Attachment Selection Overdentures Ridge evaluation and esthetics Fixed

Attachment Selection • • • Overdentures- Ridge evaluation and esthetics Fixed- Ridge evaluation, gingival esthetics Number of implants Anterior-Posterior spread Opposing arch ? ? Function Fixed- Rigid, screw retained Overdenture- Load bearing or nonload bearing • Retention • Available space • Cost

Patient Considerations • Parallel attachments for easier path of insertion • Less attachments – better • Patient dexterity • Hygiene – Stannous Fluoride rinses • 3 month recall

Anterior/Posterior Spread A line from the center of the most anterior implant to a line joining the distal aspects of the two most distal implants Indicates the amount of cantilever that can be reasonably placed Usually, 2. 5 times the A/P spread

A/P Spread Actual Length of Cantilever Depends on: • • • Stress factors Parafunctional Habits Crown heights Implant width Number of implants Opposing teeth or denture

Controlling Stress=Force/Area Force Stress Area

Torque= Force x Perpendicular distance from the line of force to the center of rotation

Cuspal Inclination

Cuspal Inclination

Treatment Plan Options Fixed Implant Supported Removable Soft Tissue Supported Implant Retained

Treatment Plan Option 1 Lower Edentulous Fixed 5 -6 Implants

Prosthetic Options-Lower 5 -6 Implants • Hybrid Denture • Fixed Crown and Bridge • Cantilever 10 -15 mm

6 Implants-Fixed Implant Supported 23 22 X X 24 25 26 27 X X

5 Implants- Fixed Implant Supported B A X X C D E X X

Treatment Plan Option 2 Lower Edentulous Removable 5 Implants

Prosthetic Options- Removable Overdenture-Implant Supported • Gold Bar w/ O Rings • Distalized O Rings • Cantilever 10 -20 mm • Gold Bar with Hader Clips • Distalized ERA’S • Cantilever 10 -20 mm C B A C D B E A D E

Treatment Plan Option 3 Lower Edentulous Removable 4 Implants

Prosthetic Options- Removable Implant and Tissue Supported • Gold Bar with O Rings • Cantilever 5 -10 mm b a • Gold Bar with Hader Clips and ERA’S • Cantilever 5 -10 mm b c d a c d

Treatment Plan Option 4 Lower Edentulous Removable 3 Implants

Prosthetic Options- Removable Overdenture-Lower Implant and Tissue Supported • Gold Bar w/ 2 - O Rings. Overdenture • No Cantilevers

3 Implants- Removable Overdenture Implant and Tissue Supported C B D

Treatment Plan Option 5 Lower Edentulous Removable 2 Implants

Prosthetic Options Removable Overdenture-Lower Tissue Supported • Gold Bar w/ Hader Clip • O Ring on each implant • ERA attachment on each implant

2 Implants-Removable Tissue Supported B D

Treatment Plans Upper Edentulous Four Options

Treatment Plan Option 1 Upper Edentulous Fixed 8 Implants

Prosthetic Options Fixed- Upper Implant Supported • Fixed Crown and Bridge • Hybrid Denture • No Cantilevers Necessary

8 Implants- Fixed Implant Supported 7 6 X 4 3 X X 10 11 X 13 14

Treatment Plan Option 2 Upper Edentulous Removable 8 Implants

Prosthetic Options- 8 Implants Removable- Upper Implant Supported • Gold Bar w/ O Rings. Overdenture • Gold Bar w/ 3 Hader Clips Overdenture- No Palate • Cantilevers-Optional

8 Implants- Removable Implant Supported • Gold Bar Overdenture w/ O Rings w/ Hader Bar / Clips 7 10 6 7 11 4 3 6 13 14 Palate 10 11 4 3 13 14 No Palate

Treatment Plan Option 3 Upper Edentulous Removable 6 Implants

Prosthetic Options Removable- Upper Implant Supported • Gold Bar w/ 4 - O Rings and distal to #s 4 and 13 • Gold Bar w/ Hader Clip- ERAS distal on #4 and 13 - Overdenture -No Palate • Cantilever 5 -10 mm

6 Implants- Removable Implant Supported • Gold Bar w/ O Rings • 5 -10 mm Cantilever 7 5 4 • Gold Bar w/ Hader clips and ERA’s • 5 -10 mm Cantilever 10 7 12 13 5 4 10 12 13

Treatment Plan Option 4 Upper Edentulous Removable 4 Implants

Prosthetic Options Removable- Upper Tissue Supported • Gold Bar w/4 O Rings. Overdenture w/ No Palate • Gold Bar w/ Hader Clip and 2 distalized ERA attachments w/ Overdenture- No Palate • No Cantilever

Arch Form 4 Implants-Tissue Supported Square Arch 6 4 Tapered Arch 11 6 13 5 11 12 Maximum contact with tissue – No contact with Bar Attachments are for retention ONLY

Treatment Planning • Design sensibility and flexibility in the treatment plan • Design and implant concepts will vary • Plan ahead for success • Have a disaster plan • In most cases, less attachments are better