Attachments in implant retained overdentures/ cosmetic dentistry training

Attachments in implant retained
overdentures
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Introduction
Many edentulous patients experience
problems with their dentures, especially
lack of stability and retention, together
with a decrease of chewing ability.
one possibilty of solving this problem is the
use of endosseous implants to which an
overdenture can be attached.

The overdenture approach facilitates
the fabrication of different types of
prostheses depending on the number
of implants placed. They are
• Implant-supported fixed screw-retained
prosthesis
• Implant-supported removable
overdenture
• Combined implant-retained and soft
tissue-supported overdenture prosthesis

Definition of attachment
A mechanical device for the fixation,
retention, and stabilization of a
prosthesis

Attachments used to retain overentures
• Ball attachments
• O – ring
• ERA attahcment system
• Spheroflex
• Locator attachment system
• ZAAG attachment system
• Bars
• Dolder bar
• Hader EDS bar
• Hybrid bar system
• Resilient
• Rigid

• The decision as to what type of
overdenture is given is determined by
the following
• Patients expectations
• Financial considerations
• Anatomic and morphologic condition of
the bone
• Shape of the alveolar ridge

Attachment selection based on
number of implants and choice of
prosthesis

Categorization of potential implant site in mandible –
By Carl E Misch

Option One
• Supported by free
standing implants in
the B and D
position.
• Implants are
independent and
not splinted

• Indications
•Indicated only when cost is the significant
patient factor
•When span between implants is too long
•When insufficinet space exists to
accommodate attachment to bar
•Arch form that is tapered anteriorly so that bar
is cantilevered posteriorly

• Most common type of attachment
used is a Ball, ring type attachment.
Eg: - O-Ring
ERA attachment
Spheroflex

O – ring attachment
• They are doughnut
shaped, synthetic
polymer objects
that posses the
ability to bend with
resistance and then
return back to their
original shape.
• The O-ring attaches
to a post with a
groove or undercut
area.

advantages
• Ease in changing the attachment
• Wide range of movement
• Low cost
• Different degrees of retention
• Elimination of time and cost of a
superstructure of a prosthesis

ERA
• Resilient precision
overdenture
attachment
• Universal hinge with
vertical movement
• Metal jacket which
holds the male
attachments

• Four angles to
accommodate
divergent implants
(0, 5, 11, 17
degrees)
• Two types standard
and micro. Selected
based on
interocclusal
distance.

Spheroflex
• The Sphero Flex is a self paralleling
combination titanium implant abutment
and ball attachment. It is the ball
attachment of choice for all implants.

Spheroflex
• Self paralleling
Implant abutment
overdenture system
with 2.5mm Ø
sphere.
• Free rotation of 7.5º
for one abutment,
15º degrees for
more than one.

Loactor Implant attachments
• Supraradicular
design which
comes in a straight
abutment and 2
angle conncections
of 10 and 20
degrees for angled
abutments.
• Total height is 3.5
mm

• The Self-Aligning
feature of the
LOCATOR attachment
allows a patient to
easily seat their
overdenture
• Different retentive
males that allow for
choice of retention
according to need of
patient

• Indicated when
• Interocclusal height is deficient
• Guide plane is necessary because of
minimal ridge height from alveolar bone
loss.

• Locator female
component on
implant
• Male component
placed on the
female component

Zaag attachment systems
• In 1972 Zest anchor was introduced to
the dental profession. Initially used as
an attachment for overdentures on
natural teeth.
• Later modified as ZAAG(Zest Anchor
Advanced Generation)
• Allows upto 15 degees of divergence
in female orientation

components
• ZAAG implant
abutment of
different heights (3,
4, 5, 6mm). Female
matrix of the system
• Male retentive
element which will
seat into the female
matrix

Female abutments in place
Male retentive part seated
Male retentive part placed
and cured in the denture
base

Option two
• Implants are
positioned in
location B and D
and splinted
together with a bar
without any
cantilever.

• The attachment used here is a clip
which is used to engage the bar
• Bar is ovoid in shape and should be
placed 2mm away from the soft tissue.

Hader bar
• Developed by
Hemet Hader in the
late 1960’s.
• Modified by English,
Staubli to EDS Hader
system. Height of
the EDS hader bar is
3 mm.

Plastic form of Hader bar Retentice clip placed on cast bar
Retentice clip being inserted
into denture base

Option three
• Three root form
implants are used.
The superstructure
connects the three
implants but without
a distal cantilever.
• Usually advocated
in V shaped ridges

• The posterior ridge form determines
the lateral movement of the
restoration
• Poor lateral stability places more
stresses on the anterior implants

• If posterior ridge
form is good ,
implants are placed
on A, C, E
• if posterior ridge is
poor, implants
placed in B, C, D
regions.

Option four (Resilient Hybrid bar design)
• Four implants are
placed in A, B, D
and E position.
• A distal cantilever
approximatly 1.5
times the A – P
distance is made.

• Attachments placed in the distal cantilever
end and the midline.
• Anterior attachment must allow prosthesis to
lift from the bar to permit rotation of distal
attachments.

• Indicated in patients who have
• Poor posterior anatomy
• Attachment placed in the anterior
section is a clip and in the distal
cantilever ball type attachments
might be placed.
• Patient benefits because there is
greater vertical support and lateral
stability.

Zaag low profile bar attachment
ZAAG female part placed directly
on the abutment
Male retentive element placed on
the denture base

Option five (Rigid Hybrid bar design)
• Five implants are
placed in (A, B, C,
D, E).
• Superstructure is
cantilevered distally
a maximum of 2.5
mm the A-P
distance or approx
15mm.

Loactor bar attachment
• Four evenly placed
Locator female
attachment cast on
superstructure in
overdenture option
- four

• Four to six retentive
elements are
included in the bar
design.
Attachments sually
used are Hader
clips, O – ring, ERA.
• Typically four
attachments are
placed evenly. Two
anterior and two
posterior.

Thank you
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Attachments in implant retained overdentures/ cosmetic dentistry training

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