Overdenture: How Many Implants with Ball Attachment?

Anon. asks:
I recently placed 3 dental implants in a patient’s mandible — two in the canine areas and another one between them, approximately at the midline. Should I use a ball attachment on all 3 dental implants and use them all for retention? Or should I use the implants in the canine areas with ball attachments for retention and use the middle implant one as a stop to break the rotational forces during mastication?

16 thoughts on “Overdenture: How Many Implants with Ball Attachment?

  1. why on earth didnt u place 4 implants? the only occasion i have left 3 implants in situ os when 1 has failed after placing 4. personally i would use locators but this is a matter of preferance

  2. Use the three for retention.. however I would place 2 or 4 implants, but 3 is better than 2 of course.

  3. I have placed three implants in the lower arch with locator attachments. The patients have been very happy. Ideally, four implants is better but if the patient has poor dexterity they may have trouble getting a prothesis out with four.

  4. I always like to know what I am opposing. Is it a Denture, Fixed, Are the teeth worn. Is the interocclussal space adequate for balls, Bar, Locators. I think that before you decide on the attachment type look at the other arch. If you use balls I would use a non precious ball. I have had gold bredent balls that the nylon attachments have worn out. Good luck!

  5. Anon, you have no reason to appologize for using three implants in the symphysis area. Sometimes the shape of the arch and condition of the bone dictates three implants.Perhaps the patient could only afford three implants.

    I have many cases with three lower anterior implants that are more than 20 years old and doing fine.

    If I were you, I would feel more secure joining all three implants together with a rigid bar and have three balls incorporated into the design.

    Plastic castable balls are incorporated into the bar design if you ample space, or lower profile Locator type retainers are excellent too.

    By incorporating the use of a bar, the forces of occlusion, be it from natural opposing teeth or a prosthesis ( removable or fixed), are equally distributed in centric and eccentric movements.

    If you chose not to use a bar, make sure the patient is not a bruxer, and keep an eye on the retainers…..you will see wear patterns on the balls, and the plastic “bushings” incorporated into the female caps will show signs of wear and will have to be changed more frequently.

    Gerald Rudick dds Montreal

  6. Very often the third implant will convert the case from an implant retained prosthesis to an implant supported one.Two implants with locator attachments will do great.Depending on what you promised the patient and how you worked up the case making a bar overdenture would be ok (I would have preferred 4 implants for this).Next time plan the case from begining to end before anything is placed or promised.At this point fabricating a bar overdenture is going to cost you(bigtime) and it sounds like you didn’t incorporate that into your fee.Use the locator attachment,forget the ball and era.They served well over the years-no doubt but the locator is much easier to work with and more retentive for a longer period of time before it needs any nylon change.Planning is everything.

  7. If you want to use a ball attachment, splint all three with a bar and put the ball attachments on the bar between the middle and outside implants using two ball attachments. You need to create an RP-5 prosthesis. Because there are only three implants a “fixed detachable” prosthesis is not the best option. Using the two ball attachments will allow movement in the prosthesis without torqueing the implants. Locator attachments will probably be your best option however and keep the cost (lab fees) down if your fee to restore the case did not plan for this.

  8. My background. I am surgical prosthodontist with 25 yerars experience. In my opinion, three implants is fine. The idea of a bar is, in my opinion, absurd. It takes more space, is harder to clean and gains no advantage. An o-ring retained overdenture is not a fixed denture because of the flexibility of the o-rings. There is not a lot of room needed and you get good retention as well as stability. The disadvantage is if they oppose porcelain crowns. The porcelain will grind the balls down. If you have porcelain crowns the locator is then next best attachment. The biggest problem is the attachments coming loose from repeated removal of the prosthesis. I developed an o-ball design about 14 years ago that uses a hexed UCLA abutment with and OCO Biomedical ball waxed to the side and cast. Their o-rings are some of the longest lasting. The cast ball is screwed down onto the implant with a separate screw that is not affected by the repeated stress. I also make the denture with a vitalium bar processed in the denture to keepit from breaking. You may e-mail me at brooksby1@aol.com for more info.

  9. I used not 4 but three because its for a denture not an fpd Ron.
    The other arch has a denture with no implants.Can u tell me what the difference of a locator and an o-ring exactly is.
    Do u have any photo or website for me to check,thanks in Regards

  10. The idea of a bar is, in my opinion, absurd. ???

    Good for you Mr Prosthodontist. Opinions are like…. well you know the rest of the story! Say what you want, but bars simply work!
    3 implants aaginst porcelain teeth? OK, thats impressive. If it’s against a Max CD, I am sure there is enough vertical! Why don’t you just say, you don’t prefer bars. The prosthesis becomes fixed if you place enough of them.

  11. Dear coleague, in my opinion three implants have to work very well, depending on the ball attach types you use (on lasting sense). It doesn´t matter if you use the three as retention or only those on the cuspids; the prostheses will have, undoubtledy, some vertical-distal-rotation behavior and biomechanically the third implant will act like a support avoiding the prosthese movement upward. It will work!
    Bar is too high to make an aesthetic-strong prosthese the advise is not to do a bar.

  12. Xe,
    locators are a great option for retention of dentures, design is significantly diferent than ball attachments,they have have a lower profile than ball attachments, that allowes for compensation of aprox up to 20 degrees of divergence for non “ideally” placed implants (not an excuse for poor planning)
    therefore you can place in areas of limited restorative space, they tend to last longer

  13. I would recommend placing Locator attachments (www.zestanchors.com) on all 3 implants. They are made for almost all implants on the market. have a lower profile then a Ball attachment and with the lower C/I ratio less chance of lateral load on the implants. They will also allow more divergence then Ball heads

  14. I would respectfully disagree on the bar option for the 3 implants. A bar will allow positioning of the distal implants distal to the position of the posterior implants and then an attachment between the midline implant and each posterior implant thus giving more stability and retention. I am not in favor of 2 implant bars as these have rotation on the bar and can laterally load the implants. With the Locator attachment one only needs 3.14mm of height for the attachment and a bar height of 3mm plus 1-2mm of space below the bar (between the bar and tissue) means one only needs 7-8mm of total height a typical ball attachment (O ring) needs 6.14mm so were only talkign a 2mm difference

  15. I want to know what the typical cost is to the patient to fabricate a mandibular immediate denture retained by two Locator abutments. How do I charge the patient appropriately? any suggestions. The oral surgeon will place the implants, not me.

  16. Hello
    I am in an area where it is unhandy to get o-rings for my locators
    that attach my dentures to my implants ,I have 4 on top and 2 on bottom ,I use the pink,will someone please let me know where I can
    order or buy new o-rings,I am able to change them myself..Thanks James

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