Dr. C. asks:
I placed two Nobel Biocare Tapered Groovy implants in the #26 and 23 positions [mandibular lateral incisors] in an edentulous mandible. The final restoration will be an implant retained overdenture [RP 5]. Should I wait three months to uncover the implants? At that visit I am planning on uncovering the implant fixtures and placing transmucosal healing abutments. How do I determine how long the Locator abutment should be? I know I am supposed to measure the gingival height from the implant fixture platform. Do I measure the gingival height at mid-buccal, where it is shortest or do I measure the gingival height on the proximal where the papillae are much taller?
Implant Retained Overdenture: Determine How Long the Locator Abutment Should Be?
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You need to order an abutment that will be supragingival from the deepest tissue(the deepest probing depth is the length you need). Having said that, the shorter the better.
The stainless steel housing (which contains the retentive element) is 2mm in height. The entire housing should be supragingival so it can properly engage the LOCATOR abutment. If you want to add an extra 1mm for hygiene access, this is a good idea. So, 3mm of the abutment should be visible (circumferentially). If you connect the abutment prior to total tissue healing, the worst that could happen is that you will get a little tissue shrinkage and more of the abutment will be supragingival. No problem. By the way, if you have a microblaster (airborne particulate abrasion with 50-60 micron aluminous oxide powder), be sure to microblast the housing if you are picking it up chairside.
The locator abutment should be completely supragingival and should be about the size to allow rotational component of the denture fixture without creating any parafunctional loads.
Ashish
http://www.drashish.com
I would use Straumann.
I love Astra, but most implants systems use Z anchor company to fabricate locator abutments. I have found out that the shorter the easier for the patients to “snap” the denture in. This will come with time, choosing the right locator abutment. Most will work, generally. Good Luck, its a great service.
Locator implant abutments are great for overdentures, partial dentures or retained by endosseous implants-max/mand. I love the features, 3.17 vertical height for externally hexed implants, 2.73mm for non-hexed implants. If you are using loactors with non-parallel implants you may want to consider using the extended range replacement males for divergence from 10-20 deg. note; some protocals to follow…progressively load case with male loactors. Sequencing procedure for the retentive caps would be to start with the lightest retention for patient specific dexterity abilities. Thus you can cont..to monitor patients specific limits and needs. If denture becomes dislodged you may progress to the next retention cap..unless you experience recoiling of the denture, proper tissue cuff hieght measurement allows correct seating without tissue pinching, and cause for rebound effect. Nylon males stay on abutments;indicates path of insertion problems. Not good for Bruxiers, Tabacco Chewers, smokers, heavy biter, angualtions..multiple abutments require a snap on parallel post on each locator head, to eval..divergence. Greater than 10deg use the #8548 red male insert .5lbs retention, next level-retention #8547 green male insert 4-7lbs of reten.These caps lack the internal male retention only retention is derived from the internal cap which floats in the housing. The divergent these locators the more wear..
Placement of locator implant abutments, determine type/size of implant, measure tissue height, from the implant platform to the crest of the highest point of gingiva.(cuff height measurment)1.5mm cuff height is built into the over all measurment, thus 2mm cuff height abutment order will be 3.5mm. Over all 1.5mm must be above the highest gingiva crest to prevent tissue impingement, not allowing the denture to full seat. remove healing caps and remove soft tissue/bone from the superior aspect of the implant body to insure positive seating of the new loctor implant abutment. abutment driver tool #8393 to engage locator impl/abut to thread into the implant. torque wrench .50 (1.25) hex insert fits inside the driver torque 20N-cm