Can a bar-overdenture be fabricated on two 3x12 mm implants at position 21/22 and 27/38? Do you recommend implant retained denture instead?
Timothy Carter comments:A bar on two implants would need to be straight and would not follow the arch form. Adding two individual Locator attachments would provide this patient with a significant improvement and would likely be a simple approach. I would not consider anything other than 2x fixtures with Locators.
Dennis Flanagan DDS MSc comments:Better to place 4-5 mini implants, observing the mental foramina, and immediately loading the denture. The mandible is too thin for standard implants. If you have a failure of a standard sized implant there may be bone loss that causes a fracture which would be difficult to treat.
Timothy Carter comments:I could not disagree any more with this statement. If mini implants were so great than the overwhelming majority of the products would not be discontinued and lets not forget that a denture is soft tissue supported so the only purpose for the implants is to retain the denture. The anterior mandible is more than capable of supporting two regular fixtures and in fact it is the currently accepted standard of care.
Gordon Fraser comments:M
Gordon Fraser comments:It is difficult all be it impossible to determine the correct course of treatment with out more information ie 3D imagery, MH,patient expectations and dental history.
Timothy Carter comments:I think it is reasonable to assume that this patient has no teeth and would like to be able to chew their food better. Historically most denture patients do pretty good with an upper denture but very few can tolerate a lower denture without additional retention. Going back to 2007 when I challenged the the American Board of Periodontology for Board Certification the Standard of Care, according to American College of Prosth., was a 2 implant retained mandibular complete denture. To the best of my knowledge that has not changed and should be more than enough information to formulate a treatment plan for this patient.
Greg Kammeyer, DDS, MS comments:No I wouldn't waste my time with mini implants. Too many fail or fracture. I don't know ANY residence trained surgeons that use them, even here, in the anterior mandible where the predictability is at its best. The literature shows this as well: 2 standard implants have fewer problems than 4-5 mini's. Dennis, how can you determine how thick this mandible is? If the patient wants minimal change Tim's 2 implant, tissue supported OD is predictable. As the bone and tissue resorb, the prosthetic becomes implant supported in the anterior, so use a metal mesh in your denture. The research shows no significant difference with a 2 implant bar versus 2 implant locator set up. Either way you are stuck with changing retention elements every 2 years. If they want moderate change, 4 implants w locators which can be upgraded to an implant supported prosthetic, if they want a great amount of change. Personally I like implant support (bar OD or FCD) as that thickens and increases the density on the posterior bone and gives them the most chewing force. Of the 2, the bar OD has a higher failure rate due to less metal than the FCD. I agree with Gordon as well that cross sectional imagery, Health history, patients expectations would help us help you more accurately help you.