Fabrication of maxillary overdenture supported by custom waxed and cast locator abutments: case report

The fabrication of a maxillary overdenture supported and retained by custom waxed and cast locator attachments will be described. These angulated abutments were made necessary by a lack of maxillary bone due to advanced periodontal problems that contributed to the loss of all of the maxillary and mandibular teeth; thus, the maxillary anterior implants were placed in a labially or facially inclined position, which necessitated placement of labially inclined implant bodies. This article describes a method for correcting this angulation to create a more vertical path of placement and to allow the facially inclined implants to be used for an overdenture retentive device.

Sequential provisional implant prosthodontics therapy

The fabrication and long-term use of first- and second-stage provisional implant prostheses is critical to create a favorable prognosis for function and esthetics of a fixed-implant supported prosthesis. The fixed metal and acrylic resin cemented first-stage prosthesis, as reviewed in Part I, is needed for prevention of adjacent and opposing tooth movement, pressure on the implant site as well as protection to avoid micromovement of the freshly placed implant body. The second-stage prosthesis, reviewed in Part II, should be used following implant uncovering and abutment installation. The patient wears this provisional prosthesis until maturation of the bone and healing of soft tissues. The second-stage provisional prosthesis is also a fail-safe mechanism for possible early implant failures and also can be used with late failures and/or for the necessity to repair the definitive prosthesis. In addition, the screw-retained provisional prosthesis is used if and when an implant requires removal or other implants are to be placed as in a sequential approach. The creation and use of both first- and second-stage provisional prostheses involve a restorative dentist, dental technician, surgeon, and patient to work as a team. If the dentist alone cannot do diagnosis and treatment planning, surgery, and laboratory techniques, he or she needs help by employing the expertise of a surgeon and a laboratory technician. This team approach is essential for optimum results.

The use of implants as retainers for removable partial dentures

There has been little presented in the literature regarding the use of implant bodies as retainers for removable partial dentures. However, these fixtures can be a useful asset for restorative dentists, as they can be used when there is insufficient bone for a fixed prosthesis or as retainers for a provisional appliance until additional dental treatment is possible.

Solutions to complications of implant therapy

Restorative dentists face challenges when implant dentistry is performed without a surgical template. Manufactured component parts (particularly screws, gold cylinders, and the implant bodies themselves) can also cause problems during these procedures. These problems will occur regardless of the mode of retention used for the prosthesis, since the same metals are involved and nearly all implant restorations have a screw somewhere. Managing these complications is essential to avoid treatment failures.

A stress-releasing intracoronal attachment for extension base removable partial dentures

Intracoronal retainer systems incorporated into splinted abutment restorations help force distribution. The additional torque introduced by the extension-based removable partial denture is applied over multiple abutments rather than to single abutment teeth. A fixed-removable prosthesis is proposed as a solution to this situation. The Thompson dowel nonlocking semiprecision attachment system is the intracoronal retainer of choice for distal extension denture bases. It allows controlled rotation or stress relief of the removable component by minimizing detrimental transfer of traumatic forces to the abutment teeth. The design and fabrication of the manufactured version of this retainer system is described.