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22 thoughts on “Palateless Maxillary Locator Case?

  1. We Small Diameter Docs do palateless Maxillary Prostheses retained by 6 O-ball Implants routinely. The amount of Palatal removal depends on amount of palatal slope and amount of residual ridge bone.

  2. Hi, we do palatess overdentures on locators routinely for the past 8 yrs and none have had any significant complications, but, they are always chrome based. When pts accept it, we extend to anterior aspect of hard palate for additional support and reduction of “rocking”

    Stefanos

  3. Treat it like a fixed case, minimum 4 to 6 implants, 6 better in case you have an unanticipated failure of integration. Metal mesh inside the denture. Don’t cantilever more than 1.5x AP spread.

    1. I always use 4 maxillary locators and a metal horse-shoe palate. The metal framework allows it to be thinner and conducts temperatures better along with being stronger and having better taste since palateless. Max

  4. Minimum is 5 maxillary implants (3.7mm diameter X 10mm length minimum) with Locators has been my experience. Tarnow has an article about this with criteria. Zero degree occlusion or lingualized. You may want to do a bite force measurement first.

  5. I have done both ways and have had success when I have used at minimum 4 implants. The case that I did with only 2 implants failed in one site despite palatial coverage (will not do that again). I also agree with the above comments.

  6. Absolutely, no problem. The ability to eliminate the palate from the denture is one of the biggest benefits to implants under a full upper denture.

    Locators will make this an implant retained and tissue supported prosthetic. I was taught 4 implants for upper removable, but I have seen successful cases with 3-6. Because it is tissue supported, the implant position is less critical. Symmetric cases with implants in first molar and canine positions work great, but I have perfectly successful cases with two implants at the first premolar area and two in the incisor area. When treatment planning a removable case, I take bone volume and angulation into consideration. I have a successful 10 year-old case with with implants replacing 2, 5, 9, 12. Those positions are clearly inappropriate to support fixed, but I am very confident doing that with removable. Those positions were selected to take advantage of the best bone and avoid sinus lifts and grafting.

    I have had problems with lab positioned housings, so I pick up the housings chairside with cold cure acrylic. Other materials are faster and easier at delivery; however, I have found that they leave the denture weaker and at risk of fracture or teeth popping off.
    I personally hold the denture in place for ten minutes rather than having the patient bite down and stay closed.

    My biggest mistakes with these:
    1) Using all acrylic – I converted some traditional full dentures to implant retained and cut out the palate. Those start to break after 4-8 months. Today I have patients keep their old denture as a backup and make a new denture with a metal framework. I tell my lab to make the framework just like they would a partial denture.

    2) Implant angulation – Zest claims 40 degrees of divergence. I have not been successful with that much angulation. The retention is compromised and the inserts wear too quickly. I corrected two cases by using angled GPS abutments (which were compatible with Locator housings and inserts, but are no longer manufactured). I have not tried the new Locator R-tx system, Zest claims 50 degrees.

    1. Dr Trevor obviously does a good number of Implant Retained , Tissue Supported Dentures.
      Nice Presentation, a good start on a textbook chapter! I agree, point by point, even though I use Small Diameter O-Ball Implants.

  7. I have restored several implant/ tissue supported max OD. Most have been locator attachment cases. My only added insight is longer term the yellow coating will begin to fail due to wear. At that point replacing locator abutments become necessary. I also recommend chairside pickup.

    1. The patient can have a provisional denture which is adapted to the post grafted ridge and relined with soft reline material in the anterior and hard reline material in the posterior. The Larell One Step Denture is an ideal solution for this condition.

  8. Youu should be talking about the position of the implants ,not the number ,when talking about locators. Locators are not made to rotate. I think the new locatorR-tax is in response to the wear on both the resilient housing and the abutment that occurs when 4 implant are used in most common position i.e. Cuspid/ bicuspid area. Locators are designed for vertical loads and retention. Place at corners of occlusal forces- cusp or bi AND molar and metal framework. Angles for the maxillary implants always challenging to get parallel

  9. Dr Flanagan,

    Can you tell us simply what this device is and where it can be purchased? For 25 years in dentistry, i have thought this would be a great tool to have!

    J Oral Implantol. 2012 Aug;38(4):361-4. doi: 10.1563/AAID-JOI-D-10-00101. Epub 2010 Sep 7.
    Jaw bite force measurement device.

    Flanagan D, Ilies H, O’Brien B, McManus A, Larrow B.
    Abstract
    We describe a cost-effective device that uses an off-the-shelf force transducer to measure patient bite force as a diagnostic aid in determining dental implant size, number of implants, and prosthetic design for restoring partia

  10. Flanagan D. Medical Devices-Bite Force Measurement- 2017 10: 141-148
    Get the reprint, it is free. It has all the info.

  11. My challenge with locators has always been getting the right amount of tissue support.
    Dr Trevor indicates he has not had luck with lab processing and instead prefers chair side.
    I have had poor luck with the lab and having the patient bite. They either don’t bite hard enough or they bite too hard. The result is a poorly supported denture or a lot of sore spots to relieve. Without the positive stop the hard palate provides I can see holding the denture in place would need an experienced touch.
    Thoughts?

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