Principles of Attachment Selection for Implant Supported Overdentures

PRINCIPLES OF ATTACHMENT SELECTION FOR IMPLANT-SUPPORTED OVERDENTURES AND THEIR IMPACT ON SURGICAL APPROACHES

Hamid Shafie, DDS* and George Obeid, DDS**

INTRODUCTION

The oral and maxillofacial surgeon often manages fully edentulous patients with dental ­implants. Unlike other dental implant treatments, the referral pattern for the fully edentulous ­patient typically comes to the oral surgeon directly from the restorative dentist. In the last two decades, periodontists, being in a leading position to assess failing teeth, have been able to take a major role in the management of the partially edentulous patient with dental implants. However, in recent years, the demographics of dental implant patients have changed in comparison to the 1980s and 1990s. Baby boomers are reaching retirement age, and dentists are facing a major influx of fully edentulous patients and patients with generalized compromised teeth who ask for cost-effective full mouth rehabilitation. The fixed restorative option, while being the most desirable, is often beyond the financial means of many edentulous patients. In addition, this option invariably needs multiple implants and complicated laboratory procedures that may be beyond the knowledge and skills of the average general dentist. In contrast, the overdenture choice is significantly less ­expensive and is within the reach of many patients that are on a limited budget, and a patient restored with an overdenture supported on two implants in the mandible or four implants in the maxilla will likely be greatly satisfied with his or her prosthesis.

While oral surgeons are at ease with various complex surgical reconstructive procedures, they are not as familiar with prosthetic options and attachments that are available to provide a satisfactory overdenture. Additionally, a successful implant-supported overdenture depends on proper positioning and distribution of the supporting implants. These factors have a direct impact on attachment selection for each particular scenario.

In this review, we will address the diagnosis and principals of attachment selection for implant overdenture therapy. This should enable the oral surgeon to establish a well-informed interaction with

* Hamid Shafie: hrshafie@implant-Dentistry.com** George Obeid: George.X.Obeid@Medstar.net

PRINCIPLES OF ATTACHMENT
SELECTION

Factors upon which attachment selection depends are listed in Table 1. Patients with advanced resorption of the alveolar ridge are good candidates for bar or telescopic attachment assemblies because these attachments offer considerable horizontal stability. ­Patients with minimum alveolar

SROMS

1

Volume 19.6