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Case report
80 Archives of Dental and Medical Research Vol 2 Issue 1
AODMR
Versatile Overdenture Locator Attachment – A Case Report
Chandan Rathod1, Sudhir Pawar1, Mahesh K Babu, Vanita Rathod2, Mousmi Biswas3,
Gausia Ahmed3
Reader, Department of Prosthodontics and Crown & Bridge, Rungta College of Dental Sciences & Research,
Kohka, Bhilai, Chhattisgarh; 1Professor & HOD, Department of Prosthodontics and Crown & Bridge, Rungta
College of Dental Sciences & Research, Kohka, Bhilai, Chhattisgarh; 2Professor & HOD, Department of Oral
Pathology, Rungta College of Dental Sciences & Research, Kohka, Bhilai, Chhattisgarh; 3Post graduate Student,
Department of Prosthodontics and Crown & Bridge, Rungta College of Dental Sciences & Research, Kohka,
Bhilai, Chhattisgarh, India
Address for Correspondence:
Dr. Mousmi Biswas, Post Graduate Student, Department of Prosthodontics and Crown & Bridge, Rungta
College of Dental Sciences & Research, Kohka, Bhilai, Chhattisgarh, India.
ABSTRACT:
From long back it has been a major challenge in the prosthetic management of the edentulous patient.
Conventional complete denture wearers experience a number of problem on daily basis such as
instability of the mandibular dentures, inability to masticate food. Overdenture increases retention,
support, improve masticatory efficiency, preserve alveolar bone thus improve the quality of life and
oral health. Conventional overdenture attachments such as O- rings, stud, ball and bar etc require
more space being less retentive. Overcome these deficiencies the locator attachment facilitates the
ease of insertion and removal, dual retention, low vertical profile thus an implant retained locator with
two implants in the inter-mentonian region alongwith the locator attachments are a viable treatment
option.
Keywords: Attachment, Locator, Overdenture.
INTRODUCTION
Edentulism is a poor health outcome and
compromise quality of life. The traditional
treatment plan for the edentulous patient is the
conventional complete denture.1 Any
mandibular complete denture relies on the
successful influences of prosthesis retention
and stability to achieve a satisfactory treatment
outcome.2,3 Implant-retained overdentures are
widely applied for the rehabilitation of
edentulous jaws as it increases retention,
stability, enhance masticatory function and
reduce alveolar bone resorption by regulating
neuromuscular adaptation.4 An implant
retained overdenture is an alternative form of
treatment to the fixed‐implant prosthesis &
offers patient an economic alternative.5It has
been successfully used to rehabilitate
edentulous patients for over 30 years.6The
McGill University (Canada) consensus
statement on overdentures, issued in 2002,
recommended “mandibular 2-implant over-
dentures” as the first choice standard of care
for the edentulous patients.7Overdentures may
be retained by bars, balls, magnets, Locator
attachment or Ceka attachments.8 Compared to
other attachments, Locator attachments add
versatility to its design.
CASE REPORT
A 74 year old female patient reported to the
department of prosthodontics with the chief
complaint of difficulty in chewing and she
also complains of loosening of her lower
denture, so she wanted fixed set of teeth.
Medical history was non-contributory. The
dental history revealed loss of teeth since 15
years due to caries and gum problems Patient
is denture wearer since 13 years. On clinical
examination-Lower ridge was severely
resorbed. Upper ridge being favourable. Other
clinical abnormalities were not seen.
Evaluation of complete blood count & serum
calcium was done. And for radiographic
Rathod et al: Versatile Overdenture Locator Attachment
81 Archives of Dental and Medical Research Vol 2 Issue 1
evaluation was done-Dentascan & OPG.
Evaluation of bone width for implant positions
was done by ridge mapping. A perio probe
was used to determine the proper gingival
depth at each implant location. A radiographic
template with gutta percha points was
fabricated to assist implant positioning. Patient
was asked to wear the new denture for 2 weeks
prior to implant placement so required
necessary correction was made accordingly.
After assessing the pre surgical profile implant
surgery was planned after obtaining the
appropriate consent.The patient was scheduled
for surgery with appropriate prior antibiotic
therapy. A midcrestal incision is made, ending
distally to the canine position (as dictated by
surgical guide), with 1 small vertical releasing
incisions. A full-thickness flap is raised with
buccal and lingual reflection. Osteotomy sites
are completed and the implants are placed,
again, using the guide pins. Two implants
were screwed (35 Ncm ) in intermentonion
region.
Placement of the superior aspect of the healing
abutment approximately just 2 mm above the
final flap position, this allows for better
healing and maturation of the soft tissue. The
implant shoulder should not be covered by the
gingiva. We had selected the height of the
locator abutment by determining the height of
the gingiva The top margin of the abutment
was 1.0 mm above the mucosa locator
abutments are placed at same horizontal level
as the insertion of the prosthesis is easier for
the patient if the locator abutments are kept at
the same horizontal level.
The patient was recalled after 3 months for the
definitive implant restoration. The soft tissue
around the provisional restoration was healthy
without any inflammation or recession. Bone
assessment in radiograph at this stage revealed
nothing untoward. The provisional restoration
was retrieved and a closed tray technique was
used after connecting the impression post to
record the final impression for fabrication of
metal ceramic restoration. The provisional
restoration was relined with resin after placing
rubber dam isolation around implants so that it
contacts only cover screw and temporary
cementation was done with non eugenol luting
cement.
After 6 months patient was recalled for
definitive metal ceramic crown and the same
was luted with glass ionomer luting cement
and necessary instructions were given. After 1
year follow-up, the peri implant soft tissue was
healthy with no signs of gingival inflammation
and no bone loss around implants was
observed radiographically.
Figure 1: Edentulous patient
Figure 2: Resorbed mandibular ridge
Figure 3: Bone mapping using K-file.
Rathod et al: Versatile Overdenture Locator Attachment
82 Archives of Dental and Medical Research Vol 2 Issue 1
Figure 4: Radiographic template fabricated with gutta-
percha points for positioning of drill
Figure 5: A full thickness flap reflected
Figure 6: surgical guide
Figure 7: appropriate positioning pilot drill for the
osteotomy sites preparation in the canine region
Figure 8: A guide pin is inserted into the osteotomy site
to ensure that the second implant is as parallel as possible
to the first
Figure 9: Completion of osteotomy.
Figure 10: Gingival former
Figure 11: Interrupted sutures placed.
Rathod et al: Versatile Overdenture Locator Attachment
83 Archives of Dental and Medical Research Vol 2 Issue 1
Figure 12: After 17 week gingival formers were replaced
with locator abutments
Figure 13: Locator block out spacer rings
Figure 14: Denture caps with attached black processing
malesonlocator abutments
Figure 15: Wax placed on locator cap for marking relief
area
Figure 16: Marking transferred on the dentures and thus
area were relieved
Figure 17: Denture caps were fixed into the relieved area
with self polymerizing acrylic resin
Figure 18: once the acrylic got cured the black
processing ring were removed with male removal tool
Figure 19: Post operative after 3 months
Rathod et al: Versatile Overdenture Locator Attachment
84 Archives of Dental and Medical Research Vol 2 Issue 1
Figure 20: Definitive restoration
DISCUSSION
Mandibular denture often presents problem to
the patient as well as dental practitioner.
Mandibular complete overdenture treatment
has been available for decades, however its use
was limited when the treatment depends on
retained teeth or root stumps as overdenture
abutments. Complete edentulous patients may
be presented with option sfor implant
supported prosthetic reconstruction that
include:
full arch implant supported fixed prosthesis,
Implant supported overdentures.
Surgical treatment is well established for
implant placement in the parasymphyseal
region of the edentulous mandible.
Overdenture with pivoting locator attachment
allow a resilient connection for the
overdenture without any retention loss.
CONCLUSION
Completely edentulous patient often seek tooth
replacement for comfort, esthetics and
function. Dental practitioners often find
difficulty in achieving retention and stability in
resorbed ridges. Implant supported
overdentures with minimally two implants
have been recommended as treatment option.
Practitioner are always looking for the
simplified treatment that provide cost
effective alternatives to more complex
treatment procedures. Therefore, the two
implant retained overdenture should be
considered as the first treatment option for
edentulous patients
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How to cite this article: Rathod C, Pawar S,
Babu MK, Rathod V, Biswas M, Ahmed G.
Versatile Overdenture Locator Attachment – A
Case Report. Arch of Dent and Med Res
2016;2(1):80-85.