Overdenture locator attachments for atrophic mandible
A 68-year-old female patient reported with major complaint of loose lower complete denture prosthesis. The patient had been wearing a denture for the past 15 years and had a complaint of loose mandibular dentures for the last 5 years. On intraoral examination, the mandibular ridge was found to be severely resorbed. A thorough medical and dental history of the patient was recorded. As per procedure, physician's consent was taken besides doing routine blood investigation and tests.\nMaxillary and mandibular study models were made. Orthopantomograph [] and Dentascan was undertaken to assess the bone for selection of implants. Since the old denture of the patient was not appropriate for implant supported prosthesis, a new prosthesis was fabricated for the patient in accordance with the physiologic and functional aspects. Dentascan and lower denture were used to fabricate surgical stent. The Noble Active narrow platform implants; size 3.5 mm × 10 mm and 3.5 mm × 13 mm [] were placed by surgically raising flap in canine to canine region. The knife edge ridge in the anterior region was flattened and basal bone improved. Standard post-operative surgical protocol was maintained and patient was asked not to use lower denture for 3 weeks. After 3 weeks, lower denture was locally relined with soft liner Mollosil Detax Germany.\nAfter 6 months of the integration period, a definitive prosthodontic therapy was started by exposing the cover screws of implants. 5 mm flared Noble active healing abutments were placed to establish per mucosal seal. After 2 weeks, healing abutments were removed and depth measurements from the implant platforms to the most coronal aspect of the surrounding gingival levels were taken with the help of World Health Organization periodontal probe. Locator Implant Abutment height was computed by measuring the total soft-tissue depth and subtracting 0.5 mm for the platform shifting area of noble active implant.\nIn the above case, on one side 3 mm and other side 4 mm (Zest Anchors) locator abutment was placed [] with the help of a special gold plated Abutment Driver. The abutments were tightened to 25-30 N with a torque wrench. The plastic resilient male caps with the metal housing can be processed into the denture by indirect laboratory technique or can be directly picked chair side. This allows denture to be snapped into the locator abutments. The chairside pick-up procedure is same as ball attachments. White blockout spacer or rings [] and black processing male are provided by the manufacturer for ease in procedure. In the above procedure, chair side pick-up procedure with auto polymerizing resin was performed and blue male inserts were given to patient for initial few months [].\nThe retention can be increased gradually by changing to higher retentive caps, according to individual patient's usage and needs. These plastic resilient caps can be easily changed chairside during a recall appointment with Locator core tool. The angulation between implants can be measured with angle measurement guide which helps in the selection of specific male resilient cap.