Case report

80 Archives of Dental and Medical Research Vol 2 Issue 1

AODMR

Versatile Overdenture Locator Attachment – A Case Report

Chandan Rathod1, Sudhir Pawar1, Mahesh K Babu, Vanita Rathod2, Mousmi Biswas3,

Gausia Ahmed3

Reader, Department of Prosthodontics and Crown & Bridge, Rungta College of Dental Sciences & Research,

Kohka, Bhilai, Chhattisgarh; 1Professor & HOD, Department of Prosthodontics and Crown & Bridge, Rungta

College of Dental Sciences & Research, Kohka, Bhilai, Chhattisgarh; 2Professor & HOD, Department of Oral

Pathology, Rungta College of Dental Sciences & Research, Kohka, Bhilai, Chhattisgarh; 3Post graduate Student,

Department of Prosthodontics and Crown & Bridge, Rungta College of Dental Sciences & Research, Kohka,

Bhilai, Chhattisgarh, India

Address for Correspondence:

Dr. Mousmi Biswas, Post Graduate Student, Department of Prosthodontics and Crown & Bridge, Rungta

College of Dental Sciences & Research, Kohka, Bhilai, Chhattisgarh, India.

ABSTRACT:

From long back it has been a major challenge in the prosthetic management of the edentulous patient.

Conventional complete denture wearers experience a number of problem on daily basis such as

instability of the mandibular dentures, inability to masticate food. Overdenture increases retention,

support, improve masticatory efficiency, preserve alveolar bone thus improve the quality of life and

oral health. Conventional overdenture attachments such as O- rings, stud, ball and bar etc require

more space being less retentive. Overcome these deficiencies the locator attachment facilitates the

ease of insertion and removal, dual retention, low vertical profile thus an implant retained locator with

two implants in the inter-mentonian region alongwith the locator attachments are a viable treatment

option.

Keywords: Attachment, Locator, Overdenture.

INTRODUCTION

Edentulism is a poor health outcome and

compromise quality of life. The traditional

treatment plan for the edentulous patient is the

conventional complete denture.1 Any

mandibular complete denture relies on the

successful influences of prosthesis retention

and stability to achieve a satisfactory treatment

outcome.2,3 Implant-retained overdentures are

widely applied for the rehabilitation of

edentulous jaws as it increases retention,

stability, enhance masticatory function and

reduce alveolar bone resorption by regulating

neuromuscular adaptation.4 An implant

retained overdenture is an alternative form of

treatment to the fixed‐implant prosthesis &

offers patient an economic alternative.5It has

been successfully used to rehabilitate

edentulous patients for over 30 years.6The

McGill University (Canada) consensus

statement on overdentures, issued in 2002,

recommended “mandibular 2-implant over-

dentures” as the first choice standard of care

for the edentulous patients.7Overdentures may

be retained by bars, balls, magnets, Locator

attachment or Ceka attachments.8 Compared to

other attachments, Locator attachments add

versatility to its design.

CASE REPORT

A 74 year old female patient reported to the

department of prosthodontics with the chief

complaint of difficulty in chewing and she

also complains of loosening of her lower

denture, so she wanted fixed set of teeth.

Medical history was non-contributory. The

dental history revealed loss of teeth since 15

years due to caries and gum problems Patient

is denture wearer since 13 years. On clinical

examination-Lower ridge was severely

resorbed. Upper ridge being favourable. Other

clinical abnormalities were not seen.

Evaluation of complete blood count & serum

calcium was done. And for radiographic

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81 Archives of Dental and Medical Research Vol 2 Issue 1

evaluation was done-Dentascan & OPG.

Evaluation of bone width for implant positions

was done by ridge mapping. A perio probe

was used to determine the proper gingival

depth at each implant location. A radiographic

template with gutta percha points was

fabricated to assist implant positioning. Patient

was asked to wear the new denture for 2 weeks

prior to implant placement so required

necessary correction was made accordingly.

After assessing the pre surgical profile implant

surgery was planned after obtaining the

appropriate consent.The patient was scheduled

for surgery with appropriate prior antibiotic

therapy. A midcrestal incision is made, ending

distally to the canine position (as dictated by

surgical guide), with 1 small vertical releasing

incisions. A full-thickness flap is raised with

buccal and lingual reflection. Osteotomy sites

are completed and the implants are placed,

again, using the guide pins. Two implants

were screwed (35 Ncm ) in intermentonion

region.

Placement of the superior aspect of the healing

abutment approximately just 2 mm above the

final flap position, this allows for better

healing and maturation of the soft tissue. The

implant shoulder should not be covered by the

gingiva. We had selected the height of the

locator abutment by determining the height of

the gingiva The top margin of the abutment

was 1.0 mm above the mucosa locator

abutments are placed at same horizontal level

as the insertion of the prosthesis is easier for

the patient if the locator abutments are kept at

the same horizontal level.

The patient was recalled after 3 months for the

definitive implant restoration. The soft tissue

around the provisional restoration was healthy

without any inflammation or recession. Bone

assessment in radiograph at this stage revealed

nothing untoward. The provisional restoration

was retrieved and a closed tray technique was

used after connecting the impression post to

record the final impression for fabrication of

metal ceramic restoration. The provisional

restoration was relined with resin after placing

rubber dam isolation around implants so that it

contacts only cover screw and temporary

cementation was done with non eugenol luting

cement.

After 6 months patient was recalled for

definitive metal ceramic crown and the same

was luted with glass ionomer luting cement

and necessary instructions were given. After 1

year follow-up, the peri implant soft tissue was

healthy with no signs of gingival inflammation

and no bone loss around implants was

observed radiographically.

Figure 1: Edentulous patient

Figure 2: Resorbed mandibular ridge

Figure 3: Bone mapping using K-file.

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82 Archives of Dental and Medical Research Vol 2 Issue 1

Figure 4: Radiographic template fabricated with gutta-

percha points for positioning of drill

Figure 5: A full thickness flap reflected

Figure 6: surgical guide

Figure 7: appropriate positioning pilot drill for the

osteotomy sites preparation in the canine region

Figure 8: A guide pin is inserted into the osteotomy site

to ensure that the second implant is as parallel as possible

to the first

Figure 9: Completion of osteotomy.

Figure 10: Gingival former

Figure 11: Interrupted sutures placed.

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83 Archives of Dental and Medical Research Vol 2 Issue 1

Figure 12: After 17 week gingival formers were replaced

with locator abutments

Figure 13: Locator block out spacer rings

Figure 14: Denture caps with attached black processing

malesonlocator abutments

Figure 15: Wax placed on locator cap for marking relief

area

Figure 16: Marking transferred on the dentures and thus

area were relieved

Figure 17: Denture caps were fixed into the relieved area

with self polymerizing acrylic resin

Figure 18: once the acrylic got cured the black

processing ring were removed with male removal tool

Figure 19: Post operative after 3 months

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84 Archives of Dental and Medical Research Vol 2 Issue 1

Figure 20: Definitive restoration

DISCUSSION

Mandibular denture often presents problem to

the patient as well as dental practitioner.

Mandibular complete overdenture treatment

has been available for decades, however its use

was limited when the treatment depends on

retained teeth or root stumps as overdenture

abutments. Complete edentulous patients may

be presented with option sfor implant

supported prosthetic reconstruction that

include:

full arch implant supported fixed prosthesis,

Implant supported overdentures.

Surgical treatment is well established for

implant placement in the parasymphyseal

region of the edentulous mandible.

Overdenture with pivoting locator attachment

allow a resilient connection for the

overdenture without any retention loss.

CONCLUSION

Completely edentulous patient often seek tooth

replacement for comfort, esthetics and

function. Dental practitioners often find

difficulty in achieving retention and stability in

resorbed ridges. Implant supported

overdentures with minimally two implants

have been recommended as treatment option.

Practitioner are always looking for the

simplified treatment that provide cost

effective alternatives to more complex

treatment procedures. Therefore, the two

implant retained overdenture should be

considered as the first treatment option for

edentulous patients

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How to cite this article: Rathod C, Pawar S,

Babu MK, Rathod V, Biswas M, Ahmed G.

Versatile Overdenture Locator Attachment – A

Case Report. Arch of Dent and Med Res

2016;2(1):80-85.