David, a dentist, asks:
What is the current thinking about using Locator attachments for mandibular overdentures?
I would like to know which design works better in the mandible, two or four dental implants with Locator attachments? Are there any better attachments that are being widely used? What about using dental implants and overdentures in the maxilla?
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Use Era attachments instead of the locator you will get much more resilency
Locators offer excellent stability – the internal external retention are superb and if attached under tissue compression in the mouth, are very stable for the patient. It’s best to build a cast framework around the locator housings in the denture so that the potential for denture fracture is eliminated.
Curious about the ERA more resilient comment (anonymous) as I have years of experience with the ERA, and when I tried the Locator, I have never gone back. Interestingly, resiliency seems to be one of the major reasons I like it better. Am I missing something?
Overall, it has just flat met my needs in a large range of applications.
the ERA gave me more limits in what I could do.
fmn
Locator is the equivalent of a big blessing!
it was created to make our life as dentist simpler, easier and much better.
I have been using them since they were invented, nothing compare to them, only fixed restorations.
The availability of different heights of cuffs makes adjusting the vertical profile such an easy task.
Using the locators with such success and good results have actually reduced or eliminated complaints about that anterior posterior component of movement on the dentures that we use to get from the other attachments.
I have use them in all kind of combinations, from two lower implants to 6 (when doing the transicion of a removable case in to fixed).
I have also use them in upper dentures with 2 to four locators conected to regular diameter implants with excellent results.
Something I like to do is to progresively load them since they come with different alternatives for retention components, black is usually for lab processing (I rather doing direct pickup), I usually start with black for about the first three months, then I start using the other colors until I finally reach the color of the stronger retention.
It is the best attachment I have ever use, and thanks to it I dont do bar overdentures anymore.
The locator atachment is far superior to the ERA.Lower profile and resilient retentive element make it a winner.The intraoral pickup is very easy. You could use it freestanding with 2 implants or make a bar with 4 using 2 on the distal extensions.You will never use another ERA.
Dr. Mosery,
It sounds to me like you are confusing the ERA and the Locator. The Locator does not offer a distal extension attachment. The ERA does.
The micro ERA is the same height as the Locator and is much smaller in diameter. You are misinformed if you think the Locator is resilient. It is not.
Not to be argumentative but the Locator can be used as a distal extension. 3i offers it as a distal extension on their PSR Architecht Cad Cam bars and it works very well.
There is misinformation here but it is not coming from Bud, Frank,Alvaro,Dr. Mosery or Ira.
The Locator is a resilient attachment, it is also the lowest and longest lasting attachment on the market.
As the inventor of the Locator
I’m truly greatful for the kind words of support.
I found the ERA to be much easier to use and there are more choices available as to size and retention. The male nylon retention component seems to last longer than that of the Locater.
David,
It’s incredible that you have ERA’s lasting so long.
There is a study out of Japan that showing that no matter what retention strenght you pick with the ERA it dropped below a pound in 500 cycles. Other attachments did much better. Just google ERA and you will find the study.
I have had locators since 2004. Because one of my maxillary implants is not parallel, I have intense pain on that side. Several abutment sizes have been used to no avail.
I also find that the Locator plastic mails are flimsy and do not last very long and often “fold in” after insertion. I have had red ones that are alot thicker than say the pink so the manufacturing of them is not consistent. The pink ones fold in and the red and green do not correct the parallism as they claim.
You would be much better off with a cast bar and bredent attachments, to minimize the maintainance issues you are having. This is a prosthesis that is custom made for your mouth and the angulation of the implants that are in your mouth. Attachments have very limited application and the implants need to be parallel in order to minimize the maintainance issues. If each attachment is not impecably clean the housings will wear even faster and maintainance issues become even more of a problem. Every case is different and the treatment planning of every case should be done prior to placement of implants. Also the patient needs to have the maintainance of each prosthetic design explained prior to proceeding with the finalized treatment plan. Implant Dentistry is an art and each case should be managed accordingly. Dr. John Willardsen, DDS.
Bars offer a whole different spectrum of treatment but the current blog is addressing Ball Attachments:
The best designs are as follows:
Atrophic mandibular ridges: Ball attachments (also great for non-parallel implants)
Moderate idges: ERA (wear quickly)
Good Ridges: Locators (need a housing which increases required height)
The patients needs the vertical support and lateral stability of the ridges to fully appreciate the retention. If you try a retentive attachment on an atrophic ridge you will have ecessive sores and quickly worn attachments.
All overdentures should have a cast frame.
Pick up acrylic: use GC resin
what is the current thought on locators in the maxilla v.s. Bar for over dentures? Do you recommend use of metal frame mesh for strength with locators? How many locators is recommended in maxilla?