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by Paresh B. Patel, DDS

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Let’s face it; the graying of America has started.With 10,000 people a day turning 65, the need toembrace these patients with products that servetheir needs is enormous. There have been quan-

tum leaps in new dental materials, products and equipment.However, few to none of these products provide the denturepatient with an economical and practical solution. Intoday’s landscape, implant therapy only reaches three to fivepercent of the population, leading most of these patients torely on cumbersome adhesive products. Many dentists I talkto don’t want to get involved with dentures or partialsbecause the end result is a frustrated doctor and patient.With seniors living longer we must offer this set of patientsthat has never been given options a predictable, economicand aesthetic solution. Narrow-diameter implants (NDIs)

with a Locator Attachment(ZEST Anchors) should beconsidered to fill this oft-overlooked void in moderndentistry (Fig. 1).

The standard body two-implant overdenture hasbeen considered by many to be the first treatment ofchoice when dealing withthe lower edentulous arch.In my experience, I rarely see a long-term edentulous ridge6mm in buccal lingual dimension, the width needed toencase a standard body implant properly in bone. Additionalprocedures are often necessary to increase the buccal lingual

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width, which can be met with resistance from the patient.By design, the two-implant solution will always have signif-icant rotation, vertical movement and will be rendered use-less if one implant fails. An elegant solution to consider inthese cases is four narrow-diameter implants with a low pro-file Locator Attachment. With this treatment, rotation ofthe denture is drastically reduced and precious alveolar boneis preserved in two additional locations, as the narrowimplant body will stimulate the bone.

Clinical Case The patient, a 68-year-old male presented with a lower

denture that would not stay in place (Fig. 2). He had sev-eral dentures made, as well as numerous relines throughoutthe years. He was frustrated and felt very unsatisfied withwhat conventional dentistry had offered him. His expecta-tions were realistic as his main request was to have a moreretentive denture. Aesthetics were not a major concern,however, he wanted his new “teeth” to be whiter than hiscurrent upper denture. His medical history did not pre-clude him from implant therapy. Diagnostic records weretaken along with a digital pan X-ray. Bone sounding meas-urements were taken with a bone caliper at the four pro-

posed sites between the mental foramen. The ridge meas-ured 4-5mm in width and would provide excellent bicorti-cal stabilization for a 2.9mm NDI. His current lowerdenture had significant problems (poor occlusion, wornteeth, inadequate flange extensions) and a new upper den-ture was treatment planned as well. Full-arch impressionswere taken with PVS (Take 1 Kerr) in custom trays (Triad).The patient returned for a tooth try-in to assess aesthetics,phonetics and occlusion (Fig. 3). After patient approval itwas returned to the dental lab (Burbank) for final process-ing, with a request to leave relief wells in the proposed loca-tions of the NDIs.

On the day of implant placementlocal anesthesia was administered and a1.2mm pilot drill with copious irrigationwas used to create the initial osteotomyto three-quarters the length of theimplant. The blunt end of an endodon-tic explorer was used to confirm no per-foration of the buccal or lingual wallshad occurred. A rotary tissue punch wasused to remove a plug of gingival tissue(Fig. 4). This serves two purposes: togive direct visualization of the ridge andprevent any epithelium from being car-ried down into the osteotomy. Becausethe bone encountered was dense in nature(D1 or D2), the next two drills (1.6mmand 2.4mm) were progressed into theosteotomy to three-quarters the length ofthe implant. A Locator OverdentureImplant (LODI) was removed from itssterile packaging and transferred to themouth with the use of the implant hand-piece driver (Fig. 5). An implant hand-piece and motor (Aseptico AEU 7000)was used to drive the self-tapping implant into the osteotomy. A handdriver placed into the torque-indicating

“[The patient] was completely satisfied with

the retention of his new lower denture, more

importantly with the ease and speed of how the

entire procedure was accomplished.”

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ratchet wrench was used withslow finger pressure for finalplacement of the implant and toensure the implant was placed tothe crest of bone. A unique fea-ture of the LODI is that it is atwo-piece NDI (Fig. 6). Theincluded Locator Attachment isremoved from the top of the ster-ile vile and is torqued on theLODI to 30Ncm. The LocatorAttachment also comes in twodifferent cuff heights, 2.5mmand 4mm. These features allowfor replacement of the LocatorAttachment if it is ever damagedor wears during service andallows the clinician to compen-sate for varying tissue heights.

All four NDIs achievedgreater than 45Ncm of torque,thus it was decided to place theimplants into service. In a sepa-rate vile, the NDI comes with aprocessing pack including thedenture cap, three different levels of retention inserts(males) and a white block out spacer (Fig. 7). The whiteblock out spacer was placed around the neck of the LocatorAttachment and the denture cap was snapped on. Fit testC&B material (QuickUp VOCO) was injected into each ofthe wells and the denture was seated over the attachments(Fig. 8). In 30 seconds the denture was removed andinspected to see if any show through was visible; none wasdetected. The relief wells in the denture were cleaned and athin coat of adhesive was placed and air-dried. QuickUpresin was placed in the denture wells and seated over thedenture caps (Fig. 9). The patient was instructed to remainclosed for 2.5 minutes. After the resin set, any voids werefilled in with pink flowable composite (QuickUP LC) thatis included in the kit. The back processing males wereremoved and replaced with the blue male (extra light reten-

tion). It is recommended to initially place the least retentivemale needed for ease of denture removal, function andpatient satisfaction.

At the end of the procedure when the patient was inter-viewed, he was completely satisfied with the retention of hisnew lower denture, more importantly with the ease andspeed of how the entire procedure was accomplished.Narrow-diameter implants with Locator Attachments arenot just another treatment but one that improves the lives ofpatients with a time proven technology. With much lessheight than the standard O-ball attachment, dentures can bemade more natural feeling because of reduced bulk and theyrequire less maintenance throughout time. The LocatorOverdenture Implant is an outstanding new product thatshould be considered by clinicians to help patients remem-ber that modern dentistry has not forgotten about them. ■

Author’s Bio

Dr. Paresh Patel is a graduate of UNC-CH School of Dentistry and the MCG/AAID MaxiCourse. He is the co-founder of the AmericanAcademy of Small Diameter Implants and is a clinical instructor at the Reconstructive Dentistry Institute. Dr. Patel has placed morethan 2,500 mini implants and has worked as a lecturer and clinical consultant on mini implants for various companies. He can bereached at pareshpateldds2@gmail.com or online at www.dentalminiimplant.com.

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