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Treatment Approach for Overdentures?

posted in Treatment Planning & Complications, Implant Supported Overdentures

« Dental Implants in a Transplant Patient? | Splinted or Free-Standing Restoration? »

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Dr. H. asks:

I have restored several edentulous maxillas using 4-5 dental implants in the maxillary anterior region to support a maxillary overdenture without palatal coverage. I have used this treatment approach in cases where there is very little bone in the posterior maxilla with great success.

I am also considering using just two dental implants in the canine areas to accomplish the same treatment objective. I have not read anything in the published literature to support this kind of treatment approach. Is anybody else doing this and what success or problems have you encountered?

OsseoNews.com Editor´s Note: The bone quality in the maxilla is less favorable than in the mandible. In the anterior maxilla most of the bone is Type II or III. In the posterior maxilla, most of the bone is Type II or IV.

6 Responses to “ Treatment Approach for Overdentures? ”

• Dr.R. Mosery February 13th, 2007

  
  

  Why? If you’ve done the other cases with 4 or 5 implants and they’ve worked out,why would you undermine the prognosis with 2?Stick with the 4 or five on the maxilla nothing less.
  You’re building the case to fail.If money is a problem don’t do the case just yet but don’t chince on the tried and true.

• kahn February 14th, 2007

  
  

  The first question that has to be asked is what is the purpose and objective of the implant placement? If it is for retention of the overdenture, then the forces degree and direction on the appliance has to be evaulated. There is no reason why two implants cannot sufice. If more retention and resistence is needed use four. One in the cuspid regions and one as far posteriorly on each side as pratical or possible. this will reduce anterior tipping from incisal forces.

  the concept of saving the case makes little sense to me. If one allows the fixtures to integrate and then applies a torque force of 35Ncm that is uneventful in motion or sensation, then the literature shows these fixtures have a success rate of greater than 99.9% if the surface is rough.

• Dr. John Cavallaro December 8th, 2007

  
  

  Unsplinted Implants Retaining Maxillary Overdentures with Partial Palatal Coverage: Report of 5 Consecutive Cases. Cavallaro/Tarnow International Journal of Oral & Maxillofacial Implants Vol 22 Number 5 2007 pp. 808-814.
  For use when very specific inclusion criteria can be met- see materials & methods section.

• Dinh X. Bui December 9th, 2007

  
  

  We should look at the skeletal relationship and envision the final prosthesis. If the patient is a class III skeletal, you can use two implants on the maxilla. If the patient is a class II skeletal, you should contemplate using three implants, with one in the anterior and one on each side in the premolar region. This will allow for anterior biting force. I found that when we use more than 3, we must make sure that the implant are relatively parallel, with maximally 15 degree offset. Moreover, when we use locator in our prosthesis, patient will have a hard time trying to remove the prosthesis in the more than three implants application.

• Dr SS December 9th, 2007

  
  

  I would not think 2 implants to support a denture in the maxilla to be appropriate as a rule of thumb .
  Whenever we talk about specific measurements with hardware we MUST also talk about context
  Just to say we have 2 implants is not enough ..D2/D3 or D4?? /we assume proper spatial relationship etc

  Bear in mind for overdentures the only force on the implant is when putting denture in and taking out
  This is the definition of IMplant Retained
  Otherwise the implants are over loaded as you have made a fixed bridge that is implant SUPPORTED

  Longer implants give greater resistance to pull out forces ..wider implants better resistance to lateral forces
  Over denture implants should have no lateral forces(at least minimal)
  This is why when placed properly the mini implants work well in the maxilla (but here you need 6…)

  The current thinking and long term efficient position I think is to have 3 implants minimum thus create a tripod of resistance
  There is a tendancy towards tipping with only 2 implants for an overdenture as the denture rotates around an axis

• Mohamed Fouda BDS January 4th, 2008

  
  

  I use 4 to 5 3.75 mm implants and o ring attachment to retain a maxillary OD with no palatal coverage and seems to work great, also 6 mini’s will work very well.
  I never tried to use only two in the maxilla, may be if you used them and didn’t remove the palatal part of the denture it will be ok.. but any way try it and please keep us updated with your progress.

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