Implant retained denture options?

Classic approach is to make a set of temporary full dentures first to find right occlusion and cosmetics. Porcelain teeth are extremely difficult to adjust in case of improper teeth set up. The Locator system is good if the jaws have "regular" profile without obvious bone protuberances and not thin submucose layer.

Personally I have found 4 implants in maxilla to be over kill unless you are looking to transition to a hybrid or fixed work down the line, or to hold bone. You just don't need them I 8 & 9 spot for retention or stability. Just my view

I never use locators in the maxilla. Especially if they can't be spread any farther apart than 6 through 11. The maxilla flares so the locators will flare and you'll get uneven wear on the buccal aspect of the attachments. Also, as the patient chews the denture will fulcrum around 6 and 11 and pop loose on 8 and 9. I only implant the maxilla if there are four well spaced implants and a bar/clip ovd or four implants like you describe connected with a bar (least favorable) or 4-6 implants and a fixed hybrid or ceramometal restoration. In my opinion locators have no use in the maxilla. period. In the mandible four locators are a little better but not much. You still will have a fulcrum around the posterior locators which can potentially pop the anterior locators loose. Locators don't have much vertical play (not as much as ERA or ball abutments) so any tissue change supporting the denture leads to fulcruming. Again, why not make a hybrid? So much more stable and predictable. Or a bar/clip OVD with the bar extending back to the first molar. This eliminates the fulcruming and creates essentially a fixed restoration. Again, I'm prejudiced since I'm a prosthodontist, but locators are only used with two implants in the anterior mandible to save costs. When the patient is paying for 8 implants it doesn't make sense to save money on the prostheses and give them inferior restorations. give them stable prostheses fixed to the implants. I tend to see general dentists do these mega locator cases since that's what the lab is telling them to do or it's the only thing they know to do. Please, if you're planning on doing these bigger fully edentulous cases educate yourself on the different restorative modalities out there. Any other choice is better than lots of locators.

you could use locators in the mandible but hold out for a bar/clip in the maxilla if you want to open the palate. Porcelain denture teeth would not necessarily be detrimental to the implants but 1) they break, 2) they don't bond to acrylic and need the diatorics for retention and 3) you can't grind in a porcelain denture tooth to fit over a bar or mesh framework. Therefore, porcelain denture teeth are usually not feasible for overdentures. I use Hereaus Kulzer's Mondial tooth, the Ivoclar phonares tooth or the Bredent denture tooth. They have the best wear characteristics of the available denture teeth. Best wishes! MWJ

With 5 implants in the maxilla, providing they are healthy, that should be enough to support a bar/clip without adding any more implants. They're nicely spaced already. I would remove 6 and 8, trim a little so there's room for the bar then fabricate a bar/clip ovd. I would extend the bar to the first molar to remove any fulcruming of the prosthesis. I like to use hader clips anteriorly and Bredent ball attachments off the distal of the bar for posterior retention. These are the lowest profile clips available. If you want to preserve a site, preserve the number 6 area for later implantation. But remember, you need plenty of interarch space (12-15mm) for the bar/clip and overdenture or screw retained prosthesis so don't graft the site without evaluating the interarch space.

If you are concerned about finances check out Bruxzir zirconium full arch provisional. It beats the arch with the fake gums. Plus the cost is much less than you would expect.

I would cast a metal frameowrk rather than use a wire mesh - the mesh will actually weaken the acrylic and also thickne the dentue base. If you make a "horse-shoe" palate shape then the tongue space is increased. I have used the 4-implant maxillary OD on Locators for several years in patients that have financial restraints and not had issue - regualr reviews to check fit of the denture bases and adjust the denture occlusion as needed are key

Your time and their money will be better spent giving the pt an implant supported lower with 4-5 implants and an upper denture to start . I agree with the statements involving locators in the maxilla ,particularly in the anterior maxilla. If you look at the case from a denture perspective and follow the movements in function this will show you the forces that will occur on the implants. When you set up 4 lower locators in the anterior and your occlusion is in the posterior you will have the fulcrum effect and dislodge the anterior locators as the tissue compresses. This is even more apparent in the maxilla even if you can get them straight up and down because the tissue compresses more. My opinion is that if you are insisting on 4 locators you place them at the distal and anterior corners of the occlusal forces (i.e. 3/2,6,11,14/155 areas) then you may get a vertical force on the implants and a stable appliance. That doesn't usually work out due to the mental nerve issue. You may get early success your way but I think you have stacked the deck with more adjustments and wear and implant loss in the next 5 years. You might consider ERA attachments if you proceed These do give some compression and possibly offer some protection Also -No porcelain teeth - no reason for that and definitely a metal framework that is cast Not only does it make it stronger but also reduces the flexure of the prosthesis JMHO

O-ring and ball attachments transfer less force to the bone and will allow for denture movement in vertical that will prevent the attachment from popping off of the more anterior implants, and will also reduce the uneven wear that will occur with locators. The attachments are not very costly and can easily be replaced when finances improve and the patient expresses a desire for fixed dentures. If the implants are left free standing try to leave as much of the palate as you can regardless of the attachment. A horse shoe shape will be much more stable over time than a thin ribbon of acrylic. The more palatal coverage the better. Does the patient know that porcelain teeth can cause a clicking sound. Perhaps a good quality hard tooth such as IPN could be used. The cost of a metal frame compared to fiber or metal mesh is similar and the cast frame may be an advantage especially for the mandibular.

I have seen more problems with locators. I amazed that they have stayed on the market as long as they have. I do not use them in my practice. I have patients that enter my practice complaining about retention with locators. I convert them to ball retained bar overdentures if there is enough vertical clearance. Ball attachments are much more reliable and require less maintenance. Just because the patient demands porcelain teeth and the removal of palatial converge, it does not mean that is the thing to do. Sounds like the patient needs to be reeducated.

Ball abutments are more retentive and retain their retention much longer than Locator abutments - esp if you use the Dalbo Classic/ Ellipse by C+M. However the implant must not be more than 10 degrees divergent - so if you are placing 4 then guided surgery is your best option, if you are dealing with tilted implants then fabricate a bar and have ball abutments integrated into it.

Hi - more than 10 degrees then if workingg at implant level then Locator is your best option, otherwise have a bar milled and use either clipc or have ball abutments lined up on your bar (they screw into the bar) - - if its a cost issue go with Locator. The other thing with Locator is if the patients maves away or to a small town its easy to help them - if its a bar and clip then can be a massive pain for an in-experienced dentist to fix