1. 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

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

3. 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

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

5. Controlling Stress Stress=Force/Area Stress Area Force

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

8. Cuspal Inclination

10. Treatment Plan Options Implant Supported Soft Tissue Supported Implant Retained FixedRemovable

11. Treatment Plan Option 1 Lower Edentulous Fixed 5-6 Implants

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

13. 22 23 2425 26 27 6 Implants-Fixed Implant Supported X XX X

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

15. Treatment Plan Option 2 Lower Edentulous Removable 5 Implants

16. 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

17. Treatment Plan Option 3 Lower Edentulous Removable 4 Implants

18. 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

19. Treatment Plan Option 4 Lower Edentulous Removable 3 Implants

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

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

22. Treatment Plan Option 5 Lower Edentulous Removable 2 Implants

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

24. BD 2 Implants-Removable Tissue Supported

25. Treatment Plans Upper Edentulous Four Options

26. Treatment Plan Option 1 Upper Edentulous Fixed 8 Implants

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

28. 8 Implants- Fixed Implant Supported 3 107 6 4 11 13 14 XX XX

29. Treatment Plan Option 2 Upper Edentulous Removable 8 Implants

30. 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

31. Gold Bar Overdenture w/ O Rings Gold Bar Overdenture w/ Hader Bar / Clips 3 11 13 314 4 6 7 4 6 7 13 14 11 10 PalateNo Palate 8 Implants- Removable Implant Supported

32. Treatment Plan Option 3 Upper Edentulous Removable 6 Implants

33. 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

34. 6 Implants- Removable Implant Supported Gold Bar w/ O Rings 5-10mm Cantilever Gold Bar w/ Hader clips and ERA’s 5-10mm Cantilever 4 512 13 107 12 5 107 13 4

35. Treatment Plan Option 4 Upper Edentulous Removable 4 Implants

36. 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

37. Arch Form 4 Implants-Tissue Supported Square ArchTapered Arch 4 611 13 125 116 Maximum contact with tissue – No contact with Bar ONLY Attachments are for retention ONLY

38. 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