Angled implants under locator attachments for maxillary denture retention?

Last Updated December 12, 2014

I have a middle-aged female patient who owns a restaurant and wants dental implants to retain her maxillary denture so that she can not have the palatal acrylic and then she could taste her food better. The prosthodontist sent an acrylic guide with request to “put 4 the implants in the marked spots for locator retention”.

I had recommended a fixed appliance, either bar or all on 4-6 but she cannot afford that. I can place four 11.5 – 13 mm tapered implants, a la all on four technique, (3.7 diameter in the anterior and 4.2 in the posterior). However, they would have to be 30 degrees from vertical in order to put the implant tables where the prosthodontist wants them. There is no vertical bone to be had.

Additionally if I move them palatally to place them more vertically, then they will essentially require more denture acrylic which would “crowd” into the palate she so much wants to feel. Actually they will be about 3-4 mm palatal to that in the anterior as it is. I will also remove about 2 mm of soft tissue reduction and about 3 mm of bone reduction to create adequate space for the locators + 4-5 mm thickness of acrylic over the locators as the denture is now about 3-6 mm in thickness.

Angled GPS abutments (similar to Locators) are now available from Implant Direct as are angled ERA attachments that are up to 30 degree from vertical. Does anyone have much experience with such a set up (angled attachments to parallel the line of draw) on angulated implants? My concern is that since the implants are not splinted, there will be more lateral force on them. Has anyone found longer term (I know the attachments haven’t been out very long term, but what ever experience you have, I’d like to know) problems with locators on angled attachments in the maxilla?

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