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Improving the Future of Overdentures with Small Diameter Implants and Locator Attachments by Paresh B Patel DDS

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We all know that one of the largest segments of the U.S. population is over 65. We all know that this section of the population has a great deal of economic buying power. But as dentists very few of us cater to this population by offering cost-effective solutions to help them live the rest of their lives enjoying one of the things we all like to do - eat.

As the average life span increases and the number of totally edentulous arches increases, these patients will suffer from poor nutrition. This can be greatly improved with the use of implants that are adequately sized to fit in the residual ridges. With the average person over 75 being on more than 11 drugs, additional preprosthetic surgery might not be necessary, case acceptance can rise, potential surgical complications can be avoided and a minimally invasive procedure can be completed with a high success rate.

Most of the small-diameter (mini) implants on the market today use the O-ring attachment as their retentive element. While this has worked well over the past decade, the height needed can create restorative issues, such as bulky acrylic areas or over-contoured areas in the palate. With the recent creation of the LODI (Locator Overdenture Implant), a low-profile attachment solution now exists. In addition to the lower height, the ability to change the amount of retention is also an option. Retention up to 5 lbs. is possible.

Case Report

A 56-year-old woman presented with a fully edentulous upper and lower arch. She reported that the teeth have been missing for more than 25 years and that she has been wearing full dentures for that entire time and is now on her fourth set. The upper denture has been well-fitting and does not require any adhesive products at this time. Her chief complaint was her ill-fitting lower denture. As an anecdotal comment, I have rarely met patients who liked their lower full dentures. With so many patients with ill-fitting lower dentures, I am at a loss as to why our profession does not make denture stabilization more accessible and affordable. The patient’s request was to add some “screws” to help hold her denture in place. I think it is important to note that most seniors now know there exists something to help them with their dentures other than adhesives. They may not call them implants but they are aware, and in some cases know someone who has implants, and will actively seek out dental offices that are well qualified to provide this service for them.

Clinical examination revealed a thin atrophic residual alveolar ridge (Fig. 1). Ridge calipers (ACE Surgical) were used to determine buccal lingual dimension at around 4mm in most areas between the mental foramen. Based off this information, a CT scan was decided on to help determine the best size implants to utilize, as well as locations. The patient was sent to get a CT scan (i-CAT FLX). The vast improvements in i-CAT digital technology now can offer a full 3D scan with radiation doses similar or lower than some panoramic images. The DICOM file was then seamlessly uploaded to 3DDX (3D Diagnostics) for conversion and treatment planning (Simplant). With the use of this service I can easily see where the most ideal areas are for the implants, as well as where they will be contained in the prosthesis (Figs. 2 and 3). This does require a dual scan where the patient scan is taken with radiographic markers placed in the existing denture (Fig. 4). Rather than make a radiographic scan appliance, nine dots of radiopaque composite (VOCO Grandio Flow) were placed on the denture in various locations to accomplish this. An additional scan of just the denture was also taken. These two scans were then merged together by the 3DDX technicians giving us the ability to generate a prosthetically driven treatment plan. Once implant size and location were agreed upon, a surgical guide was fabricated (Materalize) (Fig. 5). It is important to note that this is not just a prosthetic guide (a suck down template on a stone model from locations determined on a 2D pan X-ray), but a true surgical guide digitally made from only the CT scan. For this case, to stay within the thin ridge, five 2.9mm Locator Overdenture Implants (LODI) were selected.

On treatment day the surgical guide was tried in and assessed for fit. I like to utilize only a pilot guide (one where only the pilot bit will pass through the guide tubes) (Fig. 6). Once the pilot osteotomies are made, a blunt-ended endodontic probe is used to confirm there are no perforations of the buccal or lingual plates. Parallel pins were placed to assess the orientation and if any corrections needed to be made prior to implant placement (Fig. 7). As with most of my cases, I prefer to place the implant with a handpiece (Aesptico AEU-7000) (Fig. 8).This helps me keep a constant speed to prevent overheating the bone as well as keep the driving torque on the long axis to the implant. One by one the LODI implants were removed from the sterile vails and inserted in the A, B, C, D and E positions. Because these are twopiece implants, the Locator attachment was then placed and torqued to 30Ncm on all five implants (Fig. 9).

The existing denture was then loaded with FitCheck material (VOCO) and seated over the Locators. In 30 seconds the exact areas where relief would be needed in the denture could be identified with ease (Fig.10). A cylinder-shaped ceramic cutter (Komet) was used in the Aseptico handpiece to create the relief wells. The denture could then be soft lined (UfiGel VOCO) during the healing phase while a new denture was being fabricated. With the addition of small-diameter implants such as the Locator Overdenture Implants thin ridges can now benefit from straightforward denture stabilization with the huge benefit of a well-tested and patient-approved attachment (Fig. 11). I encourage restorative-minded dentists who wish to incorporate a few additional surgical techniques into their offices to consider getting the implant training they need and offer overdentures with the Locator attachment. You will find great success for your practice as well as offering a service to a well-deserving section of our population.

Author's Bio
Dr. Paresh Patel is a graduate of UNC-CH School of Dentistry and the MCG/AAID MaxiCourse. He is the co-founder of the American Academy of Small Diameter Implants and is a clinical instructor at the Reconstructive Dentistry Institute. Dr. Patel has placed more than 2,500 mini implants and has worked as a lecturer and clinical consultant on mini implants for various companies. He can be reached at pareshpateldds2@gmail.com or online at www.dentalminiimplant.com.
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April 2024
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