Let's face it; the graying of America has started.
With 10,000 people a day turning 65, the need to
embrace these patients with products that serve
their needs is enormous. There have been quantum
leaps in new dental materials, products and equipment.
However, few to none of these products provide the denture
patient with an economical and practical solution. In
today's landscape, implant therapy only reaches three to five
percent of the population, leading most of these patients to
rely on cumbersome adhesive products. Many dentists I talk
to don't want to get involved with dentures or partials
because the end result is a frustrated doctor and patient.
With seniors living longer we must offer this set of patients
that has never been given options a predictable, economic
and aesthetic solution. Narrow-diameter implants (NDIs)
with a Locator Attachment (ZEST Anchors) should be
considered to fill this oftoverlooked
void in modern
dentistry (Fig. 1).
The standard body twoimplant
overdenture has
been considered by many
to be the first treatment of
choice when dealing with
the lower edentulous arch.
In my experience, I rarely see a long-term edentulous ridge
6mm in buccal lingual dimension, the width needed to
encase a standard body implant properly in bone. Additional
procedures are often necessary to increase the buccal lingual width, which can be met with resistance from the patient.
By design, the two-implant solution will always have significant
rotation, vertical movement and will be rendered useless
if one implant fails. An elegant solution to consider in
these cases is four narrow-diameter implants with a low profile
Locator Attachment. With this treatment, rotation of
the denture is drastically reduced and precious alveolar bone
is preserved in two additional locations, as the narrow
implant body will stimulate the bone.
Clinical Case
The patient, a 68-year-old male presented with a lower
denture that would not stay in place (Fig. 2). He had several
dentures made, as well as numerous relines throughout
the years. He was frustrated and felt very unsatisfied with
what conventional dentistry had offered him. His expectations
were realistic as his main request was to have a more
retentive denture. Aesthetics were not a major concern,
however, he wanted his new “teeth” to be whiter than his
current upper denture. His medical history did not preclude
him from implant therapy. Diagnostic records were
taken along with a digital pan X-ray. Bone sounding measurements
were taken with a bone caliper at the four proposed
sites between the mental foramen. The ridge measured
4-5mm in width and would provide excellent bicortical
stabilization for a 2.9mm NDI. His current lower
denture had significant problems (poor occlusion, worn
teeth, inadequate flange extensions) and a new upper denture
was treatment planned as well. Full-arch impressions
were taken with PVS (Take 1 Kerr) in custom trays (Triad).
The patient returned for a tooth try-in to assess aesthetics,
phonetics and occlusion (Fig. 3). After patient approval it
was returned to the dental lab (Burbank) for final processing,
with a request to leave relief wells in the proposed locations
of the NDIs.
On the day of implant placement
local anesthesia was administered and a
1.2mm pilot drill with copious irrigation
was used to create the initial osteotomy
to three-quarters the length of the
implant. The blunt end of an endodontic
explorer was used to confirm no perforation
of the buccal or lingual walls
had occurred. A rotary tissue punch was
used to remove a plug of gingival tissue
(Fig. 4). This serves two purposes: to
give direct visualization of the ridge and
prevent any epithelium from being carried
down into the osteotomy. Because
the bone encountered was dense in nature
(D1 or D2), the next two drills (1.6mm
and 2.4mm) were progressed into the
osteotomy to three-quarters the length of
the implant. A Locator Overdenture
Implant (LODI) was removed from its
sterile packaging and transferred to the
mouth with the use of the implant handpiece
driver (Fig. 5). An implant handpiece
and motor (Aseptico AEU 7000)
was used to drive the self-tapping
implant into the osteotomy. A hand
driver placed into the torque-indicating ratchet wrench was used with
slow finger pressure for final
placement of the implant and to
ensure the implant was placed to
the crest of bone. A unique feature
of the LODI is that it is a
two-piece NDI (Fig. 6). The
included Locator Attachment is
removed from the top of the sterile
vile and is torqued on the
LODI to 30Ncm. The Locator
Attachment also comes in two
different cuff heights, 2.5mm
and 4mm. These features allow
for replacement of the Locator
Attachment if it is ever damaged
or wears during service and
allows the clinician to compensate
for varying tissue heights.
All four NDIs achieved
greater than 45Ncm of torque,
thus it was decided to place the
implants into service. In a separate
vile, the NDI comes with a
processing pack including the
denture cap, three different levels of retention inserts
(males) and a white block out spacer (Fig. 7). The white
block out spacer was placed around the neck of the Locator
Attachment and the denture cap was snapped on. Fit test
C&B material (QuickUp VOCO) was injected into each of
the wells and the denture was seated over the attachments
(Fig. 8). In 30 seconds the denture was removed and
inspected to see if any show through was visible; none was
detected. The relief wells in the denture were cleaned and a
thin coat of adhesive was placed and air-dried. QuickUp
resin was placed in the denture wells and seated over the
denture caps (Fig. 9). The patient was instructed to remain
closed for 2.5 minutes. After the resin set, any voids were
filled in with pink flowable composite (QuickUP LC) that
is included in the kit. The back processing males were
removed and replaced with the blue male (extra light retention).
It is recommended to initially place the least retentive
male needed for ease of denture removal, function and
patient satisfaction.
At the end of the procedure when the patient was interviewed,
he was completely satisfied with the retention of his
new lower denture, more importantly with the ease and
speed of how the entire procedure was accomplished.
Narrow-diameter implants with Locator Attachments are
not just another treatment but one that improves the lives of
patients with a time proven technology. With much less
height than the standard O-ball attachment, dentures can be
made more natural feeling because of reduced bulk and they
require less maintenance throughout time. The Locator
Overdenture Implant is an outstanding new product that
should be considered by clinicians to help patients remember
that modern dentistry has not forgotten about them.
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