Ian Braby says: Yes — retentive anchors are not the only choice for overdenture retention with the Straumann System. Yes, parallelism counts. I have used the Straumann Dalla bona style round ball abutment with success over the years and used their blue plastic handled lamellae tightener as needed for the matrices to be tightened in the overdenture on recall. Lab processing can be done with analogs.
|Published (Last):||16 July 2010|
|PDF File Size:||12.78 Mb|
|ePub File Size:||17.11 Mb|
|Price:||Free* [*Free Regsitration Required]|
Such implant-supported prostheses represent a compromise solution between the advantages of fixed prostheses and traditional complete removable dentures in totally edentulous patients. In scientific literature good adaptability was reported in edentulous patients provided with maxillary complete removable dentures, whereas phonetic and functional problems due to prosthesis instability were lamented by patients wearing mandibular complete removable dentures.
As to implant-supported OVDs, several advantages were pointed out just like improvement of chewing ability in comparison with traditional complete removable dentures, esthetic and phonetic improvements, lower susceptibility of the success of the rehabilitation to the optimal insertion of implants than fixed prostheses. Notwithstanding the mandibular residual ridge resorption, a sufficient amount of bone tissue often remains in the interforaminal region to properly insert at least 2 implants.
The presence of 2 or 4 osseointegrated implants in such area seems not to affect the long term success of OVDs: as to retention, stability, stress distribution and peri-implant health, comparable results were noticed with both 2 or 4 interforaminal implants. As to the supporting implant system, several studies obtained comparable results with both submerged and non-submerged implants.
Nowadays several retention systems for OVDs are available: bar clips, solitary ball attachments, magnets, telescopic crowns.
The anchorage design must be chosen after a careful evaluation of the morphology and anatomy of the edentulous arch, the position of the implants, the needs of retention, the occlusion with the antagonist arch, the hygienic habits, the economic needs and the compliance for recall of the patient. The use of solitary attachments is advisable when a satisfactory parallelism between the implants is obtained.
Solitary attachments can follow the functional distortions of the mandible because of the absence of a rigid connection; as a consequence, most of the stress concentrate at level of the symphysis avoiding implant overload. Although bars are more retentive, ball attachments are less technique sensitive, easier to clean and less costly. Controversy persists as to whether the bar clips or the ball attachments requires more maintenance. Moreover, the use bar retention systems is affected by jaw anatomy and might result in functional limitations of the tongue.
The rigid connection provided by bar clips causes lower bone resorption but higher peri-implant bone stress concentration than solitary attachments do: consequently mechanical complications might occur as bars badly withstand non axial forces. It is provided with self-positioning components with different height.
This results in several advantages for both clinicians and patients, such as rehabilitations in case of limited denture space, easy maintenance and replacement of the retentive components, easy insertion and removing of the prosthesis.
The patient had been previously provided with a mandibular complete removable denture antagonist to a maxillary metal-ceramics full-arch bridge. The patient complained about the stability and retention of the denture asking for mechanical anchorage of the prosthesis. Moreover, she complained about limited function and bad chewing ability that had affected her food habits. Surgical treatment: A crestal incision was performed with a 15c Bard Parker blade and a full-thickness flap was elevated preserving a sufficient amount of keratinized mucosa on the buccal aspect of the alveolar ridge.
Only one midline vertical buccal relieving incision was cut and buccal and lingual spreading sutures were executed to properly visualize the surgical site 3.
Due to thin bone margin in the most coronal part of the alveolar ridge, a horizontal osteotomy was performed by means of a tungsten carbide rounded bur mounted on a low-speed handpiece under constant irrigation of physiological sterile solution to model the alveolar ridge 4.
This aimed at regularizing the alveolar ridge profile and gaining a thicker flat bone plate in the apical region of the symphysis. In order to check the quantity of bone tissue removed, the horizontal osteotomy was first performed on only one side of the interforaminal area and then it was extended to the contralateral region. The mental foramina were carefully visualized by means of a periosteal elevator.
Four Straumann cylindrical implants were used: 2 Regular Neck 3. The use of 4 implants was due to the high retention needs of the patient. The two 3. Then, the two 3. The fixtures were positioned as parallel between them and as perpendicular as possible to the occlusal plane 5,6 , taking care neither to drill the lingual cortical bone nor to damage the sublingual artery.
The fixtures were covered with 1. The patients was subjected to standard antibiotic amoxicillin, 1 gr twice per day for 5 days and non-steroidal anti-inflammatory nimesulid, mg twice per day for 3 days therapies. The maintenance of oral hygiene was improved with 0. Prosthetic treatment: During the healing period, the patient wore her pre-existing mandibular complete removable denture suitably discharged and relined with a soft silicone, avoiding hard compression at level of the surgical sites.
Consequently, osseointegration of the implants and proper healing of soft tissues were allowed. The impression copings were positioned onto the abutments 11 and the final impression was taken using an acrylic resin custom tray and polyether materials. Laboratory procedures: The laboratory abutments were positioned into the impression copings and the master cast was poured with type IV gypsum 12, The traditional laboratory procedures required to build up a complete removable denture were followed to create the OVD.
Occlusal schemes and functional movements were simulated in an articulator: no anterior contacts in the centric relation position and minimal anterior contacts in excursions were created. Then, the housing processing males black were removed by means of the relative tool 14,15 and replaced with the extra light retention males blue 16, In order to achieve optimal esthetics, both the artificial teeth and the denture were anatomically characterized Finally, the OVD was finished and polished.
Two weeks after taking the final impression, the case was completed carefully checking the occlusion intraorally The patient was recalled every week in the first month after the rehabilitation and then once a month to control the occlusion and to reline the OVD with soft silicone if necessary. Oral hygiene maintenance was easy and the satisfaction of the patient was optimal. A 5-year prospective randomized clinical trial on the influence of splinted and unsplinted oral implants retaining a mandibular overdenture: prosthetic aspects and patient satisfaction.
J Oral Rehabil. Clinical aspects of a multicenter clinical trial of implant-retained mandibular overdentures in patients with severely resorbed mandibles. J Prosthet Dent. Clinical evaluation of overdenture restorations supported by osseointegrated titanium implants: a retrospective study.
Int J Oral Maxillofac Implants. Location of implants in the interforaminal region of the mandible and the consequences for the design of the superstructure. Treatment concept for mandibular overdentures supported by endosseous implants: a literature review. A long-term follow-up study of non-submerged ITI implants in the treatment of totally edentulous jaws.
Part I: Ten-year life table analysis of a prospective multicenter study with implants. Clin Oral Implants Res. Implant-supported overdentures: a longitudinal prospective study. Management of the edentulous patient. Peri-implant mucosal aspects of ITI implants supporting overdentures.
A five-year longitudinal study. A 5-year prospective multicenter follow-up report on overdentures supported by osseointegrated implants. Influence of patient age on the success rate of dental implants supporting an overdenture in an edentulous mandible: a 3-year prospective study. Long-term survival and success of oral implants in the treatment of full and partial arches: a 7-year prospective study with the ITI dental implant system.
Overdenture attachment selection and the loading of implant and denture-bearing area. Part 2: A methodical study using five types of attachment. Mandibular implant-retained overdentures: a literature review. Mandibular implant-retained overdenture: a clinical trial of two anchorage systems. The closure screws were secured onto he fixtures and the soft tissues were sutured with e-PTFE coated polyfilament sutures.
Compatibili Straumann® BoneLevel®
Such implant-supported prostheses represent a compromise solution between the advantages of fixed prostheses and traditional complete removable dentures in totally edentulous patients. In scientific literature good adaptability was reported in edentulous patients provided with maxillary complete removable dentures, whereas phonetic and functional problems due to prosthesis instability were lamented by patients wearing mandibular complete removable dentures. As to implant-supported OVDs, several advantages were pointed out just like improvement of chewing ability in comparison with traditional complete removable dentures, esthetic and phonetic improvements, lower susceptibility of the success of the rehabilitation to the optimal insertion of implants than fixed prostheses. Notwithstanding the mandibular residual ridge resorption, a sufficient amount of bone tissue often remains in the interforaminal region to properly insert at least 2 implants. The presence of 2 or 4 osseointegrated implants in such area seems not to affect the long term success of OVDs: as to retention, stability, stress distribution and peri-implant health, comparable results were noticed with both 2 or 4 interforaminal implants.
Compatibili Straumann® BoneLevel®
The transmucosal height of the abutment may vary from 1 to 4 mm, 1 to 5 mm, 1 to 6 mm, according to the system of implants used. If the height is chosen precisely, the biomechanical conditions are favorable, thanks to a point of force application close to the platform of the implant. So, it is very important to measure the maximum height existing between the platform of the implant and the mucosal edge to let emerge only 1. A combination of inside and outside retention ensures the longest lasting performance25 Fig 8. Ref 25 — a non-rigid connection to the implant: the replacement male is in static contact with the abutment, while the titanium cap in the resin of the prosthetic base allows a rotational movement, absorbing then the forces stresses without any resulting loss of retention21, Fig 7: Lowest profile 3.
LOCATOR STRAUMANN PDF
PSD Locator Compatibile