Principles of Attachment Selection for Implant Supported Overdentures
| Principles of Attachment Selection for Implant Supported Overdentures | Hamid Shafie, DDS* and George Obeid, DDS** |
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| portion is tapered, enhancing penetration in the bone and faster stabilization.
Clinical Considerations Regarding the OS Overdenture Implant Always start with the least retentive female attachment during the initial healing phase to minimize the chance of jeopardizing the initial stability of supporting implants. After eight weeks, one can switch to more retentive female attachments. If the implants have been placed in Type-III bone (such as a maxillary overdenture case) or if the implants’ primary stability is not optimum, avoid utilizing the female attachments on the day of implant placement. Instead mark the location of the implant heads inside the denture and relief the acrylic base in those areas. Then reline the inside of the denture with tissue conditioner for the first two weeks, replace the tissue conditioner with a soft liner starting on week three, and keep the soft liner until end of week eight. Utilize the female attachments eight weeks after implant placement. OS implants should always be utilized with a well-fitting denture and accurate occlusion. Avoid utilizing the OS as a transitional implant because its RBT surface characteristics will cause an expansive implant bone interface, making it very difficult to unscrew the implant without leaving a large bony defect and risking implant fracture during the unscrewing process. A minimum of four OS implants should be used for a lower-implant overdenture, if the bone quality is ideal. With poorer bone |
quality we recommend five or six implants. The OS implants should all be placed perfectly parallel to each other. We strongly recommend utilization of a paralleling device or an accurate surgical guide. (See SROMS Vol. 17, #2; Vol. 17, #3 & 4; Vol. 17, #6) The maximum correctable discrepancy in the trajectory of each implant from the sagittal plane is 14°. A proper directional ring can be used to offset a discrepancy of 14° or less. There are three directional rings available with the Maximus® OS: 0°, 7°, and 14°. The implants should be placed at least 6 mm apart from center to center. However, to simplify the implant spacing, the distance between the two mental nerve loops can be divided into five equal columns. Then, when placing five implants, one implant can be placed in the center of each column. When placing four implants, skip the middle column and place one implant in each side column. (Fig. 18) Prosthetic Steps With the OS Overdenture Implant Chair-side Utilization Procedures
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