All-on-4 Technique: Can I Do This With Locator Attachments?

yes and no. you can place 4 implants and then have a removable denture with locators , especially in the mandible. but that is not the all on 4 as described by Malo. i would not do it in the maxillae there i would prefer that the implants are splinted and Malo by definition does not do removablle.

I would say no and no. The all-on-four protocol is well described and does not involve locator attachments nor a removable prosthesis. You may place four implants and four locators and fabricate a removable prosthesis to restore the implants, but that is not the all-on-four technique. By the way, if you do, make sure that you use the least retentive inserts, or the patient will have a very hard time removing the overdenture. Good luck!

You can do an all on four with a bar overdenture.

How does everyone feel about a complete denture retained with 4 locators?

IT CAN BE CALLED THE "LOCATOR ON 4"

Locator is very limited to correct non parallel implants. ERA implant system allowS to correct 5, 11 and 17 degrees, so you can place the implants in the best bone. A horseshoe maxillary denture with 6 implants is easy.

I do these all the time. 4 implants with locators, carefull to get them parallel. Ticonium/chrome cobalt horseshoe frame w/ open palate and a very short acrylic flange. They are more cosmetic and more hygenic than a fixed detachable and cost less too. good luck have fun with it,

locator very stabil system.tesekkurler locator.

You can use the 30 Degree abutment with Locator top from Implant Direct LLC

I' am agree with Dr. Boudet, Of course you can do it but should you??? The cientific literature demostrate that there´s not any significant difference between the use of 4 or 2 implants for an overdenture. So, if you gonna do an implant retained overdenture, with 2 o´ring or a bar or even locators should be ok. If you want to use four implants, you should do another type of treatment. 4 implants for an overdenture is excesive (at least for an implant retained mucosupported overdenture). In respect to the all on four protocol, it was designed for an inmediate loaded screw retained structures, and no for removable prosthesis. The put in take out movement may affect your implan stability in the first days. Sorry, I have to say no way!

I agree with Dr. David Nelson, they work great. With 2 implants you have good retention With 4 implants you have good retention and stability on the overdenture. If you are placing the implants not parallel you can use ball anchor attachments with 15° or 25° angle correction from MIS (internal hex. 2.45) Do it!

The classical all on four as described by dr malo requires 4 implants of which 2 are angulated. This does not allow the use of locators. But a bar could be attached to the implants and the locators placed over the bar and used for retention.This is possible both in the maxilla and the mandible. to do without a bar the implants need to be parallel and also at almost the same hieght at all four locations. If they are not parralael the retentive rings tend to wear away faster than normal and require frequent replacement.

I am sure you could but why? The whole idea for me has been that when you splint the 4 implants together with the Fixed Denture and then the Hybrid Fixed Bridge, you have a circumstance that seems to be more predictable than any sort of removable. I have noticed this throughout all of my "All on 4" cases and I am up to about 50 arches of them so far. Splinting them together at the time of surgery gives a lot of stability even if you have a spinner or one that is a little questionable. I have not lost an implant under an all on 4 yet but I have lost a few under Removables whether they be locators or Hader bars. If you were going to use locators instead of "fixed" this above mentioned occasional occurance would also negate the immediate load factor and do two things: disappoint the patient and from my experience, give a higher chance of implant failure. Locators require too much messing around for me and the all on 4 fixed solution is something I see patients more favorably respond to and is immensely easier to manage.

Dr F It is a shame that you offer implant treatment without having the expertise or basic knowledge 4 implants on the maxilla need to be splinted. Obtaining parallelism for 4 implantsgoing around an arch , and keep in mind the To put it in simple terms, locator attachments must be used on parallel implants. Placing 4 parallel implants going around a curving, tilting arch is very difficult, especially as you go around architecture of the premaxilla which is angled . Yes, the locator attachment can correct slightly if implants are noneparallel but not to the degree it needs to be corrected for 4 implants going around a curved arch. From Basic implant 101, we learned that implants can withstand occlusal forces that is transmitted along its long axis A Locator attachment has a 360 degree grip around an implant. This design will allow forces from all directions to be transmitted along the implant. Overtime, these lateral, torquing forces will overload the implant and can cause at the minimum screw loosening. This cascade of events will eventually lead to implant failure. or worse implant failure. So just purely from a physics standpoint, implants are not designed for locator attachments. I had a colleague who continues to plan it this way even after seeing numerous clinical failures and after advising him against it. Maybe , finally, the advise from other colleagues will shed some light! attached to a locator receives almos all lateral and torquing type forces, the forces

I HAD A PATIENT VISIT MY OFFICE YESTERDAY FOR A CONSULT THAT HAS 4 ROOT FORMS W/ LOCATOR ATTACHMENTS IN THE MAXILLA AND AN OVER DENTURE. THIS CASE WAS DONE BY 2 OTHER DOCS BUT UT IS 12 YRS OLD AND GOING STRONG. SO EVERYTHING IS NOT CAST IN STONE.

I have placed four implants in the maxilla for overdentures for many cases. My longest is approx 18 years and is stable pt very happy to have denture without palatal acrylic. At one time she fell and broke denture and two locator abutments. Implants were fine dentist replaced abutments and new denture .Case is stable three years after accident

4 in the floor works well in the mandible with 4 locators however if you try it in the maxilla you are asking for failure. Youmight have temporary success but in the long term it will fail. The bone is just not strong enough. 4 implants in the mandible between the foramen with locators is extremely retentive and well tolerated. In my humble opinion Success in the maxilla is the exception not the rule.

Paraon N DeQuiroz FICOI, You are mistaken sir. You indeed can get parallelism on four implants in the maxilla. Do it all the time... not to say that it's easy on compromised cases with very little bone width... Check out some of the research and case series from Tarnow. When I went through residency I inherited cases just like that, over 8 years old. I only splint these days for hybrids or correct for angulation.

1. There is no need to use locator in this occsion, as four implants are enough to limit rotation. 2. Unless your eyes are integrated with parallelism gauge, the female parts of the locator would be worn so fast (less than 3 months) that the locators become unfunctional. So, do not try to re-invent the wheel if the wheel exists on Earth for a long time.

Paraon N DeQuiroz FICOI November 4th, 2010 dr, he never mentioned the maxilla in his question,so i think your comments are unjustified but i happen to agree with you re splinting in the maxilla

1. All on four works well because it is a. immediate b. splinted c. fixed EACH of these points makes it work. If you try to leave out a point, you markedly increase your failure rate: If you use Locators, you run a VERY high risk of failure of the implants if you load them immediately. In the mandible, you may load them after they have integrated. In the maxilla, you will have LONG term failure. Bone loss is significantly increased when the implants are not splinted. This is a long term finding. There is an ex. of this in the article by Jofre, Cendoya dn Munoz in JOMI 2010:25;1137-44 where mini-implants w/ locators showed bone loss at 1 1/2 years. This also occurs in standard implants. I have seen several patients lose ALL of their implants when connected to the denture by Locators in the maxilla (with a palatless denture). Finally, Locators allow for increased movement and thus ridge resorption. It is a much less expensive treatment, but at a cost. I see patients try to skimp and dentists try to cut corners. Initially this works, but after four to five years, there tends to be a mess, leaving a patient far worse then when they started. For a palatless (maxillary) denture on Locators... just say no.