August 1, 2012
by Blake Nicolucci, BSc, DDS
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.