Implants and RPD’s

John Beumer III DDS, MS Ting Ling Chang DDS Robert Faulkner DDS

Division of Advanced Prosthodontics, UCLA This  program  of  instruc1on  is  protected  by  copyright  ©.    No  por1on  of  this  program  of  instruc1on  may  be  reproduced,  recorded  or  transferred  by  any  means  electronic,  digital,  photographic,  mechanical  etc.,  or  by  any  informa1on  storage  or  retrieval  system,  without  prior  permission.  

Implants  have  been  used  under  following  circumstances  in  conjunc1on  with  RPD’s.  •  In  extension  base  RPD’s  (Kennedy  Class  I  and  II)  to  supplement  

the  support,  stability  and  reten1on  provided  by  the  exis1ng  den11on.        

•  Implants  with  ques1onable  anchorage  and  configura1ons  with  unfavorable  biomechanics  

•  Unan1cipated  implant  failures  in  key  loca1ons  •  Replacement  for  a  key  natural  tooth  abutment    •  As  a  supplement  when  the  exis1ng  den11on  cannot  provide  

sufficient  support,  stability  and  reten1on  for  the  removable  prosthesis  

Implants and RPD’s

In  extension  base  RPD’s  (Kennedy  Class  I  and  II)  to  supplement  the  support,  stability  and  reten1on  provided  by  the  exis1ng  den11on.        

Position and lengths •  Implant site most favored – 1st molar position •  Lengths vary but in recent times some clinicians have

reported successful outcomes when using implants as short as 6 mm in length (Gates et al, 2012).

In  extension  base  RPD’s  (Kennedy  Class  I  and  II)  to  supplement  the  support,  stability  and  reten1on  provided  by  the  exis1ng  den11on.        

Prosthodon1c  issues  •  Resilient  aNachments  

•  Provide  both  reten1on  and  stability  with  less  risk  of  implant  overload  (Cho,  et  al  2002)  

•  Cover  the  retromolar  pad  and  the  buccal  shelf  •  Provides  ample  support  

•  RPD  should  be  designed  with  guide  planes,  proximal  plates  and  posi1ve  rests  on  natural  tooth  abutments  

In  extension  base  RPD’s  (Kennedy  Class  I  and  II)  to  supplement  the  support,  stability  and  reten1on  provided  by  the  exis1ng  den11on.        

Complica1ons  (Gates,  et  al,  2012)  •  Peri-­‐implan11s  •  Loosening  abutments  •  Wear  aNachments  •  Occasional  implant  loss  

Implants  with  ques1onable  anchorage  and  configura1ons  with  unfavorable  biomechanics  

Why  overlay  RDP?  –  GraXed  implant  sites  –  Unfavorable  crown  implant  ra1os  –  Linear  configura1on  –  Bracing  (cross  arch  stabiliza1on  

Implants  with  ques1onable  anchorage  and  configura1ons  with  unfavorable  biomechanics  

•  Implant  connec1ng  bar  designed  to  be  implant  assisted  

•  Note  posi1ve  cingulum  rest  was  placed  on  the  canine  an  a  pothole  rest  on  the  lateral  inicsor  

Implants  with  ques1onable  anchorage  and  configura1ons  with  unfavorable  biomechanics  

•  Defini1ve  prosthesis  

Unan1cipated  implant  failures  in  key  loca1ons  

•  Two  implants  were  lost  on  each  side  and  the  pa1ent  chose  not  to  undergo  addi1onal  surgery  

•  Posi1ve  cingulum  rests  were  placed  on  each  central  (the  central  incisors  were  splinted)  and  the  posterior  molars    

•  The  aNachments  were  resilient  and  were  primarily  used  for  reten1on  so  as  to  avoid  placement  of  retainers  anteriorly  

Defini1ve  prosthesis  – Note:    The  aNachments  were  designed  to  be  engaged  on  the  same  plane  as  the  path  of  inser1on  of  the  RPD  framework  

Unan1cipated  implant  failures  in  key  loca1ons  

•  Implant  supported  removable  par1al  dentures  

Replacement  for  a  key  natural  tooth  abutment    

•  On  some  occasions  a  key  abutment  tooth  on  one  side  of  the  arch  used  to  support  and  retain  a  removable  par1al  denture  is  lost.      

•  If  the  remaining  teeth  on  that  side  of  the  arch  are  not  suitable  abutments  for  a  removable  par1al  denture  the  authors  have  replaced  the  tooth  with  an  implant/s.    

Replacement  for  a  key  natural  tooth  abutment    

•  Note  the  use  of  resilient  aNachment  

Replacement  for  a  key  natural  tooth  abutment    

l Note  the  use  of  resilient  aNachments  

As  a  supplement  when  the  exis1ng  den11on  cannot  provide  sufficient  support,  stability  and  reten1on  for  

the  removable  prosthesis  

•  Remaining  maxillary  molars  compromised  periodontally  

•  Large  RPD  obturator  •  Note  the  rests  on  the  bar  

 

Overlay Removable Partial Dentures

Note: •  Anterior open bite •  Fistulas •  Soft palate defect

Overlay Removable Partial Dentures

v Remaining teeth covered with gold copings. v Tooth tissue junction should be covered with metal as

opposed to acrylic resin v  Implants placed in posterior quadrant.

Design of the metal framework

  Note  that  the  tooth  1ssue  junc1on  of  all  overlaid  teeth  are  covered  with  metal  as  opposed  to  acrylic  resin.    The  resin  is  porous  and  if  you  cover  these  areas  with  this  material  you  will  increase  the  risk  of  gingival  caries  

  Note  the  metal  occlusal  surfaces  overlaying  the  implant  connec1ng  bar.    This  was  done  to  accommodate  for  the  lack  of  space  between  the  implant  connec1ng  bar  and  the  opposing  natural  den11on.  

Definitive prosthesis.

Overlay Removable Partial Dentures

Overlay  RPD’s  

Defini1ve  prosthesis  

As  a  supplement  when  the  exis1ng  den11on  cannot  provide  sufficient  support,  stability  and  reten1on  for  the  removable  

prosthesis  

•  Implants  were  placed  with  the  aid  of  a  surgical  template  so  they  were  aligned  consistent  with  the  path  of  inser1on  of  the  RPD  

As  a  supplement  when  the  exis1ng  den11on  cannot  provide  sufficient  support,  stability  and  reten1on  for  the  removable  

prosthesis  

Defini1ve  prosthesis  

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