Secrets_of_Dentures_files/Successful Dentures Part 2

Transcription

Topics
 Conventional Denture Treatment:
Secrets to Successful Dentures
Trends in removable prosthodontics.
Anatomy
 Maxillo-Mandibular Relationship
 Vertical Dimension
 Tooth Selection, Arrangement, and Occlusion


Part II
 Implant Supported Overdentures:
Dalhousie Continuing Education
Dr. Mark Vallee BSc MS DDS DP FRCDC
Overdenture abutments
Implant Placement
 Locator Abutments


 Converting a denture into an overdenture.
 Direct Pickup
Trends in Removable
Prosthodontics
 Patient Demographics
Conventional Denture Treatment
 Esthetic Awareness
 Implant treatment
Patient Demographics
 Average lifespan of patients:
14
Percent
13
60
Percent Edentulous
18+ yrs old
50
Percent Edentulous
65+ yrs old
12
40
11
10
1960
1970
Trends in tooth loss
1980
1990
30
1960
1970
1980
1990
Esthetic Awareness
 Will there be a need for complete dentures in
2020?
 Complete dentures patients will increase from
33.6 million adults in 1991 to 37.9 million adults in
2020.
 The 10% decline in edentulism experienced each
decade for the past 30 years will be more than
offset by the 71% increase in the adult population
older than 55 years.
Esthetic Awareness
Implant Treatment
 An increase in esthetic awareness has prompted
 Out of 33 million edentulous patients only 2-4% have received
an increase in patient demand for quality
removable prosthodontic restorative treatment.
implant treatment
 Estimated 60% of patients are NOT given implants as a
treatment option
 Implant supported overdentures are now the standard of care for
the edentulous mandible
Anatomy in Relation to Complete
Dentures
Edentulous Maxilla
Anatomy
a
c
k
d
d
j
b
i
l
e
m
g
f
h
a. Labial frenum
b. Buccal frenum
c. Labial vestibule
d. Anterior buccal vestibule
e. Posterior buccal vestibule
•Retrozygomatic space
•Coronoid bulge
f. Hamular notch
•Pterygomaxillary notch
g. Fovea palatini
h. Vibrating line
i. Residual alveolar ridge
j. Palatal rugae
k. Incisive papilla
l. Median palatine raphe
m. Maxillary tuberosity
Dentures
Edentulous Maxilla
a
c
k
d
d
j
b
i
l
e
a. Labial frenum
•Fold of mucous membrane
•Does not contain muscle
•Labial notch in denture is
narrow
b. Buccal frenum
•Overlies levator anguli oris
•May be moved in an A-P
direction by the actions of the
orbicularis oris and buccinator
Dentures
Edentulous Maxilla
a
c
k
d
d
j
b
i
l
e
m
g
m
h
g
f
Dentures
Edentulous Maxilla
a
c
k
d
d
j
b
i
l
e
m
g
h
f
f. Hamular notch
•Pterygomaxillary notch
•Does not contain any
muscles or ligaments to
interfere with the addition
of pressure with a
postdam
g. Fovea palatini
•2 small pits representing
mucous gland openings
•Usually located just
posterior to the vibrating
line
Dentures
Edentulous Maxilla
a
d
b
l
e
m
g
h
Edentulous Maxilla
a
i. Residual alveolar ridge
•Crest is primary stress
bearing area
•Fibrous CT least
displaceable and best
able to carry the stress of
mastication
j. Palatal rugae
•Secondary stress
bearing area
h. Vibrating line
•Imaginary line across palate
•Connects the
pterygomaxillary notches
c
k
d
d
j
b
i
l
e
m
g
h
f
Posterior Palatal Seal
•Area not a line
•Functions: border seal, prevent food
impaction beneath, improve retention,
compensate for shrinkage of denture
resin
•Pressure on displaceable mucosa that
covers palatal glands
•Anterior border – junction between
hard and soft palate; ‘blow’ line
•Posterior border (vibrating line) –
junction between movable and
immovable soft palate; ‘ah’ line
Dentures
Edentulous Maxilla
Denture bearing areas
d
j
i
Dentures
a
c
k
f
h
f
c. Labial vestibule
•Reflection contains no muscle
d. Anterior buccal vestibule
•Overlies buccinator muscle
whose fibers are downward and
forward and limit the height and
thickness of the buccal flange
e. Posterior buccal vestibule
•Thickness determined by the
masseter muscle
•Coronoid process of the
mandible encroaches on the
space during lateral excursions
•Labial and buccal flanges of the
denture must contact movable tissues
in order to make a seal
c
k
d
d
j
b
i
l
e
m
g
f
h
k. Incisive papilla
•Guards the incisive
canal
•Pressure will interfere
with the blood and nerve
supply causing a burning
sensation
•Provide relief
l. Median palatine raphe
Dentures
Edentulous Mandible
i
h
l
j
g
f
k
c
e
b
a
d
a. Labial frenum
b. Buccal frenum
c. Lingual frenum
d. Labial vestibule
e. Buccal vestibule
f. Residual alveolar ridge
g. Buccal shelf
h. Retromolar pad
i. Pterygomandibular raphe
j. Mylohyoid ridge
k. Alveololingual sulcus
l. Retromylohyoid space
Dentures
Edentulous Mandible
Dentures
Edentulous Mandible
i
h
l
j
g
f
k
c
e
b
a
d
a. Labial frenum
•Fold of mucous
membrane
•Does not contain muscle
b. Buccal frenum
•Overlies depressor
anguli oris (VII)
•Movable by the
buccinator and orbicularis
oris (VII) resulting in a
wide notch in the denture
c. Lingual frenum
•Overlies genioglossus
muscle (XII)
Dentures
Edentulous Mandible
Denture bearing areas
i
h
l
j
g
f
k
c
e
b
a
d. Labial vestibule
e. Buccal vestibule
•Entire periphery of denture
must end in soft tissues
•Stability of denture must
come from the maximum use
of all bony foundations where
tissues are firmly and closely
attached to bone
i
h
l
j
f
c
e
b
a
j
g
f
k
d
c
h. Retromolar pad
•Contains:
•Retromolar gland
•Pterygomandibular
raphe
•Buccinator muscle
•Temporal tendon
•Underlying basal bone is
resistant to resorption
•Coverage will provide some
border seal
i. Pterygomandibular raphe
•Extends from the pterygoid
hamulus superiorly to the
alveolar ridge inferiorly under
the retromolar gland
e
b
a
Edentulous Mandible
k
l
d
Dentures
g
i
h
d
f. Residual alveolar ridge
g. Buccal shelf
•Bounded laterally by the
external oblique ridge and
medially by the crest of the
ridge
•Attachment of buccinator
muscle (VII)
•Buccal flange rests upon
buccinator and should extend
as far as the tissues permit
•Masseter muscle (V3) may
crowd buccinator forward
against the denture causing an
indentation at the DB angle
Dentures
Edentulous Mandible
i
h
l
j
g
f
k
c
e
b
a
d
j. Mylohyoid ridge
•Attachment of mylohyoid
muscle (V3) which forms the
muscular floor of the mouth
•Fibers are almost horizontal in
front of the hyoid where they join
those of the opposite side to
form a raphe
•At the level of the hyoid they
pass almost vertically downward
to insert into the hyoid
k. Alveololingual sulcus
•Slopes toward the tongue to
permit action of the mylohyoid
•Length of flange distally
compared to anteriorly is greater
owing to the changed length and
direction of the mylohyoid fibers
Dentures
Panoramic Radiograph
Edentulous Mandible
i
h
l
l. Retromylohyoid space
•DL extension determined
by styloglossus (XII)
•Posterolateral extension
determined by superior
pharyngeal constrictor (X)
and palatoglossus (X)
•Overextension may
cause pain on swallowing
j
g
f
k
c
e
b
a
Coronoid Process of mandible
Mandibular Condyle
Glenoid Fossa
EAM
d
Maxillary Tuberosity
Articular Eminence
Nasal Septum
Anterior Nasal Spine
Hard Palate
Pterygomaxillary Fissure
Orbit
Zygomatic Arch
Maxillo-Mandibular Relationship
Pharynx
Earlobe
Mandibular Foramen
Mental Foramen
Lip Lines
Symphysis
Mandibular Canal
Maxillary Relations




External Oblique Ridge
Cervical Vertebrae
Shadow of tongue
Styloid Process
Incisal Display
Dental Midline
Occlusal Plane Orientation
Facebow
Hyoid Bone
Facial Artery Notch
Maxillary Relations
Natural Dentition
Incisal Display at Rest
 Incisal edge of central
incisor in relation to
the lip line at rest
Young woman – 3 mm
below lip line at rest
 Young man – 2 mm
 Middle age – 1.5 mm
 Elderly (>80) – 0 mm
below to 2 mm above
lip line at rest

Rest After Wax Adjustment
Maximum Smile After Wax
Adjustment
Maxillary Relations
Maxillary Relations
Dental Midline
Dental Midline
Rest After
Smile After
Maxillary Relations
Dental Midline
Maxillary Relations
 Frontal Plane
 Parallel to
interpupillary line
 Fox Plane
Maxillary Relations
Maxillary Relations
 Sagittal Plane
 Parallel to Camper’s Line
 Inferior border of the ala of
the nose to the superior
border of the tragus of the
ear
 Frankfort horizontal plane
 Orientation to the external
auditory meatus and
orbitale
 Cephalometric landmark
FHP
CL
OP
Mandibular Relations
 Vertical Dimension
 Centric Relation
Vertical Dimension
 Anatomic Landmarks
 2/3 up the height of the retromolar pad
Vertical Dimension
 Esthetics
Vertical Dimension
 Adjust occlusal plane
 Parallel to maxillary rim
 Clinical assessment of vertical
dimension
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Anatomic landmarks
Physiologic rest position
Pre-extraction records
Existing prosthesis
Esthetics
Phonetics
Swallowing
Average occlusal rim
dimensions
Vertical Dimension

Anatomic Landmarks
 Level with the lower lip
at rest
Vertical Dimension
 Phonetics
‘S’
‘F’
‘Ch’
‘M’
Vertical Dimension
Vertical Dimension
 Swallowing
 Average Occlusal Rim Dimensions
Maxillary – 22 mm
During swallowing
Mandibular – 18 mm
After swallowing
Anterior Tooth Selection
Tooth Selection
 Anterior teeth are
primarily selected to
satisfy esthetic
requirements
 Posterior teeth are
primarily selected to
satisfy masticatory
requirements/
occlusion
Guides
 Shape
 Pre-extraction records

Photos, diagnostic
casts, old radiographs
 Existing dentures
 Patient’s facial
characteristics
 Patient’s gender,
personality, age
 Arch size and shape
 Patient’s preferences

Square, tapering,
ovoid
 Size

Length, width,
circumference
 Shade
Shape
Dentogenics concept


 Rounded contours which
taper towards the cervical
ridge
 Moderate gingivo-incisal
curvature
Square
moderate
 Offers maximum light deflection and creates a bold effect
50
Size
Size
Wax rim & ruler
 Width of 6 anteriors
•Commissure of lips represents distal surface of canine
on a curve
 Average 46-56 mm
Major rugae of palate points to canine position
Tapering
 Central incisor is dominant and gingivo-incisal curvature is
 Age
 Young – tapered, ovoid, rounded
teeth
 Middle – somewhere between
young/old
 Old – square, sharp corners

curvature which tends to
disperse light and create a
softened appearance
 Personality
 Vigorous or delicate – maxillary
lateral varies more in size, form,
and position
Ovoid
 Pronounced gingivo-incisal
 Gender
 Male – rugged with square teeth
and bold central incisors
 Female – pronounced
curvatures, rounded point angles
Shape
Size
Exaggerated Smile
Size
Length
 High smile – 11%
 Reveals total length of
maxillary anterior teeth and a
continuous band of gingiva
 Average smile – 69%

Reveals 75-100% of
maxillary anterior teeth and
interproximal gingiva only
 Low smile – 20%

Displays less than 75% of
maxillary anterior teeth
Size & Shape
Size & Shape
 Determine the facial
Commercial Products
outline
 Compare form of face
to vertical lines
Width
 Square tapering
 Determine the size of
the maxillary central
 Indicator is
proportioned in a ratio
of 16:1
 Width – 9.25 mm
 Length – 11 mm
Length
56
Take a picture
Size & Shape
Insert it into a program
Shade
 Portrait shade guide
57
Aim to harmonize
between color of the
skin, hair, & eyes
 Guides

 Complexion
 Hair color
 Eye color
 Age
 Personality & activity
 Patient desires
 Need to educate patients
Shade
Anterior Tooth Arrangement

Position has been tentatively established during the
clinical refinement of the maxillary occlusal rim
 Adequate lip support
 Proper phonetics
Maxillary Anterior Tooth
Arrangement
 Central
General Arrangement
Considerations
 Labial surfaces flush with wax rim
contour
 Long axis slightly distal to
 Anterior teeth are set primarily





perpendicular
for esthetics not function
Considering creating
asymmetry after discussion
with patient
Each tooth should appear as
an individual tooth
Gingival 1/3 of maxillary
incisors provide lip support
Incisal 1/3 of maxillary incisors
provides esthetics
Maxillary anterior teeth are set
on the smile line
 Incisal edge is at occlusal plane
 Lateral
 Long axis at an angle more distal
than central
 Incisal edge is slightly above
occlusal plane
 Canine
 Long axis at a more distal angle
than lateral
 Cervical is prominent, incisal
edge looks tucked-in
 Incisal edge is at occlusal plane
61
Arrangement
62
Arrangement
• Labial surface of the centrals usually 5-7mm anterior to incisal papilla
Arrangement
Arrangement
Esthetics of natural
teeth
Golden Proportion
Avoid lampshade
convergence of roots!
Ratio of 1.618:1
Proportion between a
larger part and a smaller
part
 Width of the central
incisor is in the golden
proportion to the width of
the lateral incisor


65
66
Mandibular Anterior Tooth
Arrangement
Mandibular Anterior Tooth
Arrangement
• Teeth are set over bone
• 2-3 mm Overjet
• 0 mm Overbite
Goals of Complete Denture
Occlusion
Right Working
Tooth Selection
Posterior Tooth Selection
 Minimize trauma to the
supporting structures
 Preserve remaining
structures
 Enhance stability of the
dentures
 Facilitate esthetics and
speech
 Restore mastication
efficiency to a reasonable
level
 Decrease lateral forces to
the residual ridges
Left Working
General Concepts of Denture
Occlusion
Occlusal Spectrum
 Anatomic
Common Features
 Balanced occlusion
 Functional anatomy is the main
determinant of denture tooth
position
 Lingualized
 Non-balanced occlusion
 Simultaneous, bilateral posterior
contact in centric relation
 Centralization of centric occlusal


 Non-anatomic (Monoplane)
 Non-balanced occlusion
 Neutrocentric
Centric Relation
forces over the mandibular
residual ridges
Buccal-lingually
Anterior-posteriorly
Occlusal Spectrum
Lingualized
(lingual contact)
Criteria
 Resorbed or flabby ridges
 Physical condition of the patient
nonanatomic
(balancing
ramp)
semianatomic
 Patients who clench or brux
 Previous denture occlusion
 Ridge relationship
 Immediate dentures
 Opposing arch
anatomic
nonanatomic
Indications
Indications
Anatomic
Non-anatomic
 Good residual ridges
 Poor residual ridges
 Well coordinated patient
 Poor neuromuscular control
 Previously successful with
(Bruxers, CP, etc.)
monoplane dentures or
severely worn occlusion on
previous denture
anatomic dentures
 Class I ridge relationship
 Denture opposes natural
dentition
 When “Lingualized”
occlusion is desired
 Arch discrepancies
 Class II or III or cross-bite

Except when opposing natural
dentition
 Potential poor follow-up
Anatomic
 Good residual ridges
Non-anatomic
 Poor residual ridges
Indications
Indications
Non-anatomic
Anatomic
 Well coordinated patient
 Poor neuromuscular control
(Bruxers, CP, etc.)
Indications
Anatomic
 Class I ridge relationship
Anatomic
anatomic dentures
Non-anatomic
monoplane dentures or
severely worn occlusion on
previous denture
Indications
Non-anatomic
 Arch discrepancies
›
Class II or III or cross-bite
Anatomic Occlusion
Anatomic
 Denture opposes natural
dentition
Non-anatomic
›
Except when opposing natural
dentition
Lingualized Occlusion
Disadvantages
 Definite point of positive
 Difficult to set
 High esthetic demands
 Good esthetics
 Less adaptable to arch
 Severe mandibular ridge
 Freedom of non-anatomic
intercuspation may be
developed
 Esthetically similar to natural
dentition
 Tooth-to-tooth and cusp-to-
cusp balanced occlusion can
be achieved
 Maintains some shearing
ability after moderate wear
relation discrepancies
 Horizontal force
development due to cusp
inclinations
 Harmonious balanced
occlusion is lost with denture
base settling
 Requires frequent follow-up
and may require more
frequent relines to maintain
proper occlusion
Indications
Advantages
Advantages
atrophy
 Displaceable supporting
tissues
 Malocclusion
 Previous successful denture
with lingualized occlusion
teeth
 Potential for bilateral balance
 Centralizes vertical forces
 Minimizes tipping forces
 Facilitates bolus penetration
(mortar and pestle effect)
Non-Anatomic Occlusion
Advantages
Disadvantages
 Reduction of horizontal
 No vertical component to aid
forces
 CR can be developed as an
area instead of a point
 Freedom of movement
 Can develop solid occlusion
despite arch alignment
discrepancies
 Easily adapted to situations
prone to denture base
shifting
 Easy to set and adjust teeth
Is ‘Balance’ Necessary?
in shearing during
mastication
 Occlusal adjustment impairs
“Bolus in”
in”
efficiency unless spillways
and cutting edges restored
 Patients may complain of
lack of positive
intercuspation position
“Balance out”
out”
 Somewhat esthetically
limited (don’t look like natural
teeth)
Complete Denture Occlusion
Posterior Landmarks
Landmarks for the Arrangement of Posterior Denture
Teeth
 Investigators have not shown one
type of denture occlusion to be:
Superior in function
Safer to oral structures
 More acceptable to patients


 Neuromuscular control may be
the single most significant factor
in the successful manipulation of
complete dentures under function
 Tongue function and denture
wearing experience
 Crest of the ridge
 Mandibular posterior teeth
are centered over the ridge
 Medial/lateral
 Retromolar pad
 Medial/lateral
 Superior/inferior
 2/3 height retromolar pad
88
Posterior Landmarks
Mandibular Posterior Tooth
Arrangement
Three landmarks used to determine the plane of occlusion:
 Retromolar pad
 2/3 height retromolar pad

Incisal edge of the
mandibular central incisor
90
Arrangement

Arrangement
Horizontal Plane

 Pound’s triangle
Horizontal Plane
 Central groove of denture teeth centered over the crest of the
ridge
 Lingual aspect of mandibular teeth should be positioned within
a triangle created by drawing 2 lines from the mesial aspect
of the canine to each side of the retromolar pad
91
Arrangement

92
Arrangement
Sagittal Plane
 Boucher

 Occlusal plane of mandibular arch should be established at ⅔
Sagittal Plane
 Long axes of the teeth are perpendicular to the occlusal plane
height of the retromolar pad
 Marginal ridges of adjacent teeth should be at the same level
 Teeth are not set on the ascending area of the mandibular ridge
or the retromolar pad

Otherwise the mandibular denture tends to shift forward
93
Arrangement
94
Arrangement


Frontal Plane
Frontal Plane
 Lingual view
 Facial view
 Buccal and lingual cusps should contact the occlusal plane
 Buccal and lingual cusps should contact the occlusal plane
analyzer
analyzer
95
96
Maxillary Posterior Tooth
Arrangement
Maxillary Posterior Tooth
Arrangement
Lingual cusps should be
set over central fossa of
mandibular teeth
 Teeth should be set up
to, but not on top of, the
tuberosity
 Teeth should not extend
beyond the denture base
periphery on the facial

97
98
Conventional Dentures
 Tooth loss increases with age
 the number of edentulous people will continue to increase for
Implant Supported Overdentures
several decades because of the increase in mean age.
 Complete dentures have been the traditional standard of
care for edentulous patients for more than a century.
 Complete denture wearers are usually able to wear an
upper denture without problems, but many struggle with
the complete lower denture because they are loose.
 Conventional dentures have a bite force of 25% and 20%
chewing efficiency of natural teeth.

Dissatisfied
7.7 %
Patients are significantly more satisfied with 2-implant
overdentures than with new conventional dentures
regardless of the type of attachment system used
 bar, ball, magnet, locator.
Moderately
Satisfied
25.6 %
Fully Satisfied
66.7 %
Patient satisfaction also depends upon
expectations and some patients may have very
unrealistic expectations. For this reason it is
important to guide and educate the patient.
Implant overdentures increase the bite force to 60%
of natural teeth.
 Patients find implant overdentures significantly more
stable,
 their ability to chew various foods are significantly
easier,
 they are more comfortable
 and speak more easily.

Overdenture Attachments
 Studies of several populations have shown that ratings of
quality of life are significantly higher for patients who
receive 2-implant mandibular overdentures opposing
complete maxillary conventional dentures than for those
with conventional dentures.
 People who receive mandibular 2-implant overdentures
modify their diets which improves their nutritional state.
 Such improvements may have a strong positive impact on
general health, particularly for senior adults who are
vulnerable to malnutrition.
 2-implant overdenture are becoming the first choice of
treatment for the edentulous mandible.
 Ball attachments
 Ball and rubber o-rings and/or metal housings
 Used to be the attachment of choice
 Wear quickly, not as retentive
 Bar Attachments
 Locator™
 1-3 bars with 1-3 clips
 Lowest vertical height of 3.17mm.
 Retentive at first, get loose or break over time.
 Self aligning
 Hard to adjust and fix
 Durable
 Not as popular anymore
 Up to 40° angle correction
 Retention flexibility






Can also have a bar with locators cast or tapped into the framework.
Usually have 3 - 4 locators incorporated.
Framework can be gold (cast) or titanium (milled).
Framework must be passively attached to the implants.
Returns the bite-force of the edentulous to approximately 80% of natural
teeth.
Implant supported and retained.
Fixed Full-arch Restorations







Returns the bite-force of the edentulous pt close to natural teeth
Must have enough space for restoration, minimum of 10mm.
Framework can be gold (cast), titanium or zirconia (milled).
Prosthesis can be metal-ceramic, or metal-acrylic.
Framework must be passive.
Patient must be able to clean underneath framework
Implant supported and retained.
External-hex and Internal-hex
 External-hex Implants
 More common in the past
 Good for multiple unit restorations
 Rely more on the screw for retention of
single unit restorations.
 Internal-hex Implants
 More common now
 Md Implants usually placed in position of:
 2 implants - 33, 43
 4 implants - 32, 34, 42, 44
 Good for single tooth restorations
 Can use for multiple unit restorations -
cement retained or need specific
abutments.
 Rely more on the connection for
retention of single unit restorations.
 Mx Implants usually placed in position of:
 4 implants - 13, 23, 16, 26
 6 implants - 13, 23, 15, 25, 17, 27
 Tissue supported, implant retained.
Implant Placement
 Parallel to each other
 Perpendicular to the occlusal




plane
Same occlusal height
Equal distance from the
midline
Center of the ridge Bu-‐Li
Too far apart:
 Increased ant-‐post rocking
Surgical Guides
 A necessity.
 Allows the clinician to
have control over the
prosthetic outcome.
 Should be
made/designed by the
DDS not the lab.
 Duplicate the denture or
wax set-up in orthodontic
resin


Drill holes for placement
Slot from foramen to
foramen, end at the
incisal edge
Implant Placement
22 mm
 One implant is more distal
 Primary rotation point or
fulcrum when the patient
occludes posteriorly
 Increase complications
Wear of the attachment
Abutment loosening
 Crestal bone loss
 Implant failure
 Prosthesis fracture

17 mm

Locator Abutments
 Diameter of Locator
retention top – 3.85
mm.
 Available in a variety
of cuff heights and for
most implant types
and sizes.
 1.5 mm of the top
should be
supragingival to be
able to retain the
Height mm 1 2
overdenture.
 Recommended torque
is 20-25 Ncm.
Ø mm
height mm
3
4
5
Locator Selection
Locator Abutment Delivery
 Select the correct Locator Abutment based on the
 Seat the Locator Abutment using the Locator
level of tissue indicated when using the Abutment
Depth Gauge.
 Appropriate abutment height keeps the top 1.5
mm extended above the soft tissue.
Abutment Driver, part of the Core Tool.
 For final tightening, use the Torque Wrench Bit
together with a Torque Wrench, or insert a driver
into the Abutment Driver.
 The recommended seating torque is 20-25 Ncm.
Next steps
Implant Impressions
 Make a new denture start to finish
Open Tray Impression
Coping





Initial impression
Final impression with your choice of implant
impression
Wax Rim adjustment
Wax try-in
Delivery
 Convert an existing denture into an overdenture


Closed Tray Impression
Coping
Locator Pickup
Impression Coping
With a reline impression (indirect approach)
Direct pickup of Locator housings with a chairside
reline.
Fixture Level Impression
Abutment Level impression
 Firmly attach the Locator Abutment Pick-ups to
the Locator Abutments.
 Verify to ensure a perfect fit.
 The copings should have stable friction retention.
Converting a denture into an
overdenture.
overdenture.
 Identify the positions
of the Locator
Abutments in the
denture base.
 Relieve the denture
base to obtain
adequate space for
the impression
material and the
Locator Abutment
Pick-up.
 Make an impression
overdenture.
overdenture.
 Firmly place the
 Fabricate a working
Locator Abutment
Replica in the
impression copings,
which, if indicated, are
then repositioned in
the impression
using an elastic
impression material
 Make a reline if
needed.
model with the Locator
Abutment Replica and
high-quality stone
material.
 Complete the relining
and convert the
existing denture into a
Locator attachment
retained overdenture
overdenture.
overdenture.
 Five types of Locator
Replace the processing insert with the required
retentive insert.
 Remove the Locator Insert by using the Insert
Removal Tool portion of the Locator Core Tool.
 Press a new Locator Insert over the Insert Seating
Tool, and press the Locator Insert into the housing

Inserts are available to
obtain the required
retention for the
prosthesis.
 The inserts come with
different retentive
holding force levels:
Clear 5 Pounds
Pink 3 Pounds
 Blue 1.5 Pounds
 Green 3-4 Pounds*
 Red 1.5 Pounds*
(*for angled implants)


Direct Pickup
Direct Pickup
 Choose, insert, and tighten correct Locator

abutments
 Place processing ring and locator housing
with black processing insert on the abutments.
Identify position and relieve denture base, create vent
for excess acrylic.
 Apply acrylic and seat denture, allow for adequate
curing.
 Trim and polish, remove processing ring, and replace
insert with appropriate retentive insert.
Locator Core Tool
Locator Core Tool Use
Gap
Loosen the Insert Removal Tool
a full 3 turns counter clockwise.
You will see a visible gap.
Insert Removal Tool
Insert Seating Tool
To remove an insert from the titanium metal housing;
simply insert the tip into the insert assembly and push
straight in to the bottom of the nylon insert.
Then tilt the tool so that the sharp edge of the tip will
grab hold of the insert and pull it out of the cap.
Abutment Driver
To discard the insert from the new tip on the Locator™ Core Tool;
point the tool down and away from you and tighten the
Insert Removal Tool clockwise back onto the Locator Core Tool.
This will activate the removal pin and dislodge the insert from
the tip end of the Insert Removal Tool.
1. Loosen Insert Removal Tool
Gap
Separate the Insert Removal Tool section from
the Locator Core Tool and use the Insert Seating Tool
end of the remaining two sections to place a
new insert into the empty titanium metal housing.
2. Remove the Insert
3. Discard the Insert
4. Remove the Insert Removal
Tool
5. Place a New Insert
Questions?
Insert Seating Tool end

Secrets_of_Dentures_files/Successful Dentures Part 2

Transcription

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