Implants with ball retainers an Locator attachments on the lower jaw are an efficient solution to avoid the instability of a total prosthesis, especially for those patients with a big tongue (macroglosia) and little bone ridge retention.
Actually, the tongue tends to grow as we grow old, and even more when we lose teeth, because the leave more place for the tongue itself.
With the tongue movements, the prosthesis comes loose easily and that is usually uncomfortable for the patients because of the lack of confidence on the prosthesis while eating or speaking.
The lower jaw keeps normally enough bone on the anterior region, even in very atrophic cases. This case, from a 77 year-old male, shows more than enough bone kept. So 3 ICX implants, all three 15” x 3,75” were easily set on the most conveniet places of the lower anterior region.
The remainig lower left wisdom tooth was left in place. At 77 years of age and without sympoms and no influence on the therapie, it can as well stay in place.
So, after two months the healing caps are changed by ball retainers and the old prosthesis is relined in order to fit the new conectors.
The prosthesis is marked below, exactly where the contact points are.
Then comes the drilling until the prosthesis rests freeely on the gums.
Reline resin is added under the prosthesis. The patient bites in the normal position and the resin selfcures in the mouth.
The rubber rings inside the stainless steel structure can be chosen in three differente degrees of hardness and retention. They wear out like every rubber component and can be therefore easily changed.
After a few minutes cure time the retainers are already fixed and the retaining force can already be appreciated, as the prosthesis stays in the right position although the tongue and the cheeks exert the same force as before.
In this case, the three ball retainers proved not to be retentive enough for the patient. Normally a four implant solution provides a more retentive, more stable, four-point trapezoidal support. Nut the patient was running on a low budget and we had to go for a three implant display, with the central implant close to the mandibular synfisis.
By changing the three ball retainers into Locator attachments and just placing the softer plastic rings under the metal matrixes, we achieved a good degree of confort for the patient.
In this post I want to show the bone regenerating effect from the narrow threads around the neck of an implant, brand ICX, 8” long, 4,8” wide. You can see the one-year evolution control on this following post
Day O: a second molar on the left upper jaw was extracted on May 9, 2011 due to a tooth fracture. The X-ray was taken after the extraction. The wisdom tooth is kept behind to minimite the alveolar resortion.
Three months later, on August 16, 2001 the ICX 4,8″x8″ was set with 35 N primary stability, by means of a punch technique and small vertical sinuslift, using a collagen membrane and autogenous bone. The implant was set further distal to the center space, counting already on the future extraction. The wund is sealed with a platform-switch healing screw.
Two months later, on October 18, 2011, I make another X-ray check, test the stability of the implant.The bone has grown around the narrow neck threads. The bone is condensed around the apex and the impact sound is excellent, showing a good integration.
I insert the closed-impression post. Now has come the moment of the extraction of the third molar (wisdom tooth), because it is no longer necessary and, furthermore, interferes with the plastic cap that goes over the post. The impression is taken therefore after the extraction.
Nine days later, on October 27, 2011, the abutment is screwed in with 35 N torque and the crown is cemented with temporary cement until the 6-moth control.
* To see the the one-year evolution control go this post