabilityCost

Support

Repairability




PsychologicalComfort

Vertical Height

Following cost




PsychologicalComfort

Vertical Height

Following cost More visits

Attachment Wear

Faster Turnover




Studies suggest that when conventionaldentures are replaced with implant retainedoverdentures , patients enjoy a higher quality of life, greater self-confidence, anda better nutritional state.

Henry K., “Q&A on the future of implants”,Dental Equipment & Materials, 2006




“Conventional denture on the edentulousmandible is no longer the most appropriateprosthodontic treatment. There is nowoverwhelming evidence that a 2-implantoverdenture should become the first choice of treatment for the edentulous mandible.”

The McGill Consensus Statement




“ When I received the denture with solidattachment underneath, I became a differentperson; I feel wonderful; and I am very happywith myself and how others compliment theway I look."




Safe to go?




Check pt expectation

Interarch distance and spaceavailablity

Imaging data and graftingprocedures




What options for Maxilla?




Bar Attachment

Stud Attachment

Magnet Attachment




HADER BAR CLIPS (RIDERS)




RESILIENCE DESIGNMETAL HOUSING




Rigid SplintingMore Space

Malalignment Correction

Cost

Cleansibility

Screw Fracture




OVER-CONSTRUCTED

BAR BREAKAGE




LOCATOR ERA BALL/O-RING




COMBINATIONBALL




minimal

Malalignment Correction

Frequent Replacement

Resilient Connection

Easy Repairability

More Working Space

Cost FriendlyFaster wear-off

STUD SYSTEM




MAGNET VARIOUS SELECTION




No Undercut Limitation

Easy to wear

Corrosion

Poorest stability

Abutment protection




Facts about Complete Dentures







Why Removable?




100 edentulous archesFixed: 4-8 implants, 13-17 yrsOverdenture: 2-4 implants 4-15 yrsAnnual recalls: Osseointegration, perio indices

Subjective evaluationFixed: 38/45 V.S. Removable: 37/39

Schimitt and Zarb,1998




20 pts with edentulous maxillaFixed: 8-10 implant, 40 monthsBar Retained Overdenture: 5-8 implants, 27months

Check prosthodontic tx outcome, clinicalparametersComparable treatment outcome

Zitzmann, 2000




STUD TYPE BAR TYPE

How much space?




SPACE AVAILABILITY




2.5mm

3.0mm




How Many Implants?




Maxilla

4 implants to eliminate distal cantilever on ant.2 implants

4 Rigidly splinting implant for 4 yrs

4 or more implants placed more than 6mm

Naert, 1998

Stern, 1998

Lewis, 1992




Mandible

2 implants are often sufficient3 implants if shorter than 8mm

Stern, 1998




Mandible

21 edentulous pts, 74.2 y/oSingle implant at Mandible midlineGreat oral comfort and functionality

Cordioli M., 1997




Where to Place?




Maintenance

Replace AttachmentsReplace AttachmentsReplace Attachments

Accidental BreakageAccidental Breakage

Denture Reline




Which Design?

More favorable with a spread-out implantarrangement than with a concentrated implantarrangement and cantilever restoration.




Poor A-P Spread




Bruxer? Clencher?

Ku, 2002


Preparatory Phase• CT Scan: 1000~1500



CT Scan: 1000 1500• Graft Procedure: 300~2500

Implant Phase• Implant + Abutment: 1500~2000

Denture Phase• Attachment: 150~200• Denture: 1500~2500

Maintenance Phase• Replacement: 50~100




Questions??

implant type over denture

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