Attachment Selection

• Overdentures- Ridge evaluation and esthetics• Fixed- Ridge evaluation, gingival esthetics• Number of implants• Anterior-Posterior spread• Opposing arch ??• Function

Fixed- Rigid, screw retainedOverdenture- Load bearing or non-

load bearing• Retention• Available space• Cost

Patient Considerations

• Parallel attachments for easier path of insertion

• Less attachments – better• Patient dexterity• Hygiene – Stannous Fluoride rinses• 3 month recall

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

A/P Spread

Actual Length of Cantilever Depends on:

• Stress factors

• Parafunctional Habits

• Crown heights

• Implant width

• Number of implants

• Opposing teeth or denture

Controlling StressStress=Force/Area

Stress

Area

Force

Torque=

Force x Perpendicular distance from the line of force to the

center of rotation

Cuspal Inclination

Cuspal Inclination

Treatment PlanOptions

Implant Supported Soft Tissue SupportedImplant Retained

Fixed Removable

Treatment PlanOption 1

Lower EdentulousFixed

5-6 Implants

Prosthetic Options-Lower5-6 Implants

• Hybrid Denture

• Fixed Crown and Bridge

• Cantilever 10-15mm

22

2324 25

2627

6 Implants-Fixed Implant Supported

X

X X

X

B

A

C D

E

5 Implants- FixedImplant Supported

X

X

X

X

Treatment PlanOption 2

Lower EdentulousRemovable5 Implants

Prosthetic Options- RemovableOverdenture-Implant Supported

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

• Gold Bar with Hader Clips• Distalized ERA’S• Cantilever 10-20mm

A

BC

D

E E

DC

B

A

Treatment PlanOption 3

Lower EdentulousRemovable4 Implants

Prosthetic Options- RemovableImplant and Tissue Supported

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

• Gold Bar with Hader Clips and ERA’S

• Cantilever 5-10mm

ab c

d dcb

a

Treatment PlanOption 4

Lower EdentulousRemovable3 Implants

Prosthetic Options- Removable Overdenture-Lower

Implant and Tissue Supported

• Gold Bar w/ 2- O Rings-Overdenture

• No Cantilevers

BC

D

3 Implants- Removable Overdenture Implant and Tissue Supported

Treatment PlanOption 5

Lower EdentulousRemovable2 Implants

Prosthetic Options Removable Overdenture-Lower

Tissue Supported

• Gold Bar w/ Hader Clip

• O Ring on each implant

• ERA attachment on each implant

B D

2 Implants-Removable Tissue Supported

Treatment Plans

UpperEdentulous

Four Options

Treatment PlanOption 1

Upper EdentulousFixed

8 Implants

Prosthetic Options Fixed- Upper

Implant Supported

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

8 Implants- FixedImplant Supported

3

107

6

4

11

13

14

XX

XX

Treatment PlanOption 2

Upper EdentulousRemovable8 Implants

Prosthetic Options- 8 Implants Removable- UpperImplant Supported

• Gold Bar w/ O Rings- Overdenture

• Gold Bar w/ 3 Hader Clips Overdenture- No Palate

• Cantilevers-Optional

• Gold Bar Overdenture w/ O Rings

• Gold Bar Overdenture w/ Hader Bar / Clips

3

11

13

314

4

67

4

67

13

14

1110 10

Palate No Palate

8 Implants- RemovableImplant Supported

Treatment PlanOption 3

Upper EdentulousRemovable6 Implants

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

6 Implants- RemovableImplant Supported

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

• Gold Bar w/ Hader clips and ERA’s

• 5-10mm Cantilever

4

5 12

13

107

125

107

134

Treatment PlanOption 4

Upper EdentulousRemovable4 Implants

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

Arch Form4 Implants-Tissue Supported

Square Arch Tapered Arch

4

6 11

13125

116

Maximum contact with tissue – No contact with BarAttachments are for retention ONLYONLY

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