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4 Implants in the Mandibular Anterior Area?

posted in Techniques and Procedures

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Dr. Ruddick asks:

I have been using two dental implants to restore mandibular overdentures. I have my surgeon place a regular platform dental implant in the #22 and 27 areas and then I retrofit the existing mandibular complete denture.

I was recently at a dental implant course where several dentists were
describing how they used 4- dental implants in the mandibular anterior area
with Locator attachments instead of just two as I have been doing. Is
there a significant advantage to using 4 as opposed to 2 dental implants in
this situation? Thanks for any comments.

14 Responses to “ 4 Implants in the Mandibular Anterior Area? ”

• Anonymous October 17th, 2006

  
  

  Check out Clin Oral Implants Res. 2005 Feb;16(1):19-25. This study claims that there is no real difference.

• Anonymous October 17th, 2006

  
  

  Much greater AP and cross arch stability. Path of insertion become a more critical issue. Patients love the retention.

• Anonymous October 17th, 2006

  
  

  After 20 yrs of placing implants and seeing the goods and bads most failures have come from 2 implants with direct attachments my opinion is that over time the uneven wear and change in denture occlusion sets the 2 implant case up for failure I would much rather have a bar with 2 implants and I always try for four. I’ve seen very few failures with the 4 implnat bar with overdenture. No long term research just 20 yrs of observation and experience

• Alejandro Berg October 17th, 2006

  
  

  I completely agree with the later post, I go with a bar as often as i can when doing removables, more stable, less wear, glod clips last really long and are easy to change

• Anonymous October 17th, 2006

  
  

  each case presents different values.
  The locators were not out 20 years ago so that must have been balls or another type of housing. It has been shown that ball implants collapse and are too pivotal especially after the posterior bone resorbs and now the denture needs relining.
  The two implant overdenture has a a landmark study from Dr. Feine in Montreal.
  The thought of putting 4 in the anterior is not in my opinion a good prosthetic because the locators are too retentive to use 4. If you put two WN implants in the first molar area, then the prosthetics is implant borne like the bar borne thought. If you put 4 in the anterior, it is over treated unless you plan to add more and put on a hybird or a Fixed or fixed removable prosthetics. The locators are easier to clean and more hygienic than a bar any day.
  The bars inherent problems are 1. they can torque on the implants and 2. they are costly. 3. they are expensive. 4. Many labs do not understand the shapes and styles and retentive clips and configurations necessary to do them without some form of error. Please note that a bar requires more parties than any other type of restoration and as we all know, that may lead to more possible errors. I realize that there are many successful bar restorations but in my opinion, bars are only used to be cases that. 1. have lots of bone loss and therefore have lots of vertical2. Buccal/Lingual ridge width is too narrow to put in 4.1mm diameter implants and the case need splinting to add strength. 3. in distal extensions that the posterior needs additional protection form compression of the nerve.
  I do not disagree with others as to when and why they use bars. I just find that it is old school to do so with more modern attachment that seem to yield a combination of rigid and resilient and the locators provide that. There is more to it than that but that is my general opinion

• Jeffrey Brook October 18th, 2006

  
  

  It is my experience that 2 implants satisfy most patients. I have been placing implants for implant-retained mandibular overdentures for a varied group of restorative dentists since the late 80’s using both 2 & 4 implants & attachments. Any implant that has failed, has failed early, and seems to have failed from non-integration rather than overload from the prosthesis. Patients seem to find 2 implants supporting an overdenture to be more than satisfactory. What I find especially interesting, I advise every patient who elects only 2 implants that we can add 2 additional implants if they are not satisfied with the function or retention of the original 2 implant case. Using OSOs, Locators, ERAs,etc., not one patient in almost 20 years has asked for additional implants after having 2. That leads me to believe that 2 implants are adequate.

• Anonymous October 18th, 2006

  
  

  if four fixture are to be used, they should be place if possible in the cuspid and first molar sites. This gives not only the ap spread, but in essence makes the removable overdenture a fixed occlusal table.

  Another big advantage of the four with cuspid and molar placement is the ability to use the 3I fixed teeth in a day concept in essence making the full denture a fixed restoration. According to Bill Becker in his four on the floor study, there was a significant number of subjects that never came back to replace the denture connected to the implants as a fixed applicance to the “final” prosthesis. Some of these denture appliances functioned for over four years.

• satish joshi October 18th, 2006

  
  

  i agree with previous comment.
  instead of 4 in interforamina area if placed in 22,27,19,30 locations (even short) if IAF prohibits longer ones,will give better stability to prosthesis.

• Anonymous October 18th, 2006

  
  

  i mean IAN INFERIOR ALVEOLAR NERVE

• dr. steven kollander October 18th, 2006

  
  

  I find that three implants satisfy most criteria in the edentulous mandible. You have the stability that two does not provide and you save the patient a few dollars.

• JAM October 19th, 2006

  
  

  I think there is room for both applications, two for ball attachment overdenture and four for a barr retained overdenture. If there is an edentulous maxillae and mandible, two ball attachment with locators will do the work perfectly. If there are multiple natural teeth or fixed prosthesis in the masxillae, four implants will provide a additional stability and patient’s comfort. All depends in what you have in the opposing arch, the maxillae. There is an old study in this matter which claim accelerated posterior mandibular ridge resorbtion in overdentures with two ball attachments, requiring frequent denture adjustments.

• Anonymous October 19th, 2006

  
  

  have been placing implants since late 80’s and now dealing with first case of failing locator design on max arch
  pt has thin bone and 4 implants were placed over 2 years ago have not seen patient since restorative dentist placed prosthesis seems as if there is too much pressure and rocking of prosthesis in centric. one implant on each side is failing now i will have to add two more and remove and replace the failing ones so patient will need 6 and bars to provide more adequate retention. i always ask patients to return after restorative to check occlusion its that important each patient is different and bone density is critical

• Anonymous October 20th, 2006

  
  

  I recently inserted my first overdenture with two locator implant abutments. So far the patient can hardly get it out the retentsion was so good. I can not immagine using four locators unless you provided some sort of bilteral handles to grab the denture for removal.

• Dr.Leo October 29th, 2006

  
  

  to avoid prosthetic failure,wether its 2 or 4,patient must wear the denture four to six weeks without any retention at all,to make sure it fitts passively,and only then retention can be added.

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