Attachment Selection
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Overdentures- Ridge evaluation and esthetics
Fixed- Ridge evaluation, gingival esthetics
Number of implants
Anterior-Posterior spread
Opposing arch ??
Function
Fixed- Rigid, screw retained
Overdenture- Load bearing or nonload 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:
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Stress factors
Parafunctional Habits
Crown heights
Implant width
Number of implants
Opposing teeth or denture
Controlling Stress
Stress=Force/Area
Force
Stress
Area
Torque=
Force x Perpendicular distance
from the line of force to the
center of rotation
Cuspal Inclination
Cuspal Inclination
Treatment Plan
Options
Fixed
Implant Supported
Removable
Soft Tissue Supported
Implant Retained
Treatment Plan
Option 1
Lower Edentulous
Fixed
5-6 Implants
Prosthetic Options-Lower
5-6 Implants
• Hybrid Denture
• Fixed Crown and Bridge
• Cantilever 10-15mm
6 Implants-Fixed
Implant Supported
24
23
22
X
X
25
26
27
X
X
5 Implants- Fixed
Implant Supported
B
A
X
X
C
D
E
X
X
Treatment Plan
Option 2
Lower Edentulous
Removable
5 Implants
Prosthetic Options- Removable
Overdenture-Implant Supported
• Gold Bar w/ O Rings
• Distalized O Rings
• Cantilever 10-20mm
• Gold Bar with Hader Clips
• Distalized ERA’S
• Cantilever 10-20mm
C
B
A
C
D
B
E
A
D
E
Treatment Plan
Option 3
Lower Edentulous
Removable
4 Implants
Prosthetic Options- Removable
Implant and Tissue Supported
• Gold Bar with O Rings
• Cantilever 5-10mm
b
a
• Gold Bar with Hader
Clips and ERA’S
• Cantilever 5-10mm
b
c
d
a
c
d
Treatment Plan
Option 4
Lower Edentulous
Removable
3 Implants
Prosthetic Options- Removable
Overdenture-Lower
Implant and Tissue Supported
• Gold Bar w/ 2- O RingsOverdenture
• No Cantilevers
3 Implants- Removable Overdenture
Implant and Tissue Supported
C
B
D
Treatment Plan
Option 5
Lower Edentulous
Removable
2 Implants
Prosthetic Options
Removable Overdenture-Lower
Tissue Supported
• Gold Bar w/ Hader Clip
• O Ring on each implant
• ERA attachment on each
implant
2 Implants-Removable
Tissue Supported
B
D
Treatment Plans
Upper
Edentulous
Four
Options
Treatment Plan
Option 1
Upper Edentulous
Fixed
8 Implants
Prosthetic Options
Fixed- Upper
Implant Supported
• Fixed Crown and Bridge
• Hybrid Denture
• No Cantilevers Necessary
8 Implants- Fixed
Implant Supported
X
7
6
X
4
3
X
10
11
X
13
14
Treatment Plan
Option 2
Upper Edentulous
Removable
8 Implants
Prosthetic Options- 8 Implants
Removable- Upper
Implant Supported
• Gold Bar w/ O RingsOverdenture
• Gold Bar w/ 3 Hader Clips
Overdenture- No Palate
• Cantilevers-Optional
8 Implants- Removable
Implant Supported
• Gold Bar Overdenture • Gold Bar Overdenture
w/ O Rings
w/ Hader Bar / Clips
7
10
6
7
11
4
6
13
3
14
Palate
10
11
4
13
3
14
No Palate
Treatment Plan
Option 3
Upper Edentulous
Removable
6 Implants
Prosthetic Options
Removable- Upper
Implant Supported
• Gold Bar w/ 4- O Rings and distal
to #s 4 and 13
• Gold Bar w/ Hader Clip- ERAS
distal on #4 and 13Overdenture-No Palate
• Cantilever 5-10mm
6 Implants- Removable
Implant Supported
• Gold Bar w/ O Rings
• 5-10mm Cantilever
7
5
4
• Gold Bar w/ Hader
clips and ERA’s
• 5-10mm Cantilever
10
7
12
13
5
4
10
12
13
Treatment Plan
Option 4
Upper Edentulous
Removable
4 Implants
Prosthetic Options
Removable- Upper
Tissue Supported
• Gold Bar w/4 O RingsOverdenture w/ No Palate
• Gold Bar w/ Hader Clip and 2
distalized ERA attachments w/
Overdenture- No Palate
• No Cantilever
Arch Form
4 Implants-Tissue Supported
Square Arch
6
4
Tapered Arch
11
6
13
11
5
Maximum contact with tissue – No contact with Bar
Attachments are for retention ONLY
12
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