Prosthetic Design for Maxillary Overdenture with 2 implants?

I have a patient with 2 maxillary implants in #6 and #11 areas.  I will be placing a maxillary overdenture.  My question is what retentive components and design will help keep the implants safe?



12 thoughts on: Prosthetic Design for Maxillary Overdenture with 2 implants?

  1. Chris says:

    If you want to protect the implants, a splinted connection via an overdenture bar with resilient retaining elements is the optimal solution. An example of this would be a Hader bar with the Metal Ackermann Riders (provides both vertical and rotational function).
    If, for a variety of reasons, a stud attachment is necessary, an O-ring abutment will be the most resilient, omni-planar retentive element. Locator would be the third option.

  2. mwjdds,ms says:

    two implants in the maxilla are usually contraindicated. Most patients want the palate out of their denture and a more stable denture. With two implants the palate must be covered so there’s not a big benefit to only two implants. And there’s a risk that free standing implants will get rocked out of the bone. Maxillary implants should be splinted together because of the weak type III-IV bone. Ideally use at least 4 implants connected with a bar then use hader clips, bredent clips etc. on the bar. Again, ideally the denture is fully implant supported by the bar and no vertical play or rotation is needed in the attachements. Therefore, locators on the bar are also contraindicated since they allow vertical play and take up a lot of interarch space. In my opinion and in my treatment philosophy, we can do two implants in the anterior mandible but the maxilla is a different animal. It should always be restored with fully implant supported prostheses to open up the palate and eliminate movement.

  3. FRANK says:

    Chances are the patient will be unsatisfied. Rocking arount the axis of implants will make food go under the denture.
    Otherwise, if you go this way, locators are ok and take up little restorative space.
    good luck

  4. Bill McFatter says:

    There is no prosthetic design. This is doomed failure. Locators wil see saw and they are not designed for that You will work hard treading water with no land insight trying to satisfy yourself and the Pt If you must use them do ball and O rings. These will give you all the movement freedom you will need and some added retention. Be sure that you use a housing for the Ball that allows room for compression And no bar will work here

  5. Ed Dergosits says:

    I ignorantly placed two implants more than a decade ago in the upper cuspid sites on a few patients with high hopes that the denture would significantly function better than the existing complete denture without implants. The learning curve was very short. The implants may add a bit of retention with locator or ball and ring attachments but the results were very disappointing. Eventually the isolated implants sustained bone loss and the implants needed to be removed. My advice is to add two more implants and have a bar fabricated on 4.

  6. Val says:

    I have to agree with everyone previously on this topic who have advised that this is a bad idea and almost certain to disappoint the patient, frustrate you (and your staff- especially the receptionists who will be in the front line of angry phone calls about retention etc…) and eventually fail.
    I have (regretfully) tried this on a few patients many years ago and tried EVERYTHING to stabilise the situation (curved bars, locators, Hader bars etc…) all to no avail- you had to cover the palate with baseplate to stop the rotation and food from getting under the denture- It was this baseplate they hated in the 1st place!
    I eventually gave all 4 patients 2 more implants each at cost price. Everyone had the restoration, comfort and functionality they wanted and actually ‘word of mouthed’ me to several other “retention issue” patients many of whom I’ve managed to help.

    Bottom line:
    Explain everything to the patient and offer (at least) 2 more implants if this is to be a denture case (at cost if it makes it more acceptable)- believe me, it’ll pay dividends in the future…
    Also, doing this will significantly make your life easier from an “unhappy patient” point.

      • Val says:

        Omar

        With respect, in my experience, this never really is the case. I’ve had patients tell me exactly what you’ve said and I’ve (regretfully) given them the 2 implants for retention with locators- they were very and vociferously disappointed (this was one of the patients I mentioned previously).

  7. Manjunath P N says:

    In my opinion, always 4 implants should be placed in the maxilla, not two.
    Fabrication of the bar to support the denture will be recommended.
    It should be completely implant-supported, instead of tissue & implant supported.
    Even with 4 implants, if the bone on the buccal of any implant is thin, it will resorb
    & may fail at a later time.

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