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Implant Prosthesis for Fully Edentulous Patients Part I.

Implant Overdenture

SAMSUNG MEDICAL CENTER DONG HWAN LEE


Donghwan Lee

No diagnosis, no treatment.

If you dont know where you go, you never get lost.

Donghwan Lee

Donghwan Lee

Diagnosis & Treatment Planning


Fully Edentulous Patient Implant Prosthesis Fixed Metal Ceramic Metal Resin (Hybrid) Complete Denture Removable Spark Erosion Overdenture

Diagnosis & Treatment Planning


Evaluation of missing hard and soft tissue Proper lip support for esthetics Proper restorative space Vertical dimension Financial constraint

Donghwan Lee

Donghwan Lee

Evaluation of Missing Hard & Soft Tissue

Diagnosis & Treatment Planning


Evaluation of missing hard and soft tissue Proper lip support for esthetics Proper restoration space Vertical dimension Ridge Resorption Pattern Ideal

Classification of residual ridge form


Donghwan Lee

Siebert 1983
Donghwan Lee

Evaluation of Missing Hard & Soft Tissue

Evaluation of Missing Hard & Soft Tissue

Ridge Resorption Pattern Horizontal Class I

Ridge Resorption Pattern Vertical Class II

Classification of residual ridge form

Siebert 1983
Donghwan Lee

Classification of residual ridge form

Siebert 1983
Donghwan Lee

Evaluation of Missing Hard & Soft Tissue

Proper Lip Support for Esthetics

Ridge Resorption Pattern Combined Class III Facial Support Lip Support Smile Line

Classification of residual ridge form

Siebert 1983
Donghwan Lee Donghwan Lee

Proper Lip Support for Esthetics

Proper Lip Support for Esthetics

Facial Support Lip Support Smile Line

Donghwan Lee

Donghwan Lee

Proper Lip Support for Esthetics

Diagnosis & Treatment Planning


Evaluation of missing hard and soft tissue Proper lip support for esthetics Lip Support Smile Line Proper restorative space Vertical dimension

Donghwan Lee

Donghwan Lee

Proper Restorative Space

Proper Restorative Space

Metal Ceramic

Metal Resin (Hybrid)

Metal Ceramic

Metal Resin (Hybrid)

Teeth Resin Metal

Teeth Denture Base Resin Metal Framework Clearance for Hygiene Total

> 10 mm > 2 mm > 3 mm > 1 mm > 16 mm

Teeth Resin Metal

Donghwan Lee

Donghwan Lee

Proper Restorative Space

Proper Restorative Space

Implant Overdenture

Metal Resin (Hybrid) Fully Edentulous Patient Implant Prosthesis Fixed


Teeth Denture Base Resin Metal Framework Clearance for Hygiene Total Attachment Total > 10 mm > 2 mm > 3 mm > 1 mm > 16 mm > 4 mm > 20 mm Donghwan Lee Donghwan Lee

Metal Ceramic Complete Denture Removable Spark Erosion Overdenture More Restorative Space Metal Resin Overdenture Spark Erosion

Metal Ceramic Metal Resin (Hybrid)

Diagnosis & Treatment Planning


Evaluation of missing hard and soft tissue Proper lip support for esthetics Proper restorative space Vertical dimension Financial constraint

Types of Restorations by Number of Implants


Conventional Complete Denture Implant Overdenture Implant Retained OD Implant Retained & Supported OD Implant Supported Fully Fixed Denture Metal Ceramic Restorations Metal Resin Restorations

Donghwan Lee

Donghwan Lee

Types of Restorations by Restorative Materials

Types of Restorations by Mode of Support

Implant Overdenture Implant Retained OD Implant Retained & Supported OD Implant Supported Fully Fixed Denture Metal Ceramic Restorations Metal Resin Restorations

Implant Overdenture Implant Retained OD Implant Retained & Supported OD Implant Supported Fully Fixed Denture Metal Ceramic Restorations Metal Resin Restorations

Donghwan Lee

Donghwan Lee

Implant Overdenture

Considerations for Implant Overdenture


Number of implants Position of implants Selection of attachments Complications

Donghwan Lee

Donghwan Lee

Number of Implants for IOD

Considerations for Implant Overdenture


Number of implants Position of implants Selection of attachments Complications

Retained vs. Supported IOD

Implant Retained Prosthesis Mx. > 2 - 4 Mn. > 2 Implant Retained & Supported Prosthesis Mx. > 6 Mn. > 4

Donghwan Lee

Donghwan Lee

Retained vs. Supported IOD

Retained vs. Supported IOD

Implant Retained Overdenture

Implant Retained Overdenture


Implant-retained, tissue-supported overdenture

Donghwan Lee

Donghwan Lee

Retained vs. Supported IOD

Number of Implants for IOD

Tissue Supported ???

Success Rate of Implant Overdenture

16% (69/430) of implant fixture failure in Mx. followed for 1 year. Jemt et al., IJOMI 1992 75.4% in Mx. & 100% in Mn. of 115 implants for 7yrs. Bergendal et al., IJOMI 1998 Most Mx. Implant overdenture failure in less than 4 implants. Ekfeldt et al., IJP 1997 100% success in single implant overdenture in Mn. Of 21 implants for 7yr. Cordiloi et al., JPD 1997

Donghwan Lee

Donghwan Lee

Number of Implants for IOD

Number of Implants for IOD

Maxilla
Implant Retained Overdenture minimum 2 implants ?? minimum 4 implants implants splinted with bars full palatal coverage

Maxilla
Implant Supported Overdenture minimum 4 implants implants splinted with bars full palatal coverage Implant Supported Overdenture minimum 6 implants Spark-erosion prosthesis open palatal coverage higher restorative fee
Donghwan Lee

Donghwan Lee

Number of Implants for IOD

Mandible
Implant Retained Overdenture 2 implants with or without bar

Considerations for Implant Overdenture


Number of implants Position of implants Selection of attachments Complications

Implant Supported Prosthesis 4 to 6 implants

Donghwan Lee

Donghwan Lee

Position of Implants for IOD

Position of Implants for IOD

Considerations for Implant Overdenture


Number of implants Position of implants Arch shape Between canine and lateral incisor Vertical space for attachment Inter-Implant distance Angulation between Implants

Considerations for Implant Overdenture


Number of implants Position of implants Arch shape Between canine and lateral incisor Vertical space for attachment Inter-Implant distance Angulation between Implants *

Donghwan Lee

Donghwan Lee

Considerations for Implant Overdenture


Number of implants Position of implants Selection of attachments Ball Attachments
O-ring System Locator System

Various Types of Implant Overdenture

Bar & Clip Attachments


CM Bar & Rider/Ackermann Clips Dolder Bar System Hder Bar System/EDS System

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

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Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

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Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

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Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

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Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

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Bar Type Implant Overdenture

Bar Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Locator
Lowest profile Easy solution for divergence Self aligning Dual retention Long lasting

Characters of Locator
Lowest profile Easy solution for divergence Self aligning Dual retention Long lasting

3.17 Locator

4.85 ERA

5.82 Dal-Ro

6.14 O-Ring

6.22mm EDS

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Characterss of Locator
Lowest profile Easy solution for divergence Self aligning Dual retention Long lasting

Characters of Locator
Lowest profile Easy solution for divergence Self aligning Dual retention Long lasting

Donghwan Lee

Donghwan Lee

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Ball Type Implant Overdenture

Ball Type Implant Overdenture

Characters of Locator
Lowest profile Easy solution for divergence Self aligning Dual retention Long lasting

Characters of Locator
60

Cycles of Thousands

Lowest profile Easy solution for divergence Self aligning Dual retention Long lasting

55 50 45 40 35 30 25 20 15 10 5 0

Insertion & Extraction Test of Retention Loss


( Cycles to 0.5 Pounds Retention)

Locator
Donghwan Lee

Stren ERA
Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Locator

Donghwan Lee

Donghwan Lee

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Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

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Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Solving the Positioning Problems

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

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Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

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Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Ball Type Implant Overdenture

Donghwan Lee

Donghwan Lee

Ball Type Implant Overdenture

Considerations for Implant Overdenture


Number of implants Position of implants Selection of attachments Complications Gingival hyperplasia Fracture of denture base and clips Speech problem Extra post insertion appointments Etc
Jemt et al, 1996 IJOMI Neart et al., 1991, 1997 JPD

Donghwan Lee

Donghwan Lee

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Gingival Hyperplasia in IOD

Gingival Hyperplasia in IOD

Donghwan Lee

Donghwan Lee

Speech Problems in IOD

Speech Problems in IOD

Donghwan Lee

Donghwan Lee

Considerations for Implant Overdenture


Number of implants Position of implants Selection of attachments Complications
Evaluation of missing hard and soft tissue Proper lip support for esthetics Restorative space + Vertical dimension Retained vs. Supported Implant Retained Overdenture is Complete Denture ! !
Donghwan Lee Donghwan Lee

Thanks to Dr. Sung-O Kim Dr. Winston Chee Dr. Seung Beum Gye Dr. Seung Min Yang Dr. Jung-Han Choi

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