Attachment Selection

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Attachment Selection

• Overdentures- Ridge evaluation and esthetics
• Fixed- Ridge evaluation, gingival esthetics
• Number of implants
• Anterior-Posterior spread
• Opposing arch ??
• Function
• Fixed- Rigid, screw retained
• Overdenture- Load bearing or non- load
  bearing
• Retention
• Available space
• Cost

2
Patient Considerations

• Parallel attachments for easier path of insertion
• Less attachments better
• Patient dexterity
• Hygiene Stannous Fluoride rinses
• 3 month recall

3
Anterior/Posterior Spread

• A line from the center of the most anterior
  implant to a line joining the distal aspects of
  the two most distal implants
• Indicates the amount of cantilever that can be
  reasonably placed
• Usually, 2.5 times the A/P spread

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A/P Spread

• Actual Length of Cantilever Depends on
• Stress factors
• Parafunctional Habits
• Crown heights
• Implant width
• Number of implants
• Opposing teeth or denture

5
Controlling Stress

• StressForce/Area

Force
Stress
Area
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Torque

• Force x Perpendicular distance from the line of
  force to the center of rotation

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Cuspal Inclination
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Cuspal Inclination
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Treatment Plan Options
Fixed
Removable
Implant Supported
Soft Tissue Supported Implant Retained
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Treatment Plan Option 1
Lower Edentulous Fixed 5-6 Implants
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Prosthetic Options-Lower5-6 Implants

• Hybrid Denture
• Fixed Crown and Bridge
• Cantilever 10-15mm

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6 Implants-Fixed Implant Supported
24
25
23
26
27
22
X
X
X
X
14
5 Implants- Fixed Implant Supported
C
D
B
E
A
X
X
X
X
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Treatment Plan Option 2
Lower Edentulous Removable 5 Implants
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Prosthetic Options- RemovableOverdenture-Implant
Supported

• Gold Bar w/ O Rings
• Distalized O Rings
• Cantilever 10-20mm

• Gold Bar with Hader Clips
• Distalized ERAS
• Cantilever 10-20mm

C
C
B
D
D
B
A
E
E
A
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Treatment Plan Option 3
Lower Edentulous Removable 4 Implants
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Prosthetic Options- RemovableImplant and Tissue
Supported

• Gold Bar with Hader Clips and ERAS
• Cantilever 5-10mm

• Gold Bar with O Rings
• Cantilever 5-10mm

c
b
b
c
d
a
d
a
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Treatment Plan Option 4
Lower Edentulous Removable 3 Implants
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Prosthetic Options- Removable Overdenture-LowerIm
plant and Tissue Supported

• Gold Bar w/ 2- O Rings-Overdenture
• No Cantilevers

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3 Implants- Removable Overdenture Implant and
Tissue Supported
C
D
B
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Treatment Plan Option 5
Lower Edentulous Removable 2 Implants
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Prosthetic Options Removable Overdenture-LowerTi
ssue Supported

• Gold Bar w/ Hader Clip
• O Ring on each implant
• ERA attachment on each implant

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2 Implants-Removable Tissue Supported
B
D
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Treatment Plans Upper Edentulous Four Options
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Treatment Plan Option 1
Upper Edentulous Fixed 8 Implants
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Prosthetic Options Fixed- UpperImplant Supported

• Fixed Crown and Bridge
• Hybrid Denture
• No Cantilevers Necessary

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8 Implants- Fixed Implant Supported
X
X
10
7
6
11
X
X
4
13
3
14
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Treatment Plan Option 2
Upper Edentulous Removable 8 Implants
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Prosthetic Options- 8 Implants Removable-
UpperImplant Supported

• Gold Bar w/ O Rings- Overdenture
• Gold Bar w/ 3 Hader Clips Overdenture- No Palate
• Cantilevers-Optional

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8 Implants- Removable Implant Supported

• Gold Bar Overdenture w/ O Rings

• Gold Bar Overdenture w/ Hader Bar / Clips

7
7
10
10
11
6
6
11
13
4
4
13
3
3
14
14
Palate
No Palate
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Treatment Plan Option 3
Upper Edentulous Removable 6 Implants
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Prosthetic Options Removable- UpperImplant
Supported

• Gold Bar w/ 4- O Rings and distal to s 4 and 13
• Gold Bar w/ Hader Clip- ERAS distal on 4 and 13-
  Overdenture-No Palate
• Cantilever 5-10mm

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6 Implants- RemovableImplant Supported

• Gold Bar w/ O Rings
• 5-10mm Cantilever

• Gold Bar w/ Hader clips and ERAs
• 5-10mm Cantilever

10
7
10
7
5
12
5
12
4
13
4
13
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Treatment Plan Option 4
Upper Edentulous Removable 4 Implants
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Prosthetic Options Removable- UpperTissue
Supported

• Gold Bar w/4 O Rings- Overdenture w/ No Palate
• Gold Bar w/ Hader Clip and 2 distalized ERA
  attachments w/ Overdenture- No Palate
• No Cantilever

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Arch Form4 Implants-Tissue Supported

• Square Arch

• Tapered Arch

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11
11
6
12
5
4
13
Maximum contact with tissue No contact with
Bar Attachments are for retention ONLY
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Treatment Planning

• Design sensibility and flexibility in the
  treatment plan
• Design and implant concepts will vary
• Plan ahead for success
• Have a disaster plan
• In most cases, less attachments are better