Implant Type Over Denture
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Transcript of Implant Type Over Denture
8/3/2019 Implant Type Over Denture
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Monday, October 31, 2011
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IMPLANT TYPE OVERDENTURES
A NEW STANDARD OF CARE
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Edentulism and Complete Dentures
Background of Overdentures
Attachments of Overdentures
Clinical Consideration
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14%
16%
16%
48 %44 %
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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
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Chronic and progressive bone loss for 25 yrsMandible : Maxilla = 4 : 1
Tallgren, 2003Monday, October 31, 2011
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Chewing?
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Chewing?
Speaking?
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Chewing?
Speaking?
Smiling?
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Chewing?
Speaking?
Smiling?
Nutrition intake?
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Chewing?
Speaking?
Smiling?
Nutrition intake?
Social function?
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Chewing?
Speaking?
Smiling?
Nutrition intake?
Social function?
Psychological comfort?
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Will there be a need for complete denturesin the United States in 2020?
Douglas CW, 2002
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Will there be a need for complete denturesin the United States in 2020?
Population: 35 million(2000) 38 million(2020)
Douglas CW, 2002
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Will there be a need for complete denturesin the United States in 2020?
Population: 35 million(2000) 38 million(2020)
Denture Needs: 1~2 per person
Douglas CW, 2002
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Will there be a need for complete denturesin the United States in 2020?
Population: 35 million(2000) 38 million(2020)
Denture Needs: 1~2 per person
Denture Counts: 56 million(2000) 61.0 million (2020)
Douglas CW, 2002
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60% of dentures need to be replaced
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56m * 60% = 34m
34m * 8 hrs = 288m hrs
288 mhrs / 0.2m = 1440 hrs
1440 / 8hrs = 180 days
180 / 20 = 9 months
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Newly Extracted 8 years
15 years20 years +Mandibulectomy
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Denture
stomatitis
Angular cheilitis
Epulisfissuratum
Traumaticulcer
Emotionalstress
Headache
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Edentulism and Complete Dentures
Background of Overdentures
Attachments of Overdentures
Clinical Consideration
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Fenton, 1998
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Patrices
Matrices
Abutment
Implant
Denture
Metal Housing
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RidgePreservation
Cost
Repairability
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RidgePreservation
Retention
StabilityCost
Support
Repairability
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PsychologicalComfort
Vertical Height
Following cost
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PsychologicalComfort
Vertical Height
Following cost More visits
Attachment Wear
Faster Turnover
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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
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“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
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“ 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."
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Safe to go?
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Check pt expectation
Interarch distance and spaceavailablity
Imaging data and graftingprocedures
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Edentulism and Complete Dentures
Background of Overdentures
Attachments of Overdentures
Clinical Consideration
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What options for Maxilla?
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Bar Attachment
Stud Attachment
Magnet Attachment
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HADER BAR CLIPS (RIDERS)
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RESILIENCE DESIGNMETAL HOUSING
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Rigid SplintingMore Space
Malalignment Correction
Cost
Cleansibility
Screw Fracture
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OVER-CONSTRUCTED
BAR BREAKAGE
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LOCATOR ERA BALL/O-RING
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COMBINATIONBALL
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minimal
Malalignment Correction
Frequent Replacement
Resilient Connection
Easy Repairability
More Working Space
Cost FriendlyFaster wear-off
STUD SYSTEM
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MAGNET VARIOUS SELECTION
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No Undercut Limitation
Easy to wear
Corrosion
Poorest stability
Abutment protection
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Facts about Complete Dentures
Background of Overdentures
Attachments of Overdentures
Clinical Consideration
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Why Removable?
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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
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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
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STUD TYPE BAR TYPE
How much space?
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SPACE AVAILABILITY
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2.5mm
3.0mm
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How Many Implants?
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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
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Mandible
2 implants are often sufficient3 implants if shorter than 8mm
Stern, 1998
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Mandible
21 edentulous pts, 74.2 y/oSingle implant at Mandible midlineGreat oral comfort and functionality
Cordioli M., 1997
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Where to Place?
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Maintenance
Replace AttachmentsReplace AttachmentsReplace Attachments
Accidental BreakageAccidental Breakage
Denture Reline
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Which Design?
More favorable with a spread-out implantarrangement than with a concentrated implantarrangement and cantilever restoration.
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Poor A-P Spread
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Bruxer? Clencher?
Ku, 2002
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Preparatory Phase• CT Scan: 1000~1500
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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
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Questions??