Implants in the maxilla: any suggestions?

My patient is a 68 year old male, non smoker.  He presented with a maxillary complete denture that lacks stability.  He wants implants to have more denture stability.  How many implants would you recommend for a maxillary overdenture?  What attachments do you recommend?  Will he need sinus lifts and bone augmentation?  Will covering the palate give his overdenture greater stability?  Any recommendations?

16 thoughts on “Implants in the maxilla: any suggestions?

  1. Re O'Neill says:

    I am sure an implant retained superstructure will be an improvement on denture adhesives. I do think you had better plan both arches looking at the condition of the mandibular teeth. I would be guiding him through a CBCT and diagnostic mounted casts to get some idea of his occlusal relations. He may be a good case for a short arch but bit early to say.

  2. z says:

    CBCT first to determine thickness of bone. Plan to extract that failing lower thing as well. 4 implants on top minimum and locator abutments if you have room to place them vertically. Place implants as far distally as possible. I would try to keep the implants anterior to the sinuses to avoid lateral sinus lifts. Can angle them distally to follow the anterior wall of the sinus and get more distal extension. If you have angle the implants beyond locator’s range of angulation, you can make a bar and put locators on the bar. Keeping the palate is better if you’re going to keep his existing denture, though it will be hard to modify his existing denture to put a bar in. Plan on making him a new denture either way. Probably better to make a prosthesis that extends to first or second premolar if you wanted to remove the palate, less cantilever. With all of the expense of doing a bar, you’re most of the way to doing an all on 4, which, if you get rid of the lowers might work out ok. I would add an implant in there somewhere if you’re going to do fixed just in case.

    My guess is that he does not have enough thickness of bone to do anything without grafting or ridge splitting.

  3. Ninja says:

    One can improve denture stability with two implants and four will definitely make a big difference. Sinus lifts look like a must. Zest makes anchors that will coordinate with whatever overdenture abutments you choose to use, ball, snap on. From experience people are somewhat dissatisfied with the use of only two implants and end up blaming us for wrong predictions. It is best to get involved when four implants are affordable. Obviously there is a great deal of time involved in workup until one can actually get to the implant placement. My suggestion, always use scan and study models to establish perimeters. Nothing can be build without well designed architectural drawings.

    • dr amin nanji says:

      Upper denture instability is due to incomplete seal and poor opposing occlusal scheme.
      please advice patient that he needs to recalibrate both arches.

      properly planned full dentures will give him already better stability, i tell patients to expect at least fifty percent more improvement.
      possibly consider lower cd, with healthy roots left in situ.
      once you have a stable occlusion ,use copy dentures and ct scan to consider implant placement, this would be now to get the remaining 30-40 percent more improvement!!
      only working on the upper jaw would in my opinion be setting yourself up a one way street.

  4. Dr John Beckwith DMD, DABOI says:

    Maxilla overdenture w palate- 4 implants w AP spread
    No AP spread w 4 implants , bar w adequate intericclusal space(15mm)
    No palate- 6 implants
    Please refer to Misch tx plan of edentulous arch for more thorough explanation. There should be no guesswork. We need consistency. As a profession we are creating confusion for our patients and our colleagues by having OPINIONS regading treatment protocols.

  5. Dale Remerscheid says:

    I think you have more bone in the 3.9 area than you think. Get a CBCT for sure. Lose the remaining upper tooth and convert his partial to a full denture and reline or make a whole new upper depending on the condition of what he has now. There is no way to have any stability with one remaining upper tooth. No suction, no stability. See how that works for him while you focus on the lowers. They’re a mess. You can always revisit either SDI’s with good bicortical stabilization or regular size implants/locators on the upper later on if needed. He’s not going to be happy with a fully restored upper and nothing on the lower to oppose it with.

  6. CRS says:

    I am for once speechless at the fantastic comments posted by my colleagues Excellent Posts and thread! Nothing to add! Love the comprehensive treatment planning gentlemen!

  7. Merlin Ohmer, DDS, MAGD says:

    First take a CBCT to perform a thorough analysis and diagnosis.
    I like to use four full-size and locator attachments. If you can get the patient to agree to six, do it to have extras is any fail. Remember, patients lost their teeth for reason. Although titanium does not decay like teeth, the do get periodontally involved. They more the merrier.

  8. dr gerald rudick says:

    Have we lost our focus????
    We, as dentists have to treat the whole person, not just one specific area……take a look at the lower arch…. a complete failure….everything is rotting and falling apart.

  9. mpedds says:

    In a case like this I recommend palatal coverage. The palate is basal bone that does not resorb. It provides support for occlusal load. Without a palate all the load will either be on the implants if you plan it that way or on the remaining alveolar bone if you are using implants for retention only. Cover the palate to help save what little bone if left for this patient.

  10. bigjulie says:

    The FIRST consideration for any full arch implant supported structure is THE LABIAL FLANGE.
    Most upper dentures require a flange for lip support due to the loss of buccal bone.
    An implant supported dental arch may be perfect dentally yet the patient may be justifiably disappointed because their lip is lacking bulk and support. Bone bulk must be provided to replace the labial flange by on-lay block grafting et al … fools rush in?

  11. Ninja says:

    I have a comment but it is not directly an answer to the question that was raised regarding treatment approach to stabilize an upper denture. It looks like some of us believe that people have needs and therefore are prepared financially to reach to ultimate outcome. The skill of a dentist is to listen and deliver what the person wants and can afford. Creating a picture of a treatment plan to satisfy the provider is rather simple in comparison to finding a middle road solution. We strive to a live in Paradise but we have not gotten there yet. The patient deserves the best solution with what is affordable and achievable under the circumstances. He knows what condition he represents and in my opinion he would have addressed it right from the start. We discourage people from getting help by presenting them with something they requires a major investment, house refinancing or selling his entire farm.

  12. Luis Fabelo, DDS, MAGD says:

    I think all the above are great options and opinions. To me the diagnostic and planning stage is of paramount importance in any case. Then actual tratment recommendations should take place with the patient’s budget in mind. It is my opinion that I am not helping the patient if I plan a fixed case if the patient does not have the financial means. I always like for tge pts to give me a ballpark budget to begin planning, now that does not mean that I wont present all options.

    • Wesley Haddix says:

      Acknowledging already excellent recommendations regarding the need to start with a CBCT, comprehensive health evaluation, and treatment of both arches, may I suggest this starting point: Get a clear idea of the patient’s idea of “stability” and “successful outcome”. With that goal in mind, compare it with the necessary treatment regimen to achieve that goal, and hence the patient’s satisfaction, to their resources. After reaching mutual understanding, follow the advice already offered for treatment. All the best to both you and your patient.

  13. BillM says:

    Irrespective of the lower arch please don’t do 4 locators or 2 locators in the maxilla unless you can place them anterior and posterior to the occlusion . It is not how they work. They are for vertical support not rotation . Too many Drs feel 4 better than 2 or if 2 work in the mandible then why not 4. In most cases the occlusion is distal to the last implant creating compression on the distal implant and tension on the anterior one when in function
    If you can get an implant at the cuspid and 1st molar then you have a long term possibility with locators because you support the occlusion on the corners

  14. Ninja says:

    We all have some background in physics in the area of mechanical levers of different classes . A denture supported by implants beside biologic considerations is a mechanical device supported by implant attachments. It is not a product of genius but simply a device which is subject to vertical and lateral forces. Todays attachments allow rotation to prevent denture from dislodging because of the resulting vectors of force that are a summary of chewing forces going in different directions. One should place the support that is most advantageous to the retention of the device. There should be no question that three is better than two and four is better than three. Anything beyond three would have to be considered on individual bases. We should know from removable dentures that the availability of a tripod for partial retention was always desirable. One could never make a successfully acceptable partial by using two clasps no matter how designed.


Comments are closed.

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