The maxillary overdenture; it is seemingly an older school approach. In today’s implant dentistry, most all maxillary plans are focused on fixed approaches. Few FP-1, some FP-2 and many FP-3/4. When I say FP-4, I am referring to the new normal to remove an inch of bone and have a 22mm fixed prosthesis with 11mm of pink restorative material.
Do these restorations support cosmetic, biomechanical or biological long term successful outcomes? Based on may social media posts and accolades, it is seemingly less important to today’s implant dentist to worry about these ideas. However, it is clear that the advanced loss of hard and soft tissue support lead to more complex restorative decision making.
Maxillary Over Dentures
With that said, I believe that a decision algorithm is a valuable tool in making clinical assessments and treatment plans. Lip support, speech, cleansability, biomechanics, materials consideration and contingency planning are important criteria to be considered in deciding how the edentulous maxilla will be restored. Today, many will place as few implants as necessary and not give much thought to exit positions and how the implant position influences the outcome. Short term and long term.
After 28 years of Prosthodontic specialty practice, I honestly do not fabricate many overdentures. And we have all accepted the fact that some of the older biomechanics theories and rules were not necessarily totally correct. My desire is to provide the conditions that allow an appropriate fixed restoration. But a decision menu is still an important tool to have when evaluating the edentulous maxilla. Therefore, here it is…
The 6 questions I think we should ask ourselves in planning the completely edentulous maxilla.
- How many implants are required?
- Is bone grafting required?
- How will the provisional be managed?
- Will it be cement or screw retained?
- Will it be restored at the abutment or implant level?
- What material will be used?