Locator Attachments in Overdentures?

Dr. H asks,

I have been doing mandibular dental implant supported overdentures for some time. My standard design is for an anterior bar supported by 3-4 dental implant fixtures. I use a central clip and 2 distal ERA or preciclix attachments.

We have a new oral surgeon in town who feels locator attachments directly picked up in the overdenture is a superior restoration. I would appreciate feedback because we are starting a new case soon. How about this approach for a maxillary overdenture? Are they retentive enough for a horseshoe design?

10 thoughts on “Locator Attachments in Overdentures?

  1. Chad in MO says:

    Locator, Locator, Locator.

    Great abutment. Very simple to work with. Can easily be picked-up chairside. The problem you will have with Locator will not be enough retention but too much retention. I would suggest leaving the black processing rings in for 7-10d for the patient to adjust and then bring them back in to place the pink or green or light blue, sometimes a combination is best suited.

    We suggest 4-6 implants in the maxilla and 2-4 in the mandible these decisions are based on many factors including site prep, finances, denture construction, etc.

    Good Luck

  2. Dr.R. Mosery says:

    Your design is sound. The locator attachment used in conjunction with the bar and central clip will work great. Just substitute the locator for the era’s. I’m quite certain you will never use the era attachment again after using the locator.Don’t give up the bar design for a bunch of single standing locators,especially on the upper.Placing 4 implants on the maxillary arch will give you a nice result .If you’re going to place 6 you might as well place 8 and do a full fixed case .
    Good Luck and enjoy the locators!

  3. Dr Bruce G. knecht says:

    Locators are great for poor intraarch space. To place a bar, you need space and this is sometimes difficult in immediate extraction cases. If a bar is placed a lot of times the teeth fx off due to the bite. locators are also good due to poor implant positioning. Trying to seat a bar with implants in different directions is difficult and may not be passive.

  4. Dr. R says:

    I agree with all of the gentlemen above. Locator is a phenomenal abutment and I haven’t used an ERA since I first used a Locator.

    If you do run into a situation that Dr. Knecht described where the implants have been poorly placed you might want to consider using a cad/cam milled bar. They usually fit on any system and are made from a solid piece of titanium so you don’t have to worry about sending the bar back multiple times. I know some advanced labs perform this service and 3i does as well.

  5. Morris Bitzer DDS says:

    For Dr. Mosery: What type of bar design do you like for a Maxillary overdenture. Can an open palatal design work well? (transpalatal bar/horseshoe)

  6. Dinh X. Bui says:

    Please keep in mind that with locator, you only need 3 implant maximum. The reason is the retention. Patient will NOT be able to remove the denture otherwise. The implant should be parallel with maximally 15 degree offset. I have done locator for the last five years (since Zest introduced the abutment). Trust me, patient will appreciate that we save them money and give them the best services available.

  7. Chedid says:

    I have placed 4 3I fixtures on the maxilla with immediate placement of locators. The locators were activated to 20N/cm at surgical time since the plan was to make a maxillary implant supported overdenture. However, few days after surgery, the patient changed he mind and wants ‘fixed teeth”. My plan now is to add 2 implants in order to give enough support for a total bridge; However, I am concerned about the removal of the locators, especilly after they have been activated over the implants. what is your advice and what would be the best way to unlock the LOCATORS without damaging the implants’ stability.

  8. barth says:

    when the locators , even 2, are not 100% parallel you can forget it, imposible for the patient to remove his denture; of course we check always the models and the impressions, we work in 100% perfect conditions.

  9. christo says:

    lets not forget, you gungho dentists, that you must look to the evidence for your designs. Fixed and removable should follow indications not implant numbers, implant numbers should be biomechanically determined, and your patients will appreciate long lasting restorations. Agreed 2-4 against 4-6, but please be careful of 3 in a maxilla. you are asking for trouble mate.

  10. christo says:

    to answer chedid, a few tips for removing your locators. a light tickle with the ultrasonic on the tool tip not the implant, and failing that, you need some rotational tapping, like a crown remover. A matrix band around the tool, and a few light taps. Failing that, refer to someone with more skill/qualifications. A great example to reinforce why implants need to be positioned to allow for future changes. ORAL SURGEONS LISTEN UP!!!! Those surgeons love poor excuses for sloppy positions.

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