Dental Implants and Distal Extension

Yes...I have done this routinely for the past 6 years with 0% complications..however..the appliance has support from the residual ridge and teeth as well and NOT solely from the implants. See this months issue of "Spectrum" a Canadian Prothetics Journal for numerous case histories by Bob Vogel.

CONSIDER THE INDICATIONS AND WHEN THE NEED FOR DISTAL EXTENSION SUPPORT FOR THE RPD: 1. IF YOU HAVE A GOOD RIDGE AND RM PAD, THEN YOU REALY DO NOT NEED THE ADDITIONAL IMPLANT SUPPORT. THE PATIENTS THAT REALLY NEED THE HELP ARE THE ONES THAT ARE SEVERELY RESORBED AND THE RM PAD IS AT A HIGHER LEVEL THAN THE RESORBED LINGUAL-MYLOHYOID RESIDUAL RIDGE. THE CHEEK MUCOSA THAT LIES OVER THE CREST OF THE RIDGE CANNOT SUPPORT THE OCCLUSAL LOADS. TRY TO FIND SUITABLE BONE UNDER THE DISTAL EXTENSION TO SUPPORT THE RPD SADDLE!! SOMEWHERE ON THE BUCCAL SHELF? IN THE VESTIBULE? THROUGH THE THIN MYLOHYOID SHELF? I CANNOT FIND THE AREA FOR THE IMPLANT FOR MY PATIENTS WHO NEED IT.

Being an advocate for preventing combination syndrome or anterior hyperfunction, this approach seems logical, if possible to do. I have a patient presently wearing a transitional upper immediate complete as well as a transitional lower RPD. She is scheduled for ridge augmentation (too little residual ridge for implant placement) followed in 3 to 6 months with placement of implant fixture which will then serve as a distal abutment when the more definitive RPD is done.

I have had success using Regular Diameter Endosseous Implants in the Mandibular Second Molar area to provide soft tissue support to a free end partial lower denture. I have allowed the implants to integrate for a six month period and perform a second stage surgery for healing abutments. I have not had the same success using Mini implants for this application even when "soft loaded" initially.

I have done this quite oftern for my restorative folks with great success. We use standard diamter implants with Locator attachments and give great stability for a much decreased cost, as opposed to 3 or 4 implants per side with FPDs.

For it to be a true Kelly's Syndrome there would be a Kennedy Class 2 Bilateral distal extension opposing a max. FUD. I am not so sure it's a syndrome, but more a consequence of partial endentulism.

Great Question. In our clinical center we have been doing this for ten years both with Kennedy Class I and II RPD's resting on healing abutments as well as engaging free standing attachments (ball or Locator). Experience has been reduced need for relines, long-term stability of retention, reduced complaints from patients of loss of rentention.

I have a Hader Bar with extensions on them. We sent the bar back to the lab after it broke at the seem, it was welded back a clip placed back on the lower denture and I was bitting with a normal bite it broke again. Is it necessary for these extensions to be on the bar? Tthe person at the lab said that they had quit putting extensions on the Hader Bars.

Distal extension hader bars do not support the "I" bar design for stremgth. In our lab when suggesting distal attachments for a bar design we utilize an attachment that has close proximity to the distal walls of the implant abutment, ie: Bredent,Rhein,Ceka or PreciClix

It works very good! (I have 9 years of experience with the use of "strategic" implants with teeth and RPDs with 100% implant success. It improves retantion, stability, esthetics (we avoid metal clasps in esthetic zone). I address you to my study (7-y follow-up)published on the Compendium, October 2005:"Use of dental implants to improve unfavorable RPD design" Mijiritsky E. et al