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Attachment Selection

Attachment Selection. Overdentures- Ridge evaluation and esthetics Fixed- Ridge evaluation, gingival esthetics Number of implants Anterior-Posterior spread Opposing arch ?? Function Fixed- Rigid, screw retained Overdenture- Load bearing or non- load bearing Retention

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Attachment Selection

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  1. Attachment Selection • Overdentures- Ridge evaluation and esthetics • Fixed- Ridge evaluation, gingival esthetics • Number of implants • Anterior-Posterior spread • Opposing arch ?? • Function Fixed- Rigid, screw retained Overdenture- Load bearing or non- load bearing • Retention • Available space • Cost

  2. Patient Considerations • Parallel attachments for easier path of insertion • Less attachments – better • Patient dexterity • Hygiene – Stannous Fluoride rinses • 3 month recall

  3. Anterior/Posterior Spread A line from the center of the most anterior implant to a line joining the distal aspects of the two most distal implants Indicates the amount of cantilever that can be reasonably placed Usually, 2.5 times the A/P spread

  4. A/P Spread Actual Length of Cantilever Depends on: • Stress factors • Parafunctional Habits • Crown heights • Implant width • Number of implants • Opposing teeth or denture

  5. Controlling Stress Stress=Force/Area Force Stress Area

  6. Torque= Force x Perpendicular distance from the line of force to the center of rotation

  7. Cuspal Inclination

  8. Cuspal Inclination

  9. Treatment Plan Options Fixed Removable Implant Supported Soft Tissue Supported Implant Retained

  10. Treatment Plan Option 1 Lower Edentulous Fixed 5-6 Implants

  11. Prosthetic Options-Lower5-6 Implants • Hybrid Denture • Fixed Crown and Bridge • Cantilever 10-15mm

  12. 6 Implants-Fixed Implant Supported 24 25 23 26 27 22 X X X X

  13. 5 Implants- Fixed Implant Supported C D B E A X X X X

  14. Treatment Plan Option 2 Lower Edentulous Removable 5 Implants

  15. Gold Bar w/ O Rings Distalized O Rings Cantilever 10-20mm Gold Bar with Hader Clips Distalized ERA’S Cantilever 10-20mm Prosthetic Options- RemovableOverdenture-Implant Supported C C B D B D A E A E

  16. Treatment Plan Option 3 Lower Edentulous Removable 4 Implants

  17. Gold Bar with O Rings Cantilever 5-10mm Gold Bar with Hader Clips and ERA’S Cantilever 5-10mm Prosthetic Options- RemovableImplant and Tissue Supported b c b c d a d a

  18. Treatment Plan Option 4 Lower Edentulous Removable 3 Implants

  19. Prosthetic Options- Removable Overdenture-LowerImplant and Tissue Supported • Gold Bar w/ 2- O Rings-Overdenture • No Cantilevers

  20. 3 Implants- Removable Overdenture Implant and Tissue Supported C D B

  21. Treatment Plan Option 5 Lower Edentulous Removable 2 Implants

  22. Prosthetic Options Removable Overdenture-LowerTissue Supported • Gold Bar w/ Hader Clip • O Ring on each implant • ERA attachment on each implant

  23. 2 Implants-Removable Tissue Supported B D

  24. Treatment Plans Upper Edentulous Four Options

  25. Treatment Plan Option 1 Upper Edentulous Fixed 8 Implants

  26. Prosthetic Options Fixed- UpperImplant Supported • Fixed Crown and Bridge • Hybrid Denture • No Cantilevers Necessary

  27. 8 Implants- Fixed Implant Supported X X 7 10 6 11 X X 4 13 3 14

  28. Treatment Plan Option 2 Upper Edentulous Removable 8 Implants

  29. Prosthetic Options- 8 Implants Removable- UpperImplant Supported • Gold Bar w/ O Rings- Overdenture • Gold Bar w/ 3 Hader Clips Overdenture- No Palate • Cantilevers-Optional

  30. Gold Bar Overdenture w/ O Rings Gold Bar Overdenture w/ Hader Bar / Clips 8 Implants- Removable Implant Supported 7 10 7 10 6 11 6 11 4 13 4 13 3 14 3 14 Palate No Palate

  31. Treatment Plan Option 3 Upper Edentulous Removable 6 Implants

  32. Prosthetic Options Removable- UpperImplant Supported • Gold Bar w/ 4- O Rings and distal to #s 4 and 13 • Gold Bar w/ Hader Clip- ERAS distal on #4 and 13- Overdenture-No Palate • Cantilever 5-10mm

  33. Gold Bar w/ O Rings 5-10mm Cantilever Gold Bar w/ Hader clips and ERA’s 5-10mm Cantilever 6 Implants- RemovableImplant Supported 7 10 7 10 5 12 5 12 4 13 4 13

  34. Treatment Plan Option 4 Upper Edentulous Removable 4 Implants

  35. Prosthetic Options Removable- UpperTissue Supported • Gold Bar w/4 O Rings- Overdenture w/ No Palate • Gold Bar w/ Hader Clip and 2 distalized ERA attachments w/ Overdenture- No Palate • No Cantilever

  36. Square Arch Tapered Arch Arch Form4 Implants-Tissue Supported 6 11 6 11 5 12 4 13 Maximum contact with tissue – No contact with Bar Attachments are for retention ONLY

  37. Treatment Planning • Design sensibility and flexibility in the treatment plan • Design and implant concepts will vary • Plan ahead for success • Have a disaster plan • In most cases, less attachments are better

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