Overdenture help!!

[JohnWilson]

I wonder what @bernigts would do and say about this case??? Would you mill the bar and would it be covered under warranty?

Of course he would, the bar will never fail its the implants that will.

Just don't let this guy have you set a full complement of teeth, at the very min eliminate the second molars

 

[JKraver]

I know there is bone loss but best case is to increase AP spread angle a long implant into the posterior sections. Only way I see to make a great implant borne prosthesis. I don't think that a tissue born would work well either with the distance between those two canine area implants. Would of done the pt right by placing two implants in the laterals, and dolder or hader bar tissue supported denture.

 

[aqdental]

Ok, this are couple of pics of the case mounted. Patient had a lower single abutments locators retained denture which was not happy with. As you can see from photos upper denture has a narrower arch than lower and RHS is cross bite. His current denture was set in "normo occlusion" so his tongue space reduced quite a bit. Also the extensions of the base ( Buccal shelf and retro molar pads) not fully covered. This guy has a VERY large mouth infact my client had hard time getting his impression right but I think he did quite a good job all considering. So, patient went to see my client complaining about stability in the first place. I have to mention also that his upper needs a good reline! So maybe this is the reason to choose a bar, stop this thing to move. I'm not trying to justify anyone just telling the story as I know it.
I have made several attempts to made him aware of the risk of overloading the implants during posterior contact but his idea is to have an implant assisted over denture where the anterior is doing most of the work and not relying so much on the posterior ridge since it is flat. I don't think he understud that no matter what a lever will always take place unless we eliminate any contact with the bar which will make the all exercise useless, you end up having a 3locator over denture. But he wants to rely more on the bar than the tissue so after 3 phone calls and 1 email I'm doing this think and forget about it. I hope he is right. As I said before time will tell. He knows I think 3 proper sized abutments and proper setup and base extension would probably make a lot of difference but I can only suggest or give opinions which I did.
PS I have suggested to reline and remount the upper posteriorly to improve thinks a little.

 

[kcdt]

Ok, this are couple of pics of the case mounted. Patient had a lower single abutments locators retained denture which was not happy with. As you can see from photos upper denture has a narrower arch than lower and RHS is cross bite. His current denture was set in "normo occlusion" so his tongue space reduced quite a bit. Also the extensions of the base ( Buccal shelf and retro molar pads) not fully covered. This guy has a VERY large mouth infact my client had hard time getting his impression right but I think he did quite a good job all considering. So, patient went to see my client complaining about stability in the first place. I have to mention also that his upper needs a good reline! So maybe this is the reason to choose a bar, stop this thing to move. I'm not trying to justify anyone just telling the story as I know it.
I have made several attempts to made him aware of the risk of overloading the implants during posterior contact but his idea is to have an implant assisted over denture where the anterior is doing most of the work and not relying so much on the posterior ridge since it is flat. I don't think he understud that no matter what a lever will always take place unless we eliminate any contact with the bar which will make the all exercise useless, you end up having a 3locator over denture. But he wants to rely more on the bar than the tissue so after 3 phone calls and 1 email I'm doing this think and forget about it. I hope he is right. As I said before time will tell. He knows I think 3 proper sized abutments and proper setup and base extension would probably make a lot of difference but I can only suggest or give opinions which I did.
PS I have suggested to reline and remount the upper posteriorly to improve thinks a little.

Dr worrying a bad idea like a dog its bone.
Been to that rodeo.
My condolences...

 

[araucaria]

why not change abutments to balls and use O-rings. Tissue supported, Implant retained & resilient. Or scoop out recesses in the denture and use soft liner silicone for retention.
??

 

[kcdt]

why not change abutments to balls and use O-rings. Tissue supported, Implant retained & resilient. Or scoop out recesses in the denture and use soft liner silicone for retention.
??

Those are all excellent ideas. I think Turbyfill liked to make cast mushroom shaped abutments with silicone filled recesses. Man swore by them.

 

[Jaemin Lee]

OMG..

I swear that this case would go to hell.
I've seen several cases like this, in my clinic, because my clinic is specialized for the old patients.

First of all, your client shouldn't accept changing only one side of the dentures.
As you've mentioned, the upper arch looks very narrow as it goes to posterior area.
If you follow the upper dentition to make lower denture, then the distance between the left and right posterior denture bases will be so short that it won't accept the space for the patient's tongue to be set comfortable.
And getting impression precisely with the upper denture is also a very hard thing to do, cause it would be unstable even if you reline the denture very nicely.

For me, using a bar with locators also doesn't look to be a good idea, because it will reduce the space for the tongue a lot.
As for the patients who's been using lower complete denture long time, the tongue tends to be larger than normal , as they try to hold their moving denture with their tongue for a long time.
In my opinion, it would be better for this denture to be attached only with locators.
This will allow more space for the tongue to be set.

I recommend you to go to your client's clinic with the wax denture, and see the patient's mouth with it on.
Probabley, the tongue and vestibule of the patient would consistantly push up the lower dentures.
With those models you can't check up the tongue and upressed vestibules, which might affect stability of your denture.
And an overdenture is just a denture which get a help from implants, not an implant prosthesis.
Nice overdenture is a denture which can be set comfortable without the help of the implants.

This reminds me of tough experiences but there would be an answer if you and your client keep on trying to find it.
Good luck on you and your client!

 

[JKraver]

why not change abutments to balls and use O-rings. Tissue supported, Implant retained & resilient. Or scoop out recesses in the denture and use soft liner silicone for retention.
??

How would ball attachments work on triangle. wouldn't the middle one be under a lot of stress?

 

[aqdental]

OMG..

I swear that this case would go to hell.
I've seen several cases like this, in my clinic, because my clinic is specialized for the old patients.

First of all, your client shouldn't accept changing only one side of the dentures.
As you've mentioned, the upper arch looks very narrow as it goes to posterior area.
If you follow the upper dentition to make lower denture, then the distance between the left and right posterior denture bases will be so short that it won't accept the space for the patient's tongue to be set comfortable.
And getting impression precisely with the upper denture is also a very hard thing to do, cause it would be unstable even if you reline the denture very nicely.

For me, using a bar with locators also doesn't look to be a good idea, because it will reduce the space for the tongue a lot.
As for the patients who's been using lower complete denture long time, the tongue tends to be larger than normal , as they try to hold their moving denture with their tongue for a long time.
In my opinion, it would be better for this denture to be attached only with locators.
This will allow more space for the tongue to be set.

I recommend you to go to your client's clinic with the wax denture, and see the patient's mouth with it on.
Probabley, the tongue and vestibule of the patient would consistantly push up the lower dentures.
With those models you can't check up the tongue and upressed vestibules, which might affect stability of your denture.
And an overdenture is just a denture which get a help from implants, not an implant prosthesis.
Nice overdenture is a denture which can be set comfortable without the help of the implants.

This reminds me of tough experiences but there would be an answer if you and your client keep on trying to find it.
Good luck on you and your client!

Hi J Lee, thank you for your post. I never mentioned of changing just one side of the denture. I have explained that his current denture is set in normo occlusion therefore reducing tongue space. So I,m going to set lowers on ridge and than re-set upper post Photo shows RHS new setup in respect to current upper. Never said I will follow upper denture to setup lower. Also I have already mentioned that decision has been made for a bar with locators. Looks like we all agree is not a good idea but there is nothing I can do. Thank you for your input.

 

[Jaemin Lee]

Hi J Lee, thank you for your post. I never mentioned of changing just one side of the denture. I have explained that his current denture is set in normo occlusion therefore reducing tongue space. So I,m going to set lowers on ridge and than re-set upper post Photo shows RHS new setup in respect to current upper. Never said I will follow upper denture to setup lower. Also I have already mentioned that decision has been made for a bar with locators. Looks like we all agree is not a good idea but there is nothing I can do. Thank you for your input.

Sorry for misunderstood, I should have read more carefully what u wrote.
So you're going to make upper denture on the basis of the new lower denture.
That's a good idea!

And I want to say that it is such a pity that you cannot do anything to change the decision to use bars.
Time will tell what is right.

 

[kcdt]

How would ball attachments work on triangle. wouldn't the middle one be under a lot of stress?

Not necessarily. They're very low profile and resilient. They'd be less stressful than Locators.

 

[JKraver]

There would be fulcrum point though its bad physics.

 

[aqdental]

Sorry for misunderstood, I should have read more carefully what u wrote.
So you're going to make upper denture on the basis of the new lower denture.
That's a good idea!

And I want to say that it is such a pity that you cannot do anything to change the decision to use bars.
Time will tell what is right.

I have expressed my concern from the beginning. An implant assisted overdenture should allow for a rotational movement around the axis that joints the anterior implants. This is why you dont have a dolder in v shape on with distal cantilevers. Its all over the implant litteratures. I wasnt sure if locators would be any different without a bar (ie: allow some posterior movement without putting lever forces over the implants). A bar will stop rotation x sure unless you dont engage the bar with your superstructure or denture. In that case what is the point to have a bar? Just to splint implants which make sense only if you dont trust the fixtures to be on their own. Maybe he knows something we dont know? He is just not taking into account the enormous lever arm that we have posteriorly. Basic physics. He is just worried to stop this lower from moving and he wants me to use the bar for this purpose. He did gave me the opportunity to explain my concern but in the end he is convinced that is the best solution for this patient therefore I"m going to complete the case as requested.
Maybe time will prove all us wrong?

 

[Jaemin Lee]

I have expressed my concern from the beginning. An implant assisted overdenture should allow for a rotational movement around the axis that joints the anterior implants. This is why you dont have a dolder in v shape on with distal cantilevers. Its all over the implant litteratures. I wasnt sure if locators would be any different without a bar (ie: allow some posterior movement without putting lever forces over the implants). A bar will stop rotation x sure unless you dont engage the bar with your superstructure or denture. In that case what is the point to have a bar? Just to splint implants which make sense only if you dont trust the fixtures to be on their own. Maybe he knows something we dont know? He is just not taking into account the enormous lever arm that we have posteriorly. Basic physics. He is just worried to stop this lower from moving and he wants me to use the bar for this purpose. He did gave me the opportunity to explain my concern but in the end he is convinced that is the best solution for this patient therefore I"m going to complete the case as requested.
Maybe time will prove all us wrong?

Not a chance.
After I read your thread throughly, I found out that you had suggested posteriorly extended hybrid prosthesis or denture with 3 abutments. That is the best for this patient I think, in case the implants are proper sized and well placed. With this type of overdenture, your client cannot give the patient any reason for doing implants, because the denture will still move even after attached with bars and the metal housing for bars will reduce the space for the tongue significantly.

 

[JKraver]

I have expressed my concern from the beginning. An implant assisted overdenture should allow for a rotational movement around the axis that joints the anterior implants. This is why you dont have a dolder in v shape on with distal cantilevers. Its all over the implant litteratures. I wasnt sure if locators would be any different without a bar (ie: allow some posterior movement without putting lever forces over the implants). A bar will stop rotation x sure unless you dont engage the bar with your superstructure or denture. In that case what is the point to have a bar? Just to splint implants which make sense only if you dont trust the fixtures to be on their own. Maybe he knows something we dont know? He is just not taking into account the enormous lever arm that we have posteriorly. Basic physics. He is just worried to stop this lower from moving and he wants me to use the bar for this purpose. He did gave me the opportunity to explain my concern but in the end he is convinced that is the best solution for this patient therefore I"m going to complete the case as requested.
Maybe time will prove all us wrong?

Implants will fail he is doing his patient a disservice.

 

[araucaria]

How would ball attachments work on triangle. wouldn't the middle one be under a lot of stress?

I'm guessing you're thinking of ball & socket type attachments?
With some O-ring systems the denture will be allowed to move vertically up or down with these (limited small movement) but is tissue supported and implant retained/assisted. A flat ridge presents a certain amount of risk due to lateral forces. These offer lowest stress on the implants in the situation described imo. There may be other options I'm unaware of at this time, but it seems there's not much choice here for a solution with a reasonable level of longevity.

see this link;
http://www.preat.com/oringabutment.html

 

[dmonwaxa]

" disturbed " reborn?

 

[JKraver]

There may be other options I'm unaware of at this time, but it seems there's not much choice here for a solution with a reasonable level of longevity.

Adamantium exoskeleton is obviously the best option.

 

[araucaria]

Adamantium exoskeleton is obviously the best option.

lol Wolverine teeth!

 

[denturist-student]

If you could convince the dentist to place two more implants it might help....But otherwise cap the center implant and just dispense with the bar and place two locator females in the existying denture.