Case Presentation: Stabilizing a Maxillary Denture With Narrow-Diameter Overdenture Implants

Published Date 01/23/2019
 
Figure 1—The patient presented with a loose maxillary complete denture, requesting implants to help stabilize it. Examination of the maxillary ridge shows adequate keratinized soft tissues, narrow alveolar ridges, and adequate prosthetic space for flapless dental implants.
A healthy 75-year-old female presented with a loose maxillary complete denture and the desire to place implants to assist the denture to remain in place. Approximately 20 years ago, she had implants placed on her mandibular arch and an implant overdenture fabricated. She was always told, however, that her bone was insufficient in her maxillary arch for implants. She was referred to the author’s practice for evaluation for narrow-diameter implant placement.

A CBCT scan of the patient was made using cotton rolls for occlusal and soft-tissue separation in combination with a radiopaque PVS impression liner placed on the intaglio of her maxillary denture to enhance the radiographic visualization. A second CBCT scan of the denture was made and an extraoral digital impression was used with an intraoral scanner (3M True Definition Scanner, 3M). Six 2.4 mm x 12 mm Zest LOCATOR Overdenture Implants (LODI, Zest Dental Solutions) were planned in the computer software (Invivo, Anatomage). A computerized surgical guide was planned and fabricated (Anatomage Guide, Anatomage).

The patient was anesthetized, complete adaptation of the surgical guide confirmed, osteotomies prepared, and implants were placed using a minimally invasive technique. Recesses in the denture were prepared using specialized burs specifically designed for overdentures (Denture Prep & Polish Kit, Zest Dental Solutions). LOCATOR abutments (Zest Dental Solutions) were attached to the implants and connected the denture the same day using an overdenture attachment material (CHAIRSIDE, Zest Dental Solutions). The LOCATOR Black Processing Male inserts were kept inside the denture, and the patient was seen for recall 8 weeks later, when the tissues were fully healed. At the recall appointment, the inserts were changed from the processing males to the light, standard-range retentive male inserts.

The patient was followed up over the course of several years and has continued to report a high degree of satisfaction.
Figure 2—Radiopaque PVS impression material (Green-Mousse, Parkell) was placed onto the intaglio surface of the complete denture and a closed-mouth reline was performed.
Figure 3—Six 2.4 mm x 12 mm LOCATOR overdenture implants (LODI, Zest Dental Solutions) were planned in CBCT dental implant planning software (Invivo, Anatomage).
Figure 4—The patient was anesthetized, the surgical guide placed, and sequential osteotomies prepared with the assistance of the surgical guide.
 
Figure 5—LODI implants were placed through the guide using a minimally invasive, flapless approach.
Figure 6—LOCATOR abutments were placed onto the LODI implants using the LOCATOR core tool.
Figure 7—Final appearance of maxillary implants with abutments firmly placed onto each implant
 
Figure 8—Denture caps were placed on the LOCATOR abutments with block-out spacers and PVS utilized to verify passive fit of the denture over the caps. Recesses were created within the underside of the complete denture using specialized overdenture preparation burs (Denture Prep & Polish Kit, Zest Dental Solutions).
Figure 9—The denture caps were attached to the denture using an overdenture attachment material (CHAIRSIDE, Zest Dental Solutions). Processing males were left inside the denture for 8 weeks.
Figure 10—Final appearance of the LODI implants at 2 years
GO-TO PRODUCT USED IN THIS CASE
LOCATOR OVERDENTURE IMPLANT (LODI)
The LOCATOR Overdenture Implant (LODI) is a permanent 2-piece narrow-diameter implant solution that incorporates the LOCATOR Attachment System. LODI is an ideal implant-retained, tissue-supported overdenture option for fully or partially edentulous patients who are faced with anatomical limitations, the unwillingness or inability to endure an invasive surgery, decline bone-grafting procedures, or have financial limitations. The system provides a removable, replaceable LOCATOR attachment, reduced vertical height, aggressive thread design for primary stability, self-tapping for ease of insertion and increased stability, proven RBM roughened surface, and intuitive surgical instruments with a simple procedure.
MICHAEL DAVID SCHERER, DMD, MS, FACP
Dr. Scherer is an Assistant Clinical Professor at Loma Linda University, a clinical instructor at University of Nevada – Las Vegas, and maintains a practice limited to prosthodontics and implant dentistry in Sonora, CA. He has published articles, DVD training series, and online courses related to implant dentistry, clinical prosthodontics, and digital technology with a special emphasis on implant overdentures (learndental3d. com). Dr. Scherer also maintains the YouTube channels: “LearnLOCATOR,” “LearnLODI,” “LearnSATURNO,” “LearnLOCATOR F-Tx” and “The 3D Dentist,” popular channels on standard and narrow-diameter implant procedures and digital dentistry. Visit michaelschererdmd.com.
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