Attachment Selection Overdentures- Ridge evaluation and esthetics Fixed- Ridge evaluation, gingival esthetics Number of implants Anterior-Posterior spread Opposing arch ?? Function Fixed- Rigid, screw retained Overdenture- Load bearing or non- load bearing Retention Available space Cost

Patient Considerations Parallel attachments for easier path of insertion Less attachments – better Patient dexterity Hygiene – Stannous Fluoride rinses 3 month recall

Anterior/Posterior Spread A line from the center of the most anterior implant to a line joining the distal aspects of the two most distal implants Indicates the amount of cantilever that can be reasonably placed Usually, 2.5 times the A/P spread

A/P Spread Actual Length of Cantilever Depends on: Stress factors Parafunctional Habits Crown heights Implant width Number of implants Opposing teeth or denture

Controlling Stress Stress=Force/Area Stress Area Force

Torque= Force x Perpendicular distance from the line of force to the center of rotation

Cuspal Inclination

Treatment Plan Options Implant Supported Soft Tissue Supported Implant Retained FixedRemovable

Treatment Plan Option 1 Lower Edentulous Fixed 5-6 Implants

Prosthetic Options-Lower 5-6 Implants Hybrid Denture Fixed Crown and Bridge Cantilever 10-15mm

Implants-Fixed Implant Supported X XX X

B A C D E 5 Implants- Fixed Implant Supported X X X X

Treatment Plan Option 2 Lower Edentulous Removable 5 Implants

Prosthetic Options- Removable Overdenture-Implant Supported Gold Bar w/ O Rings Distalized O Rings Cantilever 10-20mm Gold Bar with Hader Clips Distalized ERA’S Cantilever 10-20mm A B C D EE D C B A

Treatment Plan Option 3 Lower Edentulous Removable 4 Implants

Prosthetic Options- Removable Implant and Tissue Supported Gold Bar with O Rings Cantilever 5-10mm Gold Bar with Hader Clips and ERA’S Cantilever 5-10mm a bc d d cb a

Treatment Plan Option 4 Lower Edentulous Removable 3 Implants

Prosthetic Options- Removable Overdenture-Lower Implant and Tissue Supported Gold Bar w/ 2- O Rings- Overdenture No Cantilevers

B C D 3 Implants- Removable Overdenture Implant and Tissue Supported

Treatment Plan Option 5 Lower Edentulous Removable 2 Implants

Prosthetic Options Removable Overdenture-Lower Tissue Supported Gold Bar w/ Hader Clip O Ring on each implant ERA attachment on each implant

BD 2 Implants-Removable Tissue Supported

Treatment Plans Upper Edentulous Four Options

Treatment Plan Option 1 Upper Edentulous Fixed 8 Implants

Prosthetic Options Fixed- Upper Implant Supported Fixed Crown and Bridge Hybrid Denture No Cantilevers Necessary

8 Implants- Fixed Implant Supported XX XX

Treatment Plan Option 2 Upper Edentulous Removable 8 Implants

Prosthetic Options- 8 Implants Removable- Upper Implant Supported Gold Bar w/ O Rings- Overdenture Gold Bar w/ 3 Hader Clips Overdenture- No Palate Cantilevers-Optional

Gold Bar Overdenture w/ O Rings Gold Bar Overdenture w/ Hader Bar / Clips PalateNo Palate 8 Implants- Removable Implant Supported

Treatment Plan Option 3 Upper Edentulous Removable 6 Implants

Prosthetic Options Removable- Upper Implant Supported Gold Bar w/ 4- O Rings and distal to #s 4 and 13 Gold Bar w/ Hader Clip- ERAS distal on #4 and 13- Overdenture-No Palate Cantilever 5-10mm

6 Implants- Removable Implant Supported Gold Bar w/ O Rings 5-10mm Cantilever Gold Bar w/ Hader clips and ERA’s 5-10mm Cantilever

Treatment Plan Option 4 Upper Edentulous Removable 4 Implants

Prosthetic Options Removable- Upper Tissue Supported Gold Bar w/4 O Rings- Overdenture w/ No Palate Gold Bar w/ Hader Clip and 2 distalized ERA attachments w/ Overdenture- No Palate No Cantilever

Arch Form 4 Implants-Tissue Supported Square ArchTapered Arch Maximum contact with tissue – No contact with Bar ONLY Attachments are for retention ONLY

Treatment Planning Design sensibility and flexibility in the treatment plan Design and implant concepts will vary Plan ahead for success Have a disaster plan In most cases, less attachments are better