Topics

Conventional Denture Treatment:

Secrets to Successful Dentures Trends in removable prosthodontics.
Part II Anatomy
Maxillo-Mandibular Relationship
Vertical Dimension
Tooth Selection, Arrangement, and Occlusion

Dalhousie Continuing Education Implant Supported Overdentures:

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 Patient Demographics

Average lifespan of patients: 14 60

Percent Edentulous Percent Edentulous

13
18+ yrs old 50 65+ yrs old
Percent

12

40
11

10 30
1960 1970 1980 1990 1960 1970 1980 1990

Trends in tooth loss

Patient Demographics 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

Out of 33 million edentulous patients only 2-4% have received

An increase in esthetic awareness has prompted
implant treatment
an increase in patient demand for quality Estimated 60% of patients are NOT given implants as a
removable prosthodontic restorative treatment. 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
a. Labial frenum
b. Buccal frenum
k c. Labial vestibule
d. Anterior buccal vestibule
d j d e. Posterior buccal vestibule
b Retrozygomatic space
Coronoid bulge
i l f. Hamular notch
Pterygomaxillary notch
g. Fovea palatini
e
h. Vibrating line
m
i. Residual alveolar ridge
j. Palatal rugae
g h k. Incisive papilla
f
l. Median palatine raphe
m. Maxillary tuberosity
Anatomy in Relation to Complete Anatomy in Relation to Complete
Dentures Dentures
Edentulous Maxilla Edentulous Maxilla

c. Labial vestibule
a a. Labial frenum a Reflection contains no muscle
c c
k Fold of mucous membrane k d. Anterior buccal vestibule
Does not contain muscle Overlies buccinator muscle
d d Labial notch in denture is d d whose fibers are downward and
j j
b
narrow b
forward and limit the height and
b. Buccal frenum thickness of the buccal flange
i l Overlies levator anguli oris i l e. Posterior buccal vestibule
May be moved in an A-P Thickness determined by the
direction by the actions of the masseter muscle
e orbicularis oris and buccinator e Coronoid process of the
mandible encroaches on the
m m space during lateral excursions
g h g h Labial and buccal flanges of the
f f denture must contact movable tissues
in order to make a seal

Anatomy in Relation to Complete Anatomy in Relation to Complete

Dentures Dentures
Edentulous Maxilla Edentulous Maxilla
h. Vibrating line
Imaginary line across palate
a a Connects the
c f. Hamular notch c
k k pterygomaxillary notches
Pterygomaxillary notch
Does not contain any Posterior Palatal Seal
d j d muscles or ligaments to d j d Area not a line
b interfere with the addition b Functions: border seal, prevent food
of pressure with a impaction beneath, improve retention,
i l i l
postdam compensate for shrinkage of denture
g. Fovea palatini resin
e 2 small pits representing e Pressure on displaceable mucosa that
mucous gland openings covers palatal glands
m Usually located just m Anterior border junction between
g h
posterior to the vibrating g h
hard and soft palate; blow line
f line f Posterior border (vibrating line)
junction between movable and
immovable soft palate; ah line

Anatomy in Relation to Complete Anatomy in Relation to Complete

Dentures Dentures
Edentulous Maxilla Edentulous Maxilla

a a
c c
k Denture bearing areas k k. Incisive papilla
Guards the incisive
d d
i. Residual alveolar ridge d d canal
j Crest is primary stress j
b b Pressure will interfere
bearing area with the blood and nerve
i l Fibrous CT least i l supply causing a burning
displaceable and best sensation
able to carry the stress of Provide relief
e mastication e
j. Palatal rugae l. Median palatine raphe
m Secondary stress m
g h bearing area g h
f f
Anatomy in Relation to Complete Anatomy in Relation to Complete
Dentures Dentures
Edentulous Mandible Edentulous Mandible

i
a. Labial frenum
i a. Labial frenum
l h l h Fold of mucous
b. Buccal frenum
g j c. Lingual frenum g j
membrane
d. Labial vestibule Does not contain muscle
e. Buccal vestibule b. Buccal frenum
f f. Residual alveolar ridge f Overlies depressor
k g. Buccal shelf k anguli oris (VII)
c c Movable by the
e h. Retromolar pad e
b i. Pterygomandibular raphe b buccinator and orbicularis
j. Mylohyoid ridge oris (VII) resulting in a
a d a d wide notch in the denture
k. Alveololingual sulcus
l. Retromylohyoid space c. Lingual frenum
Overlies genioglossus
muscle (XII)

Anatomy in Relation to Complete Anatomy in Relation to Complete

Dentures Dentures
Edentulous Mandible Edentulous Mandible
Denture bearing areas

i d. Labial vestibule i f. Residual alveolar ridge

l h e. Buccal vestibule l h g. Buccal shelf
Bounded laterally by the
g j g j
Entire periphery of denture external oblique ridge and
must end in soft tissues medially by the crest of the
f Stability of denture must f
ridge
k come from the maximum use k Attachment of buccinator
c of all bony foundations where c muscle (VII)
e e
b tissues are firmly and closely b Buccal flange rests upon
attached to bone buccinator and should extend
a d a d as far as the tissues permit
Masseter muscle (V3) may
crowd buccinator forward
against the denture causing an
indentation at the DB angle

Anatomy in Relation to Complete Anatomy in Relation to Complete

Dentures Dentures
Edentulous Mandible Edentulous Mandible
j. Mylohyoid ridge
Attachment of mylohyoid
h. Retromolar pad muscle (V3) which forms the
i Contains: i muscular floor of the mouth
l h Retromolar gland l h Fibers are almost horizontal in
Pterygomandibular front of the hyoid where they join
g j g j
raphe those of the opposite side to
Buccinator muscle form a raphe
Temporal tendon At the level of the hyoid they
f f
k
Underlying basal bone is k pass almost vertically downward
c resistant to resorption c to insert into the hyoid
e e
b Coverage will provide some b k. Alveololingual sulcus
border seal Slopes toward the tongue to
a d i. Pterygomandibular raphe a d permit action of the mylohyoid
Extends from the pterygoid Length of flange distally
hamulus superiorly to the compared to anteriorly is greater
alveolar ridge inferiorly under owing to the changed length and
the retromolar gland direction of the mylohyoid fibers
 Anatomy in Relation to Complete
Dentures
Edentulous Mandible Panoramic Radiograph

i
h l. Retromylohyoid space
l DL extension determined
g j by styloglossus (XII)
Posterolateral extension
determined by superior
f pharyngeal constrictor (X)
k and palatoglossus (X)
c
e Overextension may
b
cause pain on swallowing

a d

Coronoid Process of mandible

Mandibular Condyle
Maxillary Tuberosity
Glenoid Fossa Nasal Septum Pterygomaxillary Fissure
Orbit Zygomatic Arch
EAM Articular Eminence Anterior Nasal Spine Hard Palate

Maxillo-Mandibular Relationship

Pharynx External Oblique Ridge

Lip Lines Cervical Vertebrae
Earlobe Mental Foramen
Mandibular Foramen
Shadow of tongue
Styloid Process Symphysis Hyoid Bone
Mandibular Canal
Facial Artery Notch

Maxillary Relations Maxillary Relations Incisal Display at Rest

Incisal Display Natural Dentition
Dental Midline Incisal edge of central
Occlusal Plane Orientation incisor in relation to
Facebow the lip line at rest
Young woman 3 mm Rest After Wax Adjustment
below lip line at rest
Young man 2 mm
below lip line at rest
Middle age 1.5 mm
below lip line at rest
Maximum Smile After Wax
Elderly (>80) 0 mm Adjustment
below to 2 mm above
lip line at rest
Maxillary Relations Maxillary Relations
Dental Midline Dental Midline

Rest After

Smile After

Maxillary Relations Maxillary Relations

Dental Midline Occlusal Plane Orientation
Frontal Plane
Parallel to
interpupillary line
Fox Plane

Maxillary Relations Maxillary Relations

Occlusal Plane Orientation
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
FHP
Orientation to the external
auditory meatus and CL
OP
orbitale
Cephalometric landmark
 Mandibular Relations Vertical Dimension
Vertical Dimension Adjust occlusal plane Clinical assessment of vertical
Centric Relation Parallel to maxillary rim dimension
Anatomic landmarks
Physiologic rest position
Pre-extraction records
Existing prosthesis
Esthetics
Phonetics
Swallowing
Average occlusal rim
dimensions

Vertical Dimension Vertical Dimension

Anatomic Landmarks
Anatomic Landmarks
2/3 up the height of the retromolar pad
Level with the lower lip
at rest

Vertical Dimension Vertical Dimension

Esthetics Phonetics

S F

Ch M
 Vertical Dimension Vertical Dimension
Swallowing Average Occlusal Rim Dimensions

Maxillary 22 mm Mandibular 18 mm
During swallowing After swallowing

Anterior Tooth Selection

Anterior teeth are
Tooth Selection primarily selected to
satisfy esthetic
Anterior Tooth Selection
requirements
Posterior teeth are
primarily selected to
satisfy masticatory
requirements/
occlusion

Anterior Tooth Selection Anterior Tooth Selection

Guides Shape
Pre-extraction records Square, tapering,
Photos, diagnostic ovoid
casts, old radiographs Size
Existing dentures Length, width,
Patients facial circumference
characteristics Shade
Patients gender,
personality, age
Arch size and shape
Patients preferences
 Anterior Tooth Selection Shape Anterior Tooth Selection Shape

Dentogenics concept Ovoid Tapering

Gender Pronounced gingivo-incisal Rounded contours which
Male rugged with square teeth curvature which tends to taper towards the cervical
and bold central incisors disperse light and create a ridge
Female pronounced softened appearance Moderate gingivo-incisal
curvatures, rounded point angles curvature
Personality
Vigorous or delicate maxillary
Square
lateral varies more in size, form, Central incisor is dominant and gingivo-incisal curvature is
and position moderate
Age Offers maximum light deflection and creates a bold effect
Young tapered, ovoid, rounded
teeth
Middle somewhere between
young/old
Old square, sharp corners
50

Anterior Tooth Selection Size Anterior Tooth Selection Size

Wax rim & ruler

Width of 6 anteriors
Commissure of lips represents distal surface of canine
on a curve
Average 46-56 mm

Anterior Tooth Selection Size Anterior Tooth Selection Size

Major rugae of palate points to canine position Exaggerated Smile 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
Anterior Tooth Selection Size & Shape Anterior Tooth Selection 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
Length 11 mm

56

Anterior Tooth Selection Size & Shape Anterior Tooth Selection Shade

Portrait shade guide

Take a picture Insert it into a program

57

Anterior Tooth Selection Shade Anterior Tooth Arrangement

Aim to harmonize Position has been tentatively established during the
between color of the clinical refinement of the maxillary occlusal rim
skin, hair, & eyes Adequate lip support
Guides Proper phonetics
Complexion
Hair color
Eye color
Age
Personality & activity
Patient desires
Need to educate patients
 Maxillary Anterior Tooth
Anterior Tooth Arrangement Arrangement
Central
General Arrangement Labial surfaces flush with wax rim
Considerations contour
Long axis slightly distal to
Anterior teeth are set primarily perpendicular
for esthetics not function Incisal edge is at occlusal plane
Considering creating Lateral
asymmetry after discussion Long axis at an angle more distal
with patient than central
Each tooth should appear as Incisal edge is slightly above
an individual tooth occlusal plane
Canine
Gingival 1/3 of maxillary
Long axis at a more distal angle
incisors provide lip support
than lateral
Incisal 1/3 of maxillary incisors Cervical is prominent, incisal
provides esthetics edge looks tucked-in
Maxillary anterior teeth are set Incisal edge is at occlusal plane
on the smile line
61 62

Maxillary Anterior Tooth Maxillary Anterior Tooth

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

Maxillary Anterior Tooth Maxillary Anterior Tooth

Arrangement Arrangement
Esthetics of natural
teeth Avoid lampshade
Golden Proportion 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 Mandibular Anterior Tooth
Arrangement 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
Minimize trauma to the
Tooth Selection supporting structures
Preserve remaining
structures
Posterior Tooth Selection
Enhance stability of the
dentures
Facilitate esthetics and
speech Left Working
Restore mastication
efficiency to a reasonable
level
Decrease lateral forces to
the residual ridges
 General Concepts of Denture
Occlusion Occlusal Spectrum
Common Features Anatomic
Functional anatomy is the main Balanced occlusion
determinant of denture tooth Lingualized
position Balanced occlusion
Simultaneous, bilateral posterior Non-balanced occlusion
contact in centric relation
Non-anatomic (Monoplane)
Centralization of centric occlusal
Centric Relation Balanced occlusion
forces over the mandibular
residual ridges Non-balanced occlusion
Buccal-lingually Neutrocentric

Anterior-posteriorly

Occlusal Spectrum
Lingualized
Posterior Tooth Selection
(lingual contact)
Criteria
Resorbed or flabby ridges
Physical condition of the patient
non-
Patients who clench or brux
anatomic
semi- (balancing Previous denture occlusion
anatomic ramp)
Ridge relationship
Immediate dentures
Opposing arch

anatomic non-
anatomic

Posterior Tooth Selection Posterior Tooth Selection

Indications
Anatomic
Good residual ridges
Well coordinated patient
Previously successful with
anatomic dentures
Class I ridge relationship
Denture opposes natural
dentition
When Lingualized
occlusion is desired
Indications
Non-anatomic Anatomic Non-anatomic
Poor residual ridges
Good residual ridges Poor residual ridges
Poor neuromuscular control
(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
Except when opposing natural
dentition
Potential poor follow-up
 Posterior Tooth Selection
Indications
Anatomic
Well coordinated patient
Posterior Tooth Selection
Indications
Anatomic
Class I ridge relationship
Anatomic Occlusion
Advantages
Definite point of positive
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
Non-anatomic
Poor neuromuscular control
(Bruxers, CP, etc.)
Non-anatomic
Arch discrepancies
Class II or III or cross-bite
Disadvantages
Difficult to set
Less adaptable to arch
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
Posterior Tooth Selection
Indications
Anatomic
Previously successful with
anatomic dentures
Posterior Tooth Selection
Indications
Anatomic
Denture opposes natural
dentition
Lingualized Occlusion
Indications
High esthetic demands
Severe mandibular ridge
atrophy
Displaceable supporting
tissues
Malocclusion
Previous successful denture
with lingualized occlusion
Non-anatomic
Previously successful with
monoplane dentures or
severely worn occlusion on
previous denture
Non-anatomic
Immediate dentures
Except when opposing natural
dentition
Advantages
Good esthetics
Freedom of non-anatomic
teeth
Potential for bilateral balance
Centralizes vertical forces
Minimizes tipping forces
Facilitates bolus penetration
(mortar and pestle effect)
 Non-Anatomic Occlusion
Advantages
Reduction of horizontal
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
Complete Denture Occlusion
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
Posterior Landmarks
Three landmarks used to determine the plane of occlusion:
Retromolar pad
2/3 height retromolar pad
Incisal edge of the
mandibular central incisor
Is Balance Necessary?
Disadvantages
No vertical component to aid
in shearing during
mastication
Occlusal adjustment impairs
efficiency unless spillways Bolus in
in
and cutting edges restored
Patients may complain of
lack of positive
intercuspation position
Balance out
out
Somewhat esthetically
limited (dont look like natural
teeth)
Posterior Landmarks
Landmarks for the Arrangement of Posterior Denture
Teeth
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
Mandibular Posterior Tooth
Arrangement
90
Mandibular Posterior Tooth Mandibular Posterior Tooth
Arrangement Arrangement

Horizontal Plane Horizontal Plane

Pounds triangle Central groove of denture teeth centered over the crest of the
Lingual aspect of mandibular teeth should be positioned within 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 Mandibular Posterior Tooth

Arrangement Arrangement

Sagittal Plane
Boucher
Sagittal Plane
Occlusal plane of mandibular arch should be established at
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 94

Mandibular Posterior Tooth Mandibular Posterior Tooth

Arrangement 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 Maxillary Posterior Tooth
Arrangement 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.

Patient Demographics Implant Supported Overdentures

Dissatisfied
Patients are significantly more satisfied with 2-implant
7.7 % overdentures than with new conventional dentures
regardless of the type of attachment system used
bar, ball, magnet, locator.

Moderately
Fully Satisfied
Implant overdentures increase the bite force to 60%
Satisfied of natural teeth.
66.7 %
25.6 %
Patients find implant overdentures significantly more
stable,
their ability to chew various foods are significantly
easier,
Patient satisfaction also depends upon
they are more comfortable
expectations and some patients may have very
unrealistic expectations. For this reason it is and speak more easily.
important to guide and educate the patient.
Implant Supported Overdentures 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 Ball attachments
vulnerable to malnutrition. Ball and rubber o-rings and/or metal housings
2-implant overdenture are becoming the first choice of Used to be the attachment of choice
treatment for the edentulous mandible.
Wear quickly, not as retentive

Overdenture Attachments Overdenture Attachments

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

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 Overdenture Attachments
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
Good for single tooth restorations Md Implants usually placed in position of:
Can use for multiple unit restorations - 2 implants - 33, 43
cement retained or need specific 4 implants - 32, 34, 42, 44
abutments. Mx Implants usually placed in position of:
Rely more on the connection for 4 implants - 13, 23, 16, 26
retention of single unit restorations. 6 implants - 13, 23, 15, 25, 17, 27
Tissue supported, implant retained.

Implant Placement Implant Placement

Parallel to each other One implant is more distal
22 mm
Perpendicular to the occlusal Primary rotation point or
plane fulcrum when the patient
Same occlusal height occludes posteriorly
Equal distance from the Increase complications
midline Wear of the attachment
17 mm Abutment loosening
Center of the ridge Bu-Li
Crestal bone loss
Too far apart: Implant failure
Increased ant-post rocking Prosthesis fracture

Surgical Guides Panoramic Radiograph

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
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 mm
most implant types
and sizes. height mm

1.5 mm of the top

should be
supragingival to be
able to retain the
overdenture.
Height mm 1 2 3 4 5

Recommended torque
is 20-25 Ncm.
Locator Selection Locator Abutment Delivery

Select the correct Locator Abutment based on the
level of tissue indicated when using the Abutment
Depth Gauge.
Appropriate abutment height keeps the top 1.5
mm extended above the soft tissue.
Seat the Locator Abutment using the Locator
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 Closed Tray Impression
Initial impression Coping Coping
Final impression with your choice of implant
impression
Wax Rim adjustment
Wax try-in
Locator Pickup
Delivery
Impression Coping
Convert an existing denture into an overdenture
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 Converting a denture into an
overdenture. overdenture.
Identify the positions
of the Locator Make an impression
Abutments in the using an elastic
denture base. impression material
Relieve the denture
base to obtain
adequate space for
the impression
material and the Make a reline if
Locator Abutment needed.
Pick-up.

Converting a denture into an Converting a denture into an

overdenture. overdenture.
Firmly place the Fabricate a working
Locator Abutment model with the Locator
Replica in the Abutment Replica and
impression copings, high-quality stone
which, if indicated, are material.
then repositioned in
the impression Complete the relining
and convert the
existing denture into a
Locator attachment
retained overdenture

Converting a denture into an Converting a denture into an

overdenture. overdenture.
Five types of Locator
Inserts are available to
obtain the required
retention for the
prosthesis.
The inserts come with
Replace the processing insert with the required different retentive
retentive insert. holding force levels:
Remove the Locator Insert by using the Insert Clear 5 Pounds
Removal Tool portion of the Locator Core Tool. Pink 3 Pounds
Press a new Locator Insert over the Insert Seating Blue 1.5 Pounds
Tool, and press the Locator Insert into the housing 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

Separate the Insert Removal Tool section from

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.
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 2. Remove the Insert

Gap
 4. Remove the Insert Removal
3. Discard the Insert Tool

5. Place a New Insert

Questions?

Insert Seating Tool end