How to Deal with Removable Prosthetics options with Patient’s Clarance on Both Sides:
For conversational purposes lets jump ahead to where your patient has agreed that a full clearance of one or both arches is required. You both have decided that a removable prosthetic option is the best fit and they would like implants for stability and bone preservation. The patient has no budget limitations and you are going to finish the case yourself after surgical phase is complete.
What determines whether we use bar or locators to attach the denture(s).
Is it solely based on how many implants we have to work with ? And what can we get away with from an engineering perspective?
Custom milled bar above has Equator locators that are a bit smaller and work well in a combination design such as this one.
–A bar has more stability and increased retention.
– We can custom engineer a design for the case, especially with a tricky situation such as when the implants are not parallel.
– You can possibly open the bite and really improve facial symmetry.
– Locator and Novaloc attachments can be attached to the bar improving longevity of components especially given that the carbon coating on Novaloc has a lifetime warranty.
The bar above and denture below have an additional securing feature of a pin or button that pops in and out. Beautiful custom design and team work !
Some important considerations :
– Adequate vertical space is essential.
– We have to keep in mind the patients bite load and jaw bone flex.
– What is the minimum/maximum number of implants required to achieve this WITHOUT shortcuts.
– If an implant fails how will affect the support of the bar and denture?
– Does the patient have the dexterity and motivation to floss and clean a bar ?
The above pre operative, maxillary bar and over denture pictures thanks to Dr Sunny Panesar, Dr Aleksandar Janic DMD/ AAID Diplomate, and John Zahel, RDT, Spectrum Dental Laboratory.
Now lets consider locators alone. A lot less complex yes. However there are considerations here as well.
Novalock Locators from Medentika
– Less expensive than a bar.
– Individually loaded.
– You can get away with less vertical space and fewer implants.
– More straightforward appointments/chair time.
– Usually can have fewer implants.
– Locators can be replaced when worn.
– Must have adequate A-P spread to prevent the prosthesis from rocking.
– Angulation of implants can affect retention and draw, but there are angulated abutments than can help correct this issue.
– Easier to re-engineer if an implant is lost.
– Easy home care for the patient, especially if dexterity is an issue. However…I have seen these covered in calculus….
Both are excellent options. Each case and patient are unique as well.
I think maintenance is a really significant consideration in decision making. That means oral hygiene at home and regular visits to see the Hygienist are paramount to longevity.
Also keep in mind, It never hurts to consult and meet with your lab technician when planning big cases. Young guys like John are a wealth of knowledge !
Thanks for taking the time to peruse. Do share with your colleagues.
And props to Jeff for your technical input. Also a wealth of knowledge regarding implant components.
See link below for more info and to contact him.
Roberta Bertram CDA / Spectrum Lab Representative
For informating on Locators in Novaloc click below: