TABLE OF CONTENTS Aug 2012 - 0 comments

Simple Replacement of Prosthetic Components

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By: Blake Nicolucci, BSc, DDS
2012-08-01

CASE PRESENTATIONS
if anyone out there is lucky enough to have implants last for 20 to 30 years, then this might make for some interesting reading for you. I must say it is one of the longest times for survival that I’ve had a ‘delinquent’ implant patient return for work (although others have returned for some surgical repair, implant removal or replacement). The patient had implant treatment and was immediately transferred out of the city. This patient was a 40 year old hockey player when the implants were placed twenty-two years ago, — go figure! He was and still is a stocky, muscular, athletic individual with clenching forces that would make me second guess his suitability for any implant reconstruction at all today! But back in the ‘good-old-days’, we were looking for anyone who would be willing to ‘go under the knife’ for any type or style of dental implant (and because of the cost, they were few and far between!).

This article demonstrates that even after 22 years of heavy function under a complete lower denture, older implants can be salvaged and ‘restored’ to a functional state once again. Initially, the two implants used to secure the complete lower denture were fitted with male/female [ball and ‘O’ ring] attachments. However, after repeated removal and replacement, (as I mentioned earlier, this patient had the prosthesis constructed over 20 years ago), the actual metal ball on the implant (the male component of the structure) was worn so much that there were no ‘O’ rings that could be used to regain the tight fit that he had originally enjoyed. There were ‘O’ rings that are still manufactured that could be used as a replacement in the female housing of the denture, but they were all too wide to engage the worn male component in a way that would secure. In nearly every circumstance I have encountered, replacement of the ‘O’ rings was the ‘quick solution’ to this problem. But when his ‘O’ rings were replaced, they could not retain the denture to his ridge during normal function to his satisfaction.

Unfortunately, the ball component of the attachment could no longer be found on the market (or with the thousands of extra parts for many different implant systems I have used over the years). They were no longer available to purchase, and I had none left in my old ‘tackle box’. The only solution to the problem would be to replace the complete attachment system with something that would:

— Fit the older implant system (which I luckily had recorded in my files) – and

— Have the retention that was needed for a man of this stature and clenching force.

In the implant arena, there are a myriad of new styled implants, surfaces, coatings, materials and shapes, and so it becomes very important to record the style and manufacturer of the implants that have been used in each patient. There have also been some ingenious prosthetic components that have been developed since the days of the ‘Blade’ implant and the ‘Subperiosteal’ implants and I needed one right now — the ‘Locator Attachment’.

The ‘Locator’ attachments (that I had used for many years in natural teeth as an anchor to secure lower dentures with the residual roots of mandibular teeth [cuspids more particularly] that had undergone root canal therapy) turned out to be a ‘winner’ for the situation I was faced with. There was actually a thread available that would fit these old implants! The following photographs show the process of the removal of the old balls and permucosal extensions, and replacement with the newer ‘Locator’ system components. I have also included photo’s demonstrating the wrenches and attachments that are used inside the denture, as well as those used intra-orally. OH

Dr. Blake Nicolucci is president of the Canadian Society of Oral Implantology and is Oral Health magazine’s editorial board member for Implantology.

Oral Health welcomes this original article.

Photos

Figure 1. In this intra-oral photo, the ball attachments have been removed from both implants, the permucosal extension on the implant in the #33 position has yet to be removed, and the newer permucosal extension has been inserted into the implant in the #43 position after removal of the old component.
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Caption: Figure 1. In this intra-oral photo, the ball attachment...
Figure 2.This photo illustrates the old 'male' components that were removed from the implants. The ball insert is shown bottom right, and middle right. The permucosal extension is shown top left and middle left. The different style wrenches to remove these components is also demonstrated.
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Caption: Figure 2.This photo illustrates the old 'male' componen...
Figure 3. This photo shows how the two pieces are joined to each other, and into the implants.
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Caption: Figure 3. This photo shows how the two pieces are joine...
Figure 4. This is a close-up of the male component (ball attachment) showing the wear on the outer diameter reducing its retentive capacity.
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Caption: Figure 4. This is a close-up of the male component (bal...
Figure 5. In this photo you can see the old hex tool used to remove the old permucosal extensions.
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Caption: Figure 5. In this photo you can see the old hex tool us...
Figure 6. After removal of the male components (bottom and middle of the picture), the female components (that hold the 'O' rings or composite inserts) are removed from the denture (top of the photo).
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Caption: Figure 6. After removal of the male components (bottom ...
Figure 7. This photo illustrates the new permucosal extension and the specific new tool that can be used to both place and remove the new component. Note the three pronged triangular torqueing positions on the inside of the head to engage the wrench.
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Caption: Figure 7. This photo illustrates the new permucosal ext...
Figure 8. After the old intra oral components have been removed, the new 'Locator' male components can be inserted into the implants (the permucosal extensions followed by the retentive male inserts). Above you can see the Female components locked on to the male components to be picked up in the old denture with a PVS impression (that will lock on to the undercuts).
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Caption: Figure 8. After the old intra oral components have been...
Figure 9. After the old female components have been removed from the denture, the chambers produced in the denture that will house the new fixtures are made large enough so as not to restrict or interfere with the seating of the denture over the new female components (once the analogs have been attached to the male components intra-orally before the impression). In some cases, it may be necessary to tunnel completely through the other side of the denture to eliminate interferences.
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Caption: Figure 9. After the old female components have been rem...
Figure 10. In this photo, the female components have been picked up from the new intra-oral male components in a full PVS impression. This impression will be used not only for ideal positioning and stabilization of the new female components, but for a full denture reline as well (the first one he has had since he left the practice 22 years ago).
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Caption: Figure 10. In this photo, the female components have be...




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