Dental implants can be used to stabilize full and partial dentures. In many cases, patients are not against dental implants, but the expense of fixed restorations prevents them from taking advantage of the best that dentistry has to offer. A cost-effective way to give patients the esthetics they’re seeking and the affordability they demand is through the use of the overpartial or overdenture. In many of these cases, I prefer to fabricate a metal framework substructure, but in this case I opted to convert the treatment partial to an overpartial while the patient prepared financially for the final restoration (Figure 1).
Patient Presentation
The patient, a 70-year-old man in good overall health, presented with total edentulism in the upper arch and partial edentulism in the lower arch. He had a severe gag reflex and had been wearing a palate-less denture with a lot of adhesive. The patient found this unsatisfactory and sought a better solution. A traditional fixed restorative on implants was out of the patient’s budget, so we discussed a palateless overdenture. Because he could not tolerate a traditional full-palate denture, he was a good candidate for traditional metal-based partials.
Treatment
After reviewing the computed tomography scan, initial impressions were taken and custom trays fabricated to create the master cast. We created wax rims to capture the correct maxillary and mandibular relationship and did a wax try-in with teeth to verify the correct occlusion and proper excursive movements.
We placed 4 titanium implants (MIS) in the upper arch and allowed a minimum of 4 months for healing and postoperative checks for integration at 4- to 8-week intervals. After integration was confirmed, we placed healing abutments, which aided in determining the correct locator heights. We left the healing abutments in place for 2 weeks.
Our final step was to load the implants into the denture with the use of VOCO’s Quick Up system, which greatly simplifies the process. Following are detailed steps in that process:
- (1.) The male housings were placed on the implants with the block-out rings to prevent the relining material from locking on the implants. In this example, an old-fashioned marking stick was used. I used VOCO’s Fit Test C & B to block out undercuts and determine implant housing location (Figure 2).
- (2.) The denture was then relieved. It’s important to try-in the partial to ensure a passive fi t before the next step. In this case I used a prep and polish kit from PREAT Corporation (Figure 3).
- (3.) Next, we underfill both voids with VOCO’s self-curing Quick Up material (dual-barrel quick mix syringe) and used the manufacturer’s set time of 3 minutes. By underfilling the voids, we avoided material overflow, which might have created potential headaches (Figure 4). We also avoided the necessity of creating vent holes, thus saving time (Figure 5).
- (4.) Because we underfilled the voids, VOCO provides a light-cured Quick Up material that comes in a syringe with a more precise tip and single-barrel syringe to top off any voids at the male locator/implant locator interface after the “pickup” has occurred (Figure 5).
- (5.) Next, we trimmed the excess material with a slow-speed acrylic bur and green polishing point. The finished product is then ready for insertion (Figure 6).
- (6.) We left the black processing housings in place so the patient could practice removing and replacing the partial. The patient would return in approximately 2 weeks to have one of the several retentive inserts placed (Figure 7).
Meeting Patient Needs
We have many options to offer implant patients and when each is properly explained, patients always make the best choice for their interests, thus making each and every case a success.
