Implant overdenture attachments

When to use which implant overdenture attachments?

ERA=vertical resilient better for implants
Locator=rotational better for teeth

Where implant is at help decide ERA vs locator

  • Molar want rotation so Locator
  • Canine can go either way
  • PM worst area want ERA, like a teeter tooter
  • Anterior can be either (square jaw=locator or v shaped=ERA think of as similar to PM in terms of rocking forward and back)

A clinician is likely to use the standard Locator attachments when treating parallel implants.  According to Nadir that is wrong and we should use ERA.

O-Ring ball, ERA, Locator, Rhein 83, GPS are the most common US used brands.
Bredent off of canine crown Bredent VKS attachments DT thread Precision attachments, intra/extracoronal attachments with max RPD treatment plan

For the clinician who desires the greatest degree of rotational freedom, the ORS with the least retentive component is the attachment of choice. 1

O-rings from OCO Bio Howard C. loves and uses a lot

ERA max partial 2 implants

Retention Hader clip and ERAs>ERA w or without bar>Hader clip. so Hader by self no good and bar no different if just ERA Williams 2001 JPD

Ball v. locator pt like same locator more maintenance ball more vertical room

Different implant overdenture attachments by type

Bar and clip system

Some have a spacer that allows for some vertical resiliency. There are several types of bars the clips can attach to. A milled bar is more for the implant supported overdenture. A resilient bar, like the Hadar bar, has a single axis of rotation. There are also various Dolder bars that allow varying degrees of movement.

Studs

Locators, ERAs, and balls are all examples of studs and these are probably the most popular attachment types in the US.

Telescopic copings of both right and nonrigid versions.

Several companies have their own lines of these and the term “telescopic” varies on who one speaks with.

Repairs and fixes of implant overdenture attachments

If need remove locator housing.  Heat up a allen wrench of mirror handle (red hot) and insert into empty housings. It may take two attempts and light cured material doesn’t soften like like acrylic but breaks down and crumbles and takes a few extra attempts. But when they are ready you can walk the housings out with no damage to the housings.

Overly divergent implants can use kerator DT post.

Someone on there recommended screw retained abutment with locator on top BUT this might happen if cast top of locator only

locator angled

Locator on coping by holden

Broken (probably because lab sectioned original thread and cast just the top to coping)

Locators on bar by Uwe Mohr

Making sure parallel

Kit repair of ball

 

 

Overdenture attachments on a natural tooth

Custom coping in RCT tooth root

  1. Prepare canal with Zest pilot drill
  2. Use spot face diamond drill and ensure below surface 360 degrees
  3. Check fit of cast to female in access
  4. Attach cast to female to plastic parallel post and place at desired angle.
  5. Lubricate internal post space of canal with vaseline
  6. GC Pattern resin into the coronal space of root and seat cast to female with post at desired angle
  7. Remove several times prior setting to ensure draw
  8. Add additional resin as needed

At this point 1 of 2 things is done

  1. If making cast locator to pick up in existing prosthesis then just send acrylic/post/cast-to female assembly to lab to fabricate custom coping
  2. If making new prosthesis can do pick-up impression to capture when taking final impression for denture.

Either way cement female coping with Relyx luting and pick up in office.  Be sure lab has male parts and left room like this. March 12

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