5 Free-Standing Implants to Retain a Maxillary Overdenture?
Anon. asks:
I have been doing maxillary bar overdentures for some time and I have had good success with this design. However, I have seen many cases at courses where 4 free-standing implants placed in the maxillary second premolar and canine areas are used to retain an overdenture. According to my dental laboratory technicians this design will be successful only with full palatal coverage. This is something I would like to avoid. They recommended placing a fifth implant in the maxillary incisor area to compensate for not covering the palate. Are any of you using this design with 5 free-standing implants to retain a maxillary overdenture with a horeshoe major connector design? What kind of success have you had?
11 Comments on 5 Free-Standing Implants to Retain a Maxillary Overdenture?
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alejandro berg
6/2/2009
the toung is a mercyless implant killer so i dont do free-standing implants in the maxilla.
A.Romano dr. med.dr .dent
6/2/2009
the best way for a maxillary fixed overdenture is to implant one more implant in the side of the sixties or seventhies places of each side or even in the place of eighties if the osseous mass consent to do it.
Dr. Ben Eby
6/2/2009
The maxilla is a tough sell for free standing implants, if the patient has a strong bite and bone that is not as strong as it could needs to be for this design.
I have used 5 freestanding implants with a palatal metal plate as a horseshoe major connector. The design needs to be such that the acrylic attachment to the metal horseshoe is not weak. You don't want the acrylic attached teeth to fracture off... Seems obvious, when you think about it, but the mesh to hold the acrylic has to be enough to hold the acrylic and still leave room for the female attachments in the denture.
With the right patient, this is a wonderful, relatively inexpensive design.
Dr Richard Vickers OMFS
6/2/2009
For free standing implants in the maxilla to support a overdenture opposing a natural lower dentition I place a minimum of 6 fixtures to allow a even distribution of biomechanical forces across the arch form.I have seen many cases of failed implants with less than 5 fixtures have been placed and 3-6 months later implant failure mainly in the posterior fixtures.
Terry G
6/2/2009
There are more considerations here that must not be overlooked:
1- bone density
2- implant thread design, diameter and length
3- implant surface (healing time)
Keeping the palate is definitely the safe option. The other safe option is to go to 8 implants, and splin them with a fixed, screw retained bridge.
There are some techniques, making it look like a million and not cost so much, and you deliver the final fixed rigid bridge in 24hours. (no screw retained dentures here!!!)
Richard Hughes DDS, FAAID
6/3/2009
Terry G, GOOD POINTS
Dr. A
6/4/2009
I have been doing maxillary free standing implant cases with no palatal coverage for 5 years now with no implant failures yet. During my residency I followed up on many similar cases that had been restored for over 3 years. I usually place 6 implants and make a "horseshoe" denture with metal framework and use locators. I will try to convince the patients to go for a hybrid though.
Tarnow published a case series on JOMI where he showed cases that had been restored in this manner for several years using 4-6 implants.
I no longer use a bar, unless a case was referred to me with very unparalleled implants.
Jon W
6/4/2009
The problem with placing 6 implants with locators is it almost becomes too retentive; it's very difficult to remove a denture retained by six locators with even the processing rings on. The patient's palatal anatomy also makes a difference: if it's a high palatal vault, you can get good support from the axial walls and leave the top of the palate uncovered for better gustation by the patient.
roberto sosa dds
6/16/2009
sucess depends on the opposing arch. if you have a denture it could work. natural teeth in opposing use a bar
Dental Thornhill
7/15/2009
I have place five fixtures in multiple cases with success. 5 would be the minimum, 6 even better.
brian
10/5/2010
I would be aiming for four or more implants, splinted with a bar, and three locators mounted on the bar, surrounded by attached keratinized gingiva. Five or six locators is too much retention, and obtaining that degree of parallelism is easier said than done. The main issue with adding a bar is additional cost, and a requirement for some more space, potentially necessitating some alveolar height reduction. Failure rates for less than this are extremely high.
