Topics

! Conventional Denture Treatment:

Secrets to Successful Dentures

Part II

Trends in removable prosthodontics. Anatomy ! Maxillo-Mandibular Relationship ! Vertical Dimension ! Tooth Selection, Arrangement, and Occlusion
! !

Dalhousie Continuing Education Dr. Mark Vallee BSc MS DDS DP FRCDC

! Implant Supported Overdentures:

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 13

Patient Demographics
60

Percent Edentulous 18+ yrs old

50

Percent Edentulous 65+ yrs old

Percent

12 40 11 10 1960 30 1960

1970

1980

1990

1970

1980

1990

Trends in tooth loss

Patient Demographics
! Will there be a need for complete dentures in

Esthetic Awareness

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

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Anatomy
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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

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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

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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

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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

h. Vibrating line Imaginary line across palate Connects the pterygomaxillary notches
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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

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Denture bearing areas

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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

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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

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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

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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)

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Denture bearing areas 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
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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

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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

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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

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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

Mandibular Condyle Glenoid Fossa EAM

Coronoid Process of mandible Maxillary Tuberosity Nasal Septum Hard Palate Orbit Pterygomaxillary Fissure Zygomatic Arch

Articular Eminence

Anterior Nasal Spine

Maxillo-Mandibular Relationship

Pharynx Earlobe Mandibular Foramen Styloid Process

Mental Foramen Shadow of tongue

Lip Lines

External Oblique Ridge

Cervical Vertebrae

Symphysis Mandibular Canal

Hyoid Bone Facial Artery Notch

Maxillary Relations
! ! ! !

Maxillary Relations
Natural Dentition
! Incisal edge of central

Incisal Display at Rest

Incisal Display Dental Midline Occlusal Plane Orientation Facebow

incisor in relation to the lip line at rest

Young woman 3 mm below lip line at rest ! Young man 2 mm below lip line at rest ! Middle age 1.5 mm below lip line at rest ! Elderly (>80) 0 mm below to 2 mm above lip line at rest
!
Rest After Wax Adjustment

Maximum Smile After Wax Adjustment

Maxillary Relations
Dental Midline

Maxillary Relations
Dental Midline

Rest After

Smile After

Maxillary Relations
Dental Midline

Maxillary Relations
Occlusal Plane Orientation

! Frontal Plane ! Parallel to

interpupillary line
! Fox Plane

Maxillary Relations
Occlusal Plane Orientation

Maxillary Relations
Occlusal Plane Orientation

! Sagittal Plane ! Parallel to Campers 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
! Adjust occlusal plane
! Parallel to maxillary rim

! Clinical assessment of vertical

dimension
! ! ! ! ! ! ! !

Anatomic landmarks Physiologic rest position Pre-extraction records Existing prosthesis Esthetics Phonetics Swallowing Average occlusal rim dimensions

Vertical Dimension
! Anatomic Landmarks ! 2/3 up the height of the retromolar pad

Vertical Dimension
!

Anatomic Landmarks
! Level with the lower lip

at rest

Vertical Dimension
! Esthetics

Vertical Dimension
! Phonetics

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Vertical Dimension
! Swallowing

Vertical Dimension
! Average Occlusal Rim Dimensions

Maxillary 22 mm

Mandibular 18 mm

During swallowing

After swallowing

Anterior Tooth Selection Tooth Selection

Anterior Tooth Selection ! Anterior teeth are

primarily selected to satisfy esthetic requirements ! Posterior teeth are primarily selected to satisfy masticatory requirements/ occlusion

Anterior Tooth Selection

Guides
!

Anterior Tooth Selection

! Shape
!

! Pre-extraction records

Photos, diagnostic casts, old radiographs

Square, tapering, ovoid Length, width, circumference

! Size
!

! Existing dentures ! Patients facial

characteristics
! Patients gender,

! Shade

personality, age
! Arch size and shape ! Patients preferences

Anterior Tooth Selection

Dentogenics concept
! Gender ! Male rugged with square teeth and bold central incisors ! Female pronounced curvatures, rounded point angles ! Personality ! Vigorous or delicate maxillary lateral varies more in size, form, and position ! Age ! Young tapered, ovoid, rounded teeth ! Middle somewhere between young/old ! Old square, sharp corners

Shape

Anterior Tooth Selection

!

Shape

Ovoid
! Pronounced gingivo-incisal

Tapering
! Rounded contours which

curvature which tends to disperse light and create a softened appearance !

taper towards the cervical ridge ! Moderate gingivo-incisal curvature

Square
! Central incisor is dominant and gingivo-incisal curvature is

moderate
! Offers maximum light deflection and creates a bold effect

50

Anterior Tooth Selection

! Width of 6 anteriors

Size

Anterior Tooth Selection

Wax rim & ruler

Size

on a curve ! Average 46-56 mm

Commissure of lips represents distal surface of canine

Anterior Tooth Selection

Major rugae of palate points to canine position

Size

Anterior Tooth Selection

Exaggerated Smile Length

Size

! 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 Displays less than 75% of maxillary anterior teeth

! Low smile 20%

!

Anterior Tooth Selection

Commercial Products

Size & Shape

Anterior Tooth Selection

! Determine the facial

Size & Shape

outline
! Compare form of face

to vertical lines
! Square tapering

Width

! 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

Anterior Tooth Selection

Take a picture

Size & Shape

Anterior Tooth Selection

! Portrait shade guide

Shade

Insert it into a program

57

Anterior Tooth Selection

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

Anterior Tooth Arrangement

General Arrangement Considerations
! Anterior teeth are set primarily !

Maxillary Anterior Tooth Arrangement

! Central ! Labial surfaces flush with wax rim

contour
! Long axis slightly distal to

! ! ! !

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
61

perpendicular
! 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
62

Maxillary Anterior Tooth Arrangement

Maxillary Anterior Tooth Arrangement

Labial surface of the centrals usually 5-7mm anterior to incisal papilla

Maxillary Anterior Tooth Arrangement

Golden Proportion
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
! !

Maxillary Anterior Tooth Arrangement

Esthetics of natural teeth Avoid lampshade convergence of roots!

65

66

Mandibular Anterior Tooth Arrangement

Mandibular Anterior Tooth Arrangement

Teeth are set over bone

Anterior Tooth Arrangement

Anterior Tooth Arrangement

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

Left Working

efficiency to a reasonable level

! Decrease lateral forces to

the residual ridges

General Concepts of Denture Occlusion

Common Features
! Functional anatomy is the main

Occlusal Spectrum
! Anatomic
! Balanced occlusion

determinant of denture tooth position

! Simultaneous, bilateral posterior

contact in centric relation

! Centralization of centric occlusal

! Lingualized ! Balanced occlusion ! Non-balanced occlusion

Centric Relation

forces over the mandibular residual ridges

! !

Buccal-lingually Anterior-posteriorly

! Non-anatomic (Monoplane) ! Balanced occlusion ! Non-balanced occlusion ! Neutrocentric

Occlusal Spectrum
Lingualized (lingual contact)

Posterior Tooth Selection

Criteria
! Resorbed or flabby ridges ! Physical condition of the patient
nonanatomic (balancing ramp)

! Patients who clench or brux ! Previous denture occlusion ! Ridge relationship ! Immediate dentures ! Opposing arch

semianatomic

anatomic

nonanatomic

Posterior Tooth Selection

Indications
Anatomic
! Good residual ridges ! Well coordinated patient ! Previously successful with

Posterior Tooth Selection

Indications
Anatomic
! Good residual ridges

Non-anatomic
! Poor residual ridges ! Poor neuromuscular control

Non-anatomic
! Poor residual ridges

anatomic dentures

! Class I ridge relationship ! Denture opposes natural

dentition

(Bruxers, CP, etc.) ! Previously successful with monoplane dentures or severely worn occlusion on previous denture
! Arch discrepancies ! Class II or III or cross-bite ! Immediate dentures
!

! When Lingualized

occlusion is desired

Except when opposing natural dentition

! Potential poor follow-up

Posterior Tooth Selection

Indications
Anatomic
! Well coordinated patient

Posterior Tooth Selection

Indications
Anatomic
! Previously successful with

Non-anatomic
! Poor neuromuscular control

Non-anatomic
! Previously successful with

(Bruxers, CP, etc.)

anatomic dentures

monoplane dentures or severely worn occlusion on previous denture

Posterior Tooth Selection

Indications
Anatomic
! Class I ridge relationship

Posterior Tooth Selection

Indications
Anatomic
! Denture opposes natural

Non-anatomic
! Arch discrepancies

Non-anatomic
! Immediate dentures

Class II or III or cross-bite

dentition

Except when opposing natural dentition

Anatomic Occlusion
Advantages
! Definite point of positive

Lingualized Occlusion
Indications
! High esthetic demands ! Severe mandibular ridge

Disadvantages
! Difficult to set ! Less adaptable to arch

Advantages
! Good esthetics ! 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

atrophy
! Displaceable supporting

teeth

! Potential for bilateral balance ! Centralizes vertical forces ! Minimizes tipping forces ! Facilitates bolus penetration

tissues
! Malocclusion ! Previous successful denture

with lingualized occlusion

(mortar and pestle effect)

Non-Anatomic Occlusion
Advantages
! Reduction of horizontal

Is Balance Necessary?

Disadvantages
! No vertical component to aid

forces
! CR can be developed as an

in shearing during mastication

! Occlusal adjustment impairs

area instead of a point

! Freedom of movement ! Can develop solid occlusion

efficiency unless spillways and cutting edges restored

! Patients may complain of

Bolus in in Balance out out

despite arch alignment discrepancies

! Easily adapted to situations

lack of positive intercuspation position

! Somewhat esthetically

prone to denture base shifting

! Easy to set and adjust teeth

limited (dont look like natural teeth)

Complete Denture Occlusion

! Investigators have not shown one

Posterior Landmarks
! Crest of the ridge
! Mandibular posterior teeth

Landmarks for the Arrangement of Posterior Denture Teeth

type of denture occlusion to be:

Superior in function Safer to oral structures ! More acceptable to patients
! !

are centered over the ridge

! Medial/lateral

! Neuromuscular control may be

the single most significant factor in the successful manipulation of complete dentures under function
! Tongue function and denture

! Retromolar pad
! Medial/lateral ! Superior/inferior ! 2/3 height retromolar pad

wearing experience

88

Posterior Landmarks
Three landmarks used to determine the plane of occlusion: ! Retromolar pad
! 2/3 height retromolar pad

Mandibular Posterior Tooth Arrangement

Incisal edge of the mandibular central incisor

90

Mandibular Posterior Tooth Arrangement

Mandibular Posterior Tooth Arrangement

Horizontal Plane
! Pounds triangle ! Lingual aspect of mandibular teeth should be positioned within

Horizontal Plane
! Central groove of denture teeth centered over the crest of the

ridge

a triangle created by drawing 2 lines from the mesial aspect of the canine to each side of the retromolar pad

91

92

Mandibular Posterior Tooth Arrangement

Mandibular Posterior Tooth Arrangement

Sagittal Plane
! Boucher ! Occlusal plane of mandibular arch should be established at !

Sagittal Plane
! Long axes of the teeth are perpendicular to the occlusal plane ! Marginal ridges of adjacent teeth should be at the same level

height of the retromolar pad

! 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 94

Mandibular Posterior Tooth Arrangement

Mandibular Posterior Tooth Arrangement

! !

Frontal Plane
! Lingual view ! Buccal and lingual cusps should contact the occlusal plane

Frontal Plane
! Facial view ! 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

Implant Supported Overdentures

! the number of edentulous people will continue to increase for

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.

Patient Demographics
Dissatisfied 7.7 %

Implant Supported Overdentures

!

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.
!

Implant Supported Overdentures

! Studies of several populations have shown that ratings of

Overdenture Attachments

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

Overdenture Attachments

Overdenture Attachments

! Bar Attachments
! 1-3 bars with 1-3 clips ! Retentive at first, get loose or break over time. ! Hard to adjust and fix ! Not as popular anymore

! Locator
! Lowest vertical height of 3.17mm. ! Self aligning ! Durable ! Up to 40 angle correction ! Retention flexibility

Overdenture Attachments

Fixed Full-arch Restorations

! ! ! ! ! !

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.

! ! ! ! ! ! !

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

Overdenture Attachments

single unit restorations.

! Internal-hex Implants
! More common now ! Good for single tooth restorations ! Can use for multiple unit restorations ! Md Implants usually placed in position of: ! 2 implants - 33, 43 ! 4 implants - 32, 34, 42, 44 ! 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.

cement retained or need specific abutments. ! Rely more on the connection for retention of single unit restorations.

<&.,#"$(8,#9+&+"$
! 8#1#,,+,($%(+#9;(%$;+1 ! 8+1.+"4)90,#1($%($;+(%99,02#, ! ! ! !
22 mm

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?0,910&(G;+"($;+(.#$)+"$ %99,04+2(.%2$+1)%1,' ! <"91+#2+(9%&.,)9#$)%"2

17 mm H+#1(%?($;+(#$$#9;&+"$ !70$&+"$(,%%2+")": ! -1+2$#,(7%"+(,%22 ! <&.,#"$(?#),01+ ! 81%2$;+2)2(?1#9$01+
! !

! <"91+#2+4(#"$A.%2$(1%9E)":

Surgical Guides
! A necessity. ! Allows the clinician to

Panoramic Radiograph

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

Panoramic Radiograph

Panoramic Radiograph

Panoramic Radiograph

Panoramic Radiograph

Panoramic Radiograph

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.

mm height mm

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
! Make a new denture start to finish
! ! ! ! ! ! !

Implant Impressions
Open Tray Impression Coping Closed Tray Impression Coping

Initial impression Final impression with your choice of implant impression Wax Rim adjustment Wax try-in Delivery With a reline impression (indirect approach) Direct pickup of Locator housings with a chairside reline.

! Convert an existing denture into an overdenture

Locator Pickup Impression Coping

I)6$01+(B+J+,(<&.1+22)%"

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.

! Identify the positions

Converting a denture into an overdenture.

! Make an impression

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.

using an elastic impression material

! Make a reline if

needed.

Converting a denture into an overdenture.

! Firmly place the

Converting a denture into an overdenture.

! Fabricate a working

Locator Abutment Replica in the impression copings, which, if indicated, are then repositioned in the impression

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

Converting a denture into an overdenture.

Converting a denture into an 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.

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.

Insert Removal Tool

Insert Seating Tool

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.

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.

1. Loosen Insert Removal Tool

Gap

2. Remove the Insert

3. Discard the Insert

4. Remove the Insert Removal Tool

5. Place a New Insert Questions?

Insert Seating Tool end