Dentaltown March 2022 - 27

DocPelk
What do you fi nd is the minimum vertical height from the tissue needed for these? My
concern is that I never have enough, especially in the posterior. ■
10-12 mm is ideal but it can work with less. If you don't have space, then more bone reduction
is needed at surgery or the vertical can typically be opened. Using a low-profi le attachment
like OD Secure also helps-they are signifi cantly smaller than Locator housings. ■
1/21/2022
Mk9
That's part of the challenge and really needing the right patient/anatomy. The anterior maxilla
is often at an angle that is different from the posterior and makes it diffi cult to keep them
parallel to each other. Or would require grafting to ant max undercut, etc. When done correctly
and restored correctly they can be great, but as you said, they have a tight margin of error before
it can become a nightmare.
I can't see the angulation of the maxilla on the scans you presented to point out what I'm
talking about, so I hope I'm making myself clear. By no means am I saying that what you did
isn't good; I think it's really great. I am just pointing out why these aren't always slam-dunk cases
and can have pitfalls. The amount of posterior bone height you have in this case is great as well.
Quite the luxury.
What are the shortest implants you're comfortable using in the maxilla for overdentures?
7 mm? 10 mm? (I rarely would go longer unless it's an immediate implant.) If you have the
prosthetic room, would you prefer a bar, or are you happier with Locators? Nice case. And as
always, thanks for taking the time to post. Always learn a lot. ■
1/21/2022
sekersha
This is great, MHD. I am starting my fi rst few overdenture cases in the near future and
your cases are much appreciated to supplement my training. My offi ce sees more cases that will
involve extractions and immediate denture placement versus existing dentures transitioning to
implant overdentures.
How are you handling these immediate denture cases? Are you placing immediate implants
at the time of extractions if possible? You mentioned you always want a metal mesh. Are you
then always making an immediate denture and then making a new denture later? Thanks again
for the case presentation. ■
1/21/2022
mhd2013
Great observations. The angulation of the maxilla is often problematic and the posterior
bone in this case is a luxury for sure. If the implants can't be placed in reasonable angulations,
then that indicates the need for bone reduction and a bar to correct off-angled implants.
I am absolutely comfortable with 7 mm implants for Locators! I am doing an Ao4 case next
week where one of the implants is a 5.8 x 7.5. I am absolutely comfortable with Locators if I can
get four implants in ideal bone and excellent positions. If not, then a bar is a great option to
correct for nonideal situations.
Yes, extraction and immediate placement are very common. In those cases, the teeth themselves
are used as " guides " for implant placement. A duplicate of the immediate denture can
also be used as the guide. Yes, typically an immediate is made fi rst and soft relined, then a fi nal
denture is made three months later with a metal framework. ■
1/21/2022
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1/21/2022
mhd2013
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