Conversion of case to Locator attachments?

Steri-Oss Replace is external hex. Steri-Oss Replace Select is internal tri-lobe. Can you post x-ray? You will need to remove bar and measure tissue depth to determine Locator abutment height. Best, Darwin

X-Ray added to case photos above. Just refresh page.

Reason for doing switch from bar to locator? Locators best when 2 lateral incisor area,soft tissue borne ,3 locators could work but also needs to be tissue borne ,get ready to change those plastic inserts often!.

I think it is a good plan, did the bar break?

These appear to be the 3.5 internal tri-lobe Steri-Oss Replace Select implants. Darwin

The only things I would add is be prepared with a range of locator caps. The locator abutments themselves are standard zest type now . I think you should be able to probe your tissue height and determine what height you need before taking off bar. then I'd have for example a 1 and 2mm height attachment for each, assuming that's your measurement. You can always use them later in another case but better to have a choice. So measure first. I would also recommend doing a. Chairside cold cure at first to see if you are able to get a good attachment for each. If the case is going to be a full lab reline then let lab do them but be prepared for one not to engage when you get it back and have the cold cure and another processing kit ready. Since you don't look exactly parallel have a few zero angle caps ready also.

Your x-ray and photo do not show any problem with the bar, (other than room for one more bar-clip) Why do you feel that migrating to three "Locator" attachments is going to make the patient's removable prosthesis more stable.?

The denture will bottom out on the locator attachments, rock on them, wear, and then have to be replaced often. With the spacing of the implants, if the vertical will allow it, ball and O-ring might be better with the free standing implants. The denture made on these implants will be tissue borne regardless of what attachments are used and the tissues will yield allowing denture movement around the implants.

I am all about saving a patient money. What do you guys think of this idea? How about blocking out the undercut under the bar a little bit and then treat this bar as teeth. Take an impression and have your lab fabricate a framework as you would for a RPD. Process the framework within the new denture. Pretty hard metal that may never wear out, it could fit over the bar any way you design it, and you could even add pins to fit inside of where the attachments were. Any comments?

mpedds, A money saver that I have used in a case like this: 1. Remove the attachments from the existing denture and prepare retentive undercuts. 2. Block out the space under the bar by burnishing tin foil (lead foil from x-ray film if you do not have tin foil) over the bars and slightly over the soft tissue below the bars. 3. Coat the prepared space in the existing denture with bonding adhesive for chair-side placement of a long term soft denture liner. Seat the denture with the soft liner in it and allow it to cure in the mouth with the patient closed on the denture. 4. Peal the foil from the denture. A sharp blade can be used to remove excess denture liner. I have used this for temps as well as for patients with limited finances. When done with care expect one to two years of service before needing another "reline". providing

First re-do the case. Your chances of success with a 10 y/o removable prosth are small You haven't mentioned the occlusion or opposing arch. Cases like this can form unique occlusal wear / functional dynamics. Most likely there has been some posterior changes in the ridge. This bar design allowed no rotation in function and this dynamic can create heavy anterior occlusal pressure since this part on the prosth is fully supported. Anterior wear and premaxilla damage can result if pt is in upper denture. Now you have an upper denture that functions in both horizontal and vertical planes - more than likely decreased VDO and reverse smile line. A Combination syndrom. You have no idea how the lower denture fits the tissue and you know it does not fit the anterior tissue. If you modify this denture be prepared that it won't work. If you must use this set use a soft liner procedure in the lower as a trial to see what happens . As stated above use only 2 Locators. As soon as you engage the middle implant you create a fulcrum with compression on the distal implants and tension on the anterior Locators dont compress. You may be replacing the liners often if you use 3. You don't want to resist rotation. Since your occlusion is distal to the implants this movement needs to be free. I would hate to spend the time and money adding locators to this denture only to realize they really need a new prosthesis. This is 10years old. Redo it or be prepared to chase your tail and frustrate both you and the patient With a new over denture you may be better using ERAs or balls if you want to resist rotation and use all 3. These allow compression and rotation The implant placement calls for a bar but the retentive design needs to allow for a rotation on the distal retentive element. Misch has some good designs in his book and the current design is not one of them

Yes WTM, these attachments do function in different ways. What movement that they allow must be considered early in treatment planning, even before implant placement. The above case is an example of poor treatment planning from the start, but it still served the patient for ten years. In most circles that would be considered a successful treatment. We must take into consideration our patients expectations as well as their tolerance to the changes that occur with denture fit and function with time and age. mpedds suggested a less costly way to help a person who might be in a position with rather limited finances. I suggested a way to help a person who can not afford even what mpedds had suggested. I have to agree with you that it would be best to redo the entire case including the maxillary teeth as well as the mandibular teeth provided that it meets the patient's desires and the finances allow it.

Dr Bob. I like your resolution here if there are financial hardships. It helps correct fit and occlusion and allows some degrees of forgiveness of altered function. I would be curious how much time was spent working with the original case and the complications that occurred. Acceptance of the situation and inability to afford a change may be more to do with 10 years of service than acceptable function.

If the ERA loops are worn out, remove the bar, have the lab cut the old loops off, cast new loops and solder/weld them back on. The original males in the denture should still fit into the females. This is easy, cheap and doesn't require modifying the denture. The bar/ERA/hader retention is a much better clip retention mechanism than are three locators

You can just have your lab recast the worn out loops. If you truly want to convert it to a tissue supported overdenture, call Sterngold and order the SNAP abutments. You'll save a lot vs Locators. The don't require a metal housing and the retention inserts last much longer. They also have ORA's which are the ball and o-rings which may be your best option over a button style abutment. They have EZ PickUp Material for your chairside pickup. Great material!

I am a hygienist as well as a speaker on peri-implantitis. It appears that there is significant bone loss around these implants and the tissue appears to be inflammed. I would like to see the probed readings and determine the periodontal health of these implants before doing anything...after working with an oral surgeon and doing prophys on his implant patients, the first and foremost thing we would accomplish is to get the tissue healthy, determine the bone health, attain excellent oral hygiene and then establish a plan. I hope this helps from a hygiene point of view. Thanks, Kathy