New hope for denture wearers
Denture wearers now have options to improve retention with
snap attachments to dental implants and mini dental implants.
Some of the more popular methods to convert an ill fitting
lower dentures are:
- A bar
connecting 2 or more implants called a hader bar or a bar with individual
snaps
- Independent
regular implants snaps to retain a denture
- Mini
implants that can snap over an
o-rings in a metal housing held in
the denture.
Details
I have worked with all three of these snap-on systems and
each has its particular advantages and disadvantages. I will cover them in more
detail below.
The
hader bar
The hader bar consists of 2
or more implants and a custom cast metal bar connecting the implants. The
denture houses one or more metal retainers and plastic clips.
The advantages of
this system are:
1. The
implants do not have to be placed parallel (which is challenging to do and not
always possible).
2. The
retention is good and depending on the configuration, one or several retentive
clips can be placed increasing retention.
3. If
the bar has implants placed in both the back and front areas of the jaws, there
is almost no movement of the denture during use.
4. Can
be used for upper and lower dentures.
5. Implants
can be loaded immediately if planned and a computer generated surgical guide
system with CT scan is utilized. The implants are splinted with the computer milled titanium bar
.
The disadvantages are:
- Full
sized implants must be placed.
- The
cast bar increases the cost.
- The
casting steps to the process
- Due to
the height needed some patients may not have enough vertical space
available for this type if retention system unless the bite is opened or
the bone is surgically lowered.
- The
cost is highest due to the type of implants needed, the lab procedures for
the cast bar, and additional appointments.
Cast bar with ERA or Locator attachments
This type of system utilizes a
cast bar and has 2 to several retentive clips soldered onto it. The 2 most
common brands of clips are Locator and ERA.
The
advantages of this system are:
1. The
implants do not have to be parallel (which is challenging to do and not always possible).
2. The
retention can be increased with multiple clips.
3. If
the bar has implants placed in both the back and front areas of the jaws, there
is almost no movement of the denture during use.
4. Can
be used for upper and lower dentures.
The disadvantages are:
1. Full
sized implants must be placed.
- The
cast bar increases the .
- The
casting adds steps to the process.
- Due to
the height needed some patients may not have enough vertical space without
modification.
- The
cost is highest due to the type of implants needed, the lab procedures for
the cast bar, and additional appointments.
Locator clip or ERA clip
The Locator/ERA type clip can be
directly attached to 2 or more regular sized implants and provide good
retention.
The advantages of these systems are:
1. Lower
cost than the bar system.
2. Less
time involved in fabricating as it is done chairside.
3. Less
vertical clearance is needed verses a bar system.
4. Can
be used for upper and lower dentures.
Mini Implant system
The Mini implant system consists
of 4 or more implants placed in the across the front of the lower jaw and
housings placed in the lowe3r denture with o-rings for retention.
The advantages are:
1. Immediate
loading of the implants (the entire process from implant placement to denture
housing and loading of the housings can be done in about 1 hour
2. Lowest
cost of all. Lower cost of the mini implants (about ½ the cost of conventional
implants each).
3. Less
bone is required for placement in atrophic jaws
4. Fast
healing as no tissue flaps are needed in most cases to view the site
5. Less
discomfort due to the smaller size and simple placement technique
6. Do
not have to be perfectly parallel with each other
Disadvantages are:
1. Can
only be placed in lower jaw due to lower density of the bone in the upper jaw.
2. May
not be able eliminate some slight denture movement in the back when chewing
(usually not a problem)
3. Cannot
be mixed with regular implants very easily.
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