The fabrication of LOCATOR-retained overdentures anchored on 4 implants
Our female patient, 60, reported to our clinic with the following complaints and requests:
Her lower teeth were unattractive, loose and painful on bite.
She wanted to replace her missing teeth with the aim of being able to chew again.
She did not discard the idea of having implants installed.
She only wanted to deal with her lower teeth and was seeking a permanent solution.
Image no. 1: The first panoramic radiograph of the lower teeth affected by periodontal disease
The clinical examination revealed that her teeth were severely affected by periodontal disease (chronic periodontitis) and were beyond repair. Had her periodontitis been treated earlier and had she undergone both subgingival and supragingival tartar removal (scaling both beneath and above the gums) at least twice a year, her teeth could have been preserved for much longer. At the first treatment all her lower teeth were removed, so the lower arch was ready to be reorganised. An immediate lower denture was made to ensure teeth for the 3-month healing time, so she could feel at ease to smile without her self-confidence and quality of life being compromised. The treatment would continue after 3-4 months’ healing, with the bone and gums having healed at the sites of the tooth extractions.
Second treatment phase: implant surgery, provisional denture reline (3 workdays)
Following 3 months’ healing time, the treatment was resumed with the installation of implants. For the thorough planning of the site and size of the implants a CBCT (Cone beam computed tomography scan was made in which to examine the remaining bone mass in 3 dimensions prior to the intervention.
Image no. 2 By means of a CT scan the bone mass can be examined in 3 dimensions and the exact site and size of the implant can be planned
Taking into consideration our patient’s requests and financial means, we decided on mounting 4 implants into the mandible which would support a LOCATOR-retained overdenture. Overdentures anchored on implants (LOCATOR-attached bars) have the great advantage of being stable, reasonably priced, and the fact that they do not necessitate a bone graft).
Image no. 3: Follow-up panoramic radiograph with the implants and healing abutments (gingiva formers) installed in the mandible
Image no. 4: Intraoral view of the healing abutments
Third treatment phase: the fabrication of permanent tooth restorations (5 workdays)
Following 3 months’ healing it was time for the last treatment phase, that is, the fabrication of the permanent denture for the lower implants. The healing abutments see that precision impression taking can be performed easily and almost painlessly. Following removal of the gingiva formers a so called impression coping is screwed into the implants which accurately records the location and axial position of the dental implants for the dental technician. A follow-up panoramic radiograph is prepared to verify the seamless fit of the impression copings in the implants.
Image no. 3: Follow-up panoramic radiograph of the closed tray impression copings inserted into the lower implants
Image no. 4: Intraoral view of the closed tray impression copings
With overdentures several trial fittings are necessary to verify the seamless fit and immaculate aesthetics of the denture.
At the trial fitting of the teeth the emphasis lies on aesthetics and the correct contact of the teeth. At this trial fitting custom requests as to the position and the shape of the teeth can be taken into consideration.
Image no. 5: LOCATOR caps on the master cast
Image no. 6: The positions of the LOCATOR caps in the denture. The LOCATOR rubber inserts need to be replaced every few years to restore the stability of the overdenture
Image no. 7: LOCATOR-retained overdenture on the master cast
At handover the LOCATORS are screwed onto the implants with the appropriate torque which will seamlessly support the new overdenture.
Image no. 8: Intraoral view of the LOCATORS
Image no. 9: Follow-up panoramic radiograph of the lower LOCATOR abutments following handover, allowing for easy verification of the accurate fit of the LOCATORS
A few weeks on, eating, speaking and smiling will also be perfect, the patient will have restored their self confidence and will feel at ease to socialise again without feeling embarrassed. The hardest period is the first eight days following handover. Patiens are advised to read aloud, talk and eat so that the function of the muscles, tongue and temporomandibular joint is restored to normal without delay. Patients are to reckon with a 2-month accustomisation period after which everything will feel normal.
Image no. 10: The finished LOCATOR-retained overdenture
Image no. 11: The new smile
Our patient was extremely satisfied with her new teeth and left the clinic with a broad smile. She reports for regular check-ups and oral hygiene treatments.
Divinyi T: Orális implantológia. Semmelweis Kiadó, Budapest, 2007.
Fábián T: A fogpótlástan alapjai. Semmelweis Kiadó, Budapest, 2001.