[Amy]

I agree. You should be good if the implant has enough bone support. However, I would mention the deficient gum support to the patient and show him/her with visuals, then document in your notes that options were given about potential outcomes down the way.

[Amy]

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.

[Amy]

Nice job, Andrew! Send us some updated pictures when you place the implant.

[Amy]

Hi Jeremy – great case and good insight, Ivan!

From a boards perspective (because I’ve dealt with them here in Texas), I would make sure you document everything and do perio charting to cover yourself. Just as my professor in dental school often repeated: if it’s not in the note, it never happened!

[Amy]

I agree – sometimes you get that “dimple” from the cover screw and tissue not fully healing, but it doesn’t compromise the final goal of getting an implant crown. If anything, it makes it nice and easy to find at uncovery! (Mostly if you’re doing overdenture uncovery).