Implant-Retained Overdentures: How Many Implants in Midline and Canine Sites?

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Anon. asks:
I recently attended a lecture on implant-retained overdentures where the speaker recommended using 3 dental implants placed at the canine sites bilaterally and a third implant in the midline. He has long-term follow-ups on these patients demonstrating the success of this design. I have also seen treatment plans for 2 implants in the canine/lateral incisor sites that seems to be the most popular. Some lecturers recommend placing 4 implants with 2 bilaterally in the canine sites and lateral incisor sites. I have also seen treatment plans where only 1 implant is placed in the midline. All of these designs seem to work. The solo implant in the midline would seem to be the simplest and easiest to execute. I would like to get some feedback from readers. Does a solo implant in the midline work as well as these other designs? Which design do you favor and why?

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11 Responses to “ Implant-Retained Overdentures: How Many Implants in Midline and Canine Sites? ”

• Kilick July 7th, 2008

  
  

  Dear Anon,

  the midline implant for an overdenture doesn’t seem like a good idea. The midline is the weakest part of the lower denture and is prone to fracture. If you can only place one implant, place it away from the midline. And as for design or number of implant, the more the better, that’s all. It all depends on how much the patient can afford.

• Nicholas Varras, CDT July 8th, 2008

  
  

  Anon,

  Kilik has a good point with just one implant. If I can elaborate on that. The one or two implant designs can work, however, you will only create some lateral stability (referring to the mandible). With only two implants, every time the patient starts to chew sticky food we will get posterior lift. If using free standing implant abutments like the ERA or any other attachment, I would recommend a minimum of three attachments for the mandible (the bicuspid areas and slightly off the midline). The maxilla represents other issues, particularly where most patients like to go palateless when they pay for implants. The minimum I would recommend here would be 4. This will ensure a stable prosthesis. With regards to going palateless in the maxilla, I would not do it without a metal substructure and at least a strap across the post-palatal seal area. Hope this helps.

• R. Hughes July 8th, 2008

  
  

  Do not use just one root form. You will have too much lateral and a-p movement. Use two at the least. With two you will have an a-p moment and possable gingival irritation. Think of four to six implants and stay off the midline.

• Dr A.R.Rokn July 9th, 2008

  
  

  2 implants in canine site or lateral sites is the min treatment,if it is possible for 4 implants,it will have better stability and comforte.putting implant in midline is a personal experiment not a scentific evidence.

• RB July 9th, 2008

  
  

  One question for you…would you rather have a three legged chair or a four-legged chair….It may have worked on some of his patients, however so has immediate placement and function but overall experience the results are always satisfactory in the long-term…I urge you to keep from cutting corners…the body heals and functions in a certain way and we all need to understand this and quit trying to change what we have no control over

• Dr.Roitman July 9th, 2008

  
  

  One implant in the midline will hardly offer ANY stability, just retention. On the other hand, two in canine area may be just enough (mandibula) and anyway, if you can place one in the middle, you should always be able to place two on both sides, so I don’t see any rationale for one.

• marik ina July 9th, 2008

  
  

  RB and Ritman have a view, i just want to added some tips, its depends also with the denture that u use for the over denture. is it stabled ? or loose ? maybe you should consider about doing rebasing.
  the lateral movement or a p movement can make the implant into trouble such broken or failure ( in the case of mini implant )
  also the plastic for bar attachment and rubber for the housing you should keep maintain them. this is the most important for the overdenture. plastic cant last 10 years in your mouth neither do rubber or else

• cory c. July 10th, 2008

  
  

  you gotta consider arch form and max or mand. a narrow v-shaped small arch w/ 2 implants is not gonna rock w/ 2 implants at canines. a large, ovoid, long arch is [a-p rocking].this is on the mand. arch. on max. it almost always does w/ only 2. the max will rock w/ 4 if you place them at sites 6,8,9,11 and the arch is a long v-shape but wont if its a wide ovoid shape.definitely have a metal subframe like the other guy said.

• maria berrazueta July 14th, 2008

  
  

  we forget, we´re talking about a mucouse suported denture. Implants are not suppose to hold all the charge of the prothesis. In an overdenture the better way to improve retention and stability is placing two implants in the place of canines. You get better suport with an aditament like Era or Locator than with oring. if you work properly the prothesis and oclusion you can almost avoid posterior lift.

• Dr. R. Wright July 14th, 2008

  
  

  I like to minimally place 4 implants. 2 in the canines and the other 2 in the lateral areas. The denture is usually very stable. Stay away from the 1 implant in the midline.

• Dr.Rafael Mosery July 27th, 2008

  
  

  With two implants the case is implant retained.As soon as you introduce the 3rd or 4th you lose this. Now you have a tripod or table and the case is now implant supported.That doesn’t mean it won’t work it just changes the physics of the case and you should have this factored into the big picture ie: bite,opposing arch etc. to assure a favorable outcome.

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