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3 Types of Implant Overdentures: Which Patients Are the Best Candidates?

Find out which type of implant-supported denture is best for your edentulous patient.

July 25, 2022
Author
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Smile Bulletin Staff
Glidewell
3 Types of Implant Overdentures: Which Patients Are the Best Candidates?
  1. Mini Implant Overdentures
  2. Locator® Overdentures
  3. Locator CAD/CAM Milled Bar Overdenture

While traditional dentures remain the most common method of treating fully edentulous patients, these removable appliances cause issues in many cases, including discomfort, sore spots, prosthetic instability, and a diminished capability to speak and chew.¹ For this reason, implant-supported dentures, or implant overdentures, have become an increasingly popular choice among patients. Because implants serve as anchors that stabilize the denture and hold the prosthesis in place, patients report improved chewing function, speech and comfort, as well as substantially higher rates of satisfaction with treatment and oral health-related quality of life.²

While the fixed full-arch implant restoration, which holds the prosthesis in place via screw retention, represents the premium option for fully edentulous implant patients,³ the removable implant overdenture is an excellent treatment option for many. Implant overdentures are less expensive because fewer implants are required and they help many patients avoid the bone grafting procedures that are sometimes needed to facilitate a fixed prosthesis. Further, the surgical procedure for implant overdentures is more straightforward in many cases, allowing more general dentists to perform the procedure in their own practices, and thus expanding the availability of care to more patients, many of whom do not follow through with treatment when referred to a specialist for implant placement.

Dentists have three primary restorative options for implant overdenture cases, allowing for maximum flexibility when treatment planning for the edentulous arch. All three of these options provide for denture stabilization via an attachment system, in which the overdenture snaps over the implants and remains firmly in place during use, while allowing for removal by the patient for cleaning.

For dentists who are not yet placing implants for their fully edentulous patients, there are courses available that provide clinicians with straightforward surgical techniques for establishing the foundation needed for an implant overdenture. For those who prefer to refer out their patients for implant surgery, courses on the prosthetic protocols for fully edentulous patients can help dentists deliver a predictable restorative outcome.

Here, we will review the three most common implant overdentures, which patients they are ideally suited for, and the guidelines dentists can follow as they determine which option is best for the case at hand.

1. Mini Implant Overdentures

Although not as popular as conventional-diameter implants, small-diameter, or mini, implants can serve as a valuable addition to any implant practitioner’s armamentarium. Small-diameter implants, such as the Inclusive® Mini Implant System, have a simplified surgical protocol and are an excellent option for patients who can’t receive conventional-diameter implants due to limited finances, medical circumstances that preclude more invasive surgical procedures, or minimal bone volume that would otherwise require extensive grafting to facilitate implant treatment.

Unlike conventional-diameter implants, mini implants are engineered with O-ball heads that hold the overdenture in place by connecting to O-ring housings that fit snugly over the implants.

Clinical dentistry images by Ramond Choi, DDS, M.S.

Clinical dentistry by Raymond Choi, DDS, M.S.

When patients complain of an unstable denture, mini implants are a less expensive means of addressing their concerns and improving dental function. Here, four Inclusive Mini Implants were placed for such a patient, and his existing denture was modified to snap over the mini implants — all in the same appointment.

Another advantage of mini implant overdentures is that the implants can be placed and the prosthesis delivered in a single appointment, as the dentist can cure the O-ring housings into the patient’s denture chairside after implants have been placed, provided that sufficient initial stability of the implants is achieved and the existing prosthesis is well fitting and meets the functional and esthetic requirements of the patient. Lab-fabricated mini implant overdentures are a highly effective option as well, and are available at a low price that expands the patient population able to receive implant treatment.

2. Locator® Overdentures

The Locator Overdenture is a removable, implant-retained denture that is stabilized by a minimum of two implants. For edentulous patients who desire a more stable prosthesis, do not have sufficient vertical or horizontal ridge thickness to receive the implants needed to establish the A-P spread for a fixed restoration, and would prefer to avoid grafting procedures in advance of implant treatment, the Locator Overdenture is an excellent option. The surgical protocol has traditionally called for parallel implant placement, although recent innovations in Locator Abutment design allow for up to 40 degrees of angle correction between implants.

The Locator Overdenture

The Locator Overdenture is held in place via an attachment system that seats over Locator Abutments connected to the implants, providing enhanced stability, comfort and chewing function. Note how the overdenture is stabilized by implant retention yet is still supported by the soft tissue, which is a key distinction from fixed full-arch implant restorations.

After the implants have been placed and allowed sufficient time to integrate with the bone, the restorative protocol is straightforward. Initial impressions are submitted to the lab, which provides a wax rim so the jaw relationship can be recorded. Once the denture setup has been approved by the patient and the doctor, metal housings that contain retentive rubber caps are incorporated into the denture. At the final delivery appointment, the overdenture snaps onto Locator Abutments connected to the implants.

As with mini implants, in some situations, the Locator Attachments can be added to the patient’s existing denture if the prosthesis is properly designed. Dentists also have the option of incorporating the Locator attachments into the prosthesis chairside, as outlined at the end of Dr. Timothy Kosinski’s article in Chairside® magazine.

Clinical dentistry by Timothy F. Kosinski, DDS, MAGD

Clinical dentistry by Timothy F. Kosinski, DDS, MAGD

Unhappy with the fit, comfort and chewing capability of her denture, this patient requested a more stable prosthesis. Because she wanted treatment to be as economical as possible and was happy with the esthetics of her denture, four implants were placed toward the anterior, where ample bone was available, to support a Locator Overdenture. The patient was extremely happy with the outcome and the improved function and comfort afforded by her implant overdenture.

3. Locator CAD/CAM Milled Bar Overdenture

The Locator CAD/CAM Milled Bar Overdenture is the premium option when it comes to removable solutions for the fully edentulous implant patient. Unlike the freestanding implants used for mini implant overdentures and Locator Overdentures, this type of overdenture is supported by a high-strength titanium bar, thereby distributing functional forces more evenly among the implants and resulting in a prosthesis that can be both tissue- and implant-supported.

The Locator Abutments for this type of overdenture can be situated along the length of the implant bar, affording flexibility both in the number of Locator Abutments used and where the abutments are situated along the bar. For example, in some cases the abutments can be positioned further toward the posterior than possible with an Implant Overdenture, which can improve prosthetic function and stability. The implant bar also raises the level of the abutment-attachment connections, which eases pressure on the hard and soft tissue.

The restorative protocol for the Locator CAD/CAM Milled Bar Overdenture is similar to the Locator Overdenture, although during impression-taking, the clinician must capture an implant verification jig in the final impression, which adds some chair time to the procedure. Further, an additional appointment is required to try in the implant bar to ensure a passive fit before the final prosthesis is fabricated.

Implant CAD/CAM Milled Bar overdenture b&a

This patient requested a solution for his loose-fitting denture and agreed to receive implant treatment. Lacking the posterior bone volume needed to achieve the A-P spread for a BruxZir® Implant Prosthesis, the patient wished to avoid the time and expense of ridge augmentation. An Implant CAD/CAM Milled Bar overdenture was the perfect solution for the patient, as the Locator Abutments could be positioned further toward the posterior, providing for a more stable prosthesis.

Conclusion

As dentists continue to embrace implants as the optimal means of tooth replacement, clinical flexibility is crucial in expanding access to care, particularly for the fully edentulous, who stand to benefit the most from treatment. The optimal solution for the individual patient depends on their oral health, preferences, bone volume and finances. Although the fixed full-arch implant prosthesis produces the best outcome, the removable implant overdenture provides an effective solution for many patients and dramatically improves form, function and comfort, making it a valuable treatment option.

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REFERENCES

  1. Bajunaid SO, Alshahrani AS, Aldosari AA, Almojel AN, Alanazi RS, Alsulaim TM, Habib SR. Patients’ satisfaction and oral health-related quality of life of edentulous patients using conventional complete dentures and implant-retained overdentures in Saudi Arabia. Int J Environ Res Public Health. 2022 Jan 4;19(1):557.
  2. Mishra SK, Chowdhary R. Patient’s oral health-related quality of life and satisfaction with implant supported overdentures — a systematic review. J Oral Biol Craniofac Res. 2019 Oct-Dec;9(4):340-6. doi: 10.1016/j.jobcr.2019.07.004.
  3. Brennan M, Houston F, O’Sullivan M, O’Connell B. Patient satisfaction and oral health-related quality of life outcomes of implant overdentures and fixed complete dentures. Int J Oral Maxillofac Implants. 2010 Jul-Aug;25(4):791-800.

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