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UPPER OVERDENTURE CASE
I have a 61 yo F I am placing 4 implants for in the maxilla to restore as an overdenture. Her bone is not the best, and there are several areas where the bone is angulated, and I will likely have to angle the implants slightly. I was hoping to get your feedback on my plan, and then take it from there. I have included the cuts of where I want to place the implants, and have attached a description of how I want to place them. Please let me know what you think.
implant 3:
5×8.5 mm
osteotomy 2 mm
place subcrestal 1 mm
straight up and down
implant 5:
4×10 mm
osteotomy 3 mm
place subcrestal 1 mm
slight lingual angle 10 degrees
implant 13:
4 x 10 mm
no osteotomy
place subcrestal 2 mm
slight lingual angle 10 degrees
implant 14:
5 x 7 mm
osteotomy 2.5 mm
place subcrestal 1 mm
slight angle lingual 10 degrees
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4 Replies
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Hey there Ahmad! Thanks for sharing this case! This looks like an excellent candidate for an overdenture case, my friend.
Is this your first case?
I like your plan. I see how the anterior segment of the maxilla is deficient in bone so placing 2 implants on either side is great. You have massive amount of bone in this case. Will you be doing anything with the opposing arch?
Would love to hear these additional details.
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Thanks for responding Ivan!
Haha, what gave it away? (the emoji doesnt show up for some reason)
Yes it is my first. I have placed lots of single unit implants, but this will be my first overdenture case. For the mandible, we are restoring with a partial denture.
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This reply was modified 1 week, 2 days ago by ahmadred.
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Haha nothing gave it away!
I ask about the lower arch because of the occlusal plane. See how it goes up in the anterior teeth as those teeth super erupt?
I wanted to know if that occlusal plane will be corrected. It’s okay to leave it as is, but if the lower teeth were compromised also, it would be great to correct the occlusion with both arches.
It looks like you have decent bone volume. Will you be doing extraction and implant placement immediately? Guided or free hand? I just posted a video today of a simple surgery that looks very much like this case. Here’s the link: https://youtu.be/DnqevKAabYk?si=cEbU351oJ1lapkGb
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This reply was modified 1 week, 2 days ago by
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hey Ahmad,
I just now saw your post and hopefully, you haven’t done it yet. A few tips from someone who has completed 1,000+ of these over-denture surgeries + restoring:
1) I would make sure you do good alveoplasty – think back to dental school when we made wax rims: exactly like that, NO undercuts. I use the “finger swipe” test – as in, after you feel like you are done, run your fingers across the buccal aspect and make sure nothing feels “sharp” through your gloved hands.
Restorative issues if not done: sore spots, patients will complain that denture is not “touching” evenly or that there are “gaps”, this usually becomes a problem when they get the hard reline (no more soft liners) because you can’t make the hard arylic “wrap around” the tissues
2) After you do good alveo, you should be able to place all the implants in with zero angulation. Make the implants as parallel to each other as possible.
Restorative issues if not done: function issues – one housing will click in, others will not; having to re-do pick-ups multiple times from different angulation
Also be mindful to NOT have any that are buccally displaced because you could potentially have silver housing that pokes through.
I also agree with Ivan – best to do top and bottom together, remind him/her that tops can only match what is on bottom so that one day, if they choose to get bottom dentures, it is recommended to get a brand new upper to make occlusion work with full prosthetics.
3) I would highly recommend flapping all of your surgeries. It’s easier to see a bony defect when the tissue is reflected vs basing your surgery on a denture template.
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