LOCATOR FIXED for full-arch restorations

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Dr. Xavier E. Saab explains a new way to deliver fixed full-arch restorations utilizing traditional LOCATOR® abutments and a new fixed attachment system

Introduction

The treatment of edentulous arches with full-arch fixed dental prosthetics is the oldest form of restorations placed on root form endosseous implants as presented by Brånemark, et al., in 1977.1 Many different techniques and philosophies of fixed full-arch restorations have been developed and described in the past 55 years, which include, but are not limited to, different types of restorative materials, implant numbers and angulations, management of the restorative space, healing protocols, and analog or digital workflows. Even though some of these variations of full-arch therapy may be clinically simpler to perform than others, the final prostheses usually require final insertion with prosthetic screws that make the prosthetic material easier to fracture and create the necessity to utilize materials to seal screw access holes. These issues increase the maintenance times and the potential for prosthetic complications throughout the life of the prostheses.

Imagine being able to design and build an FP-3 full-arch (fixed-detachable hybrid) prosthesis, utilizing the current techniques used to make a simple denture or overdenture. Imagine being able to deliver these prostheses with a single snap and perform maintenance and repair appointments without having to drill screw access covers, removing screws, choosing new screws, torquing the prosthesis, and resealing it after the required procedure.

This article presents a new, innovative, and simple technique to deliver fixed full-arch prostheses utilizing a proven and well-known removable overdenture abutment (Zest LOCATOR®), with a new FDA-approved fixed prosthetic attachment (LOCATOR FIXED™ Attachment System), while using traditional denture fabrication procedures.

Figures 1A and 1B Pre extraction records
Figures 1A and 1B: 1A. Pre-extraction records. Patient presented with periodontal concerns and extensive decay. 1B. Six LOCATOR® Implants (Zest Dental Solutions) were placed in strategic positions for a future fixed-prosthesis option

Patient background

Our patient presented with maxillary and mandibular terminal dentitions. Different options were discussed with him for the replacement of his teeth, which included complete dentures, implant-retained overdentures, and fixed prostheses on implants. After considering the costs and benefits of each alternative, the patient decided to have all his remaining teeth removed and replaced with maxillary and mandibular implant-retained overdentures.

Figures 2A and 2B
Figures 2A and 2B: 2A. A conventional prosthesis was fabricated with the intention to convert to a fixed prosthesis. 2B. LOCATOR FIXED housings were attached using intraoral pickup method and CHAIRSIDE Attachment Processing Material (Zest Dental Solutions)

Initial treatment plan

Interim dentures were fabricated prior to the extractions. All remaining teeth were removed, alveoloplasty performed, and implants placed at the same appointment. The interim dentures were inserted immediately after surgery with a tissue-conditioning reline material. The patient was allowed to heal for 4 months, then the implants were successfully tested for osseointegration. LOCATOR abutments were selected and torqued as recommended by the manufacturer prior to beginning the definitive prosthetic treatment. Maxillary and mandibular implant-retained overdentures were fabricated using traditional indirect techniques. Both prostheses included metal frameworks for strength and long-term survival, and the LOCATOR housing was picked up chairside at the time of delivery.

Figures 3A and 3B
Figures 3A and 3B: 3A. The prosthesis was trimmed and adjusted to eliminate the palate and flanges to convert into a fixed prosthesis. 3B. Processing inserts were replaced with LOCATOR FIXED (Zest Dental Solutions) inserts

Our patient reported to be very pleased with his new smile at the time of delivery. But after several adjustment appointments, he reported constant problems with his maxillary overdenture causing gagging and nausea after 1 or 2 hours of wearing his prosthesis. For over 1 year, he only wore his denture a few hours per day and at mealtimes, and he felt his quality of life had not improved since the time of extractions.

Figures 4A and 4B 4A. Before extractions and implants. 4B. After surgical procedures
Figures 4A and 4B: 4A. Before extractions and implants. 4B. After surgical procedures and prosthetic conversion into a fixed full-arch prosthesis

Revised treatment plan

We discussed the possibility of changing the type of prosthesis on the maxilla from removable to fixed. We explained to the patient the availability of a novel attachment system utilizing his existing LOCATOR abutments, and he expressed excitement about the possibility. A new maxillary complete denture was fabricated around the LOCATOR abutment utilizing the indirect technique and conventional procedures. This time the denture did not have a metal-reinforcing framework since it will be converted into a fixed prosthesis.

Summary

For over 4 decades, the delivery of full-arch implant prosthetics has been a convoluted series of clinical and laboratory procedures that have made it challenging for the general practitioner to make this therapy easily accessible to a great number of patients in need. The use of the traditional LOCATOR abutment with the LOCATOR FIXED Attachment System and simple removable prosthetic techniques will make full-arch implant rehabilitation a more predictable and economical way to reach many underserved patients. It will allow more general dentists to grow personally and professionally. And it will make the hygiene, maintenance, and repair appointments simpler and more efficient for the general dental practice.

Xavier E. Saab DDS MSXavier E. Saab, DDS, MS, completed his residency and specialty training in Prosthodontics at The University of Texas Houston Health Science Center Dental Branch, where he received his Master of Science degree. Dr. Saab also completed residency rotation in the MD Anderson Cancer Center Department of Head and Neck Surgery. He serves as a Clinical Assistant Professor in the graduate program of the UTHHSC Dental Branch Department of Restorative Dentistry. Dr. Saab is highly renowned for lecturing and teaching continuing education to dentists around the world in Implant Dentistry and Prosthodontics.

Dr. Saab hails from a family of dental specialists and grew up assisting his father, a Periodontist. He completed his doctorate at the University of Guayaquil, Ecuador, as the valedictorian of his class and Magna Cum Laude graduate. Dr. Saab is an active member of the American College of Prosthodontists. He also trained at the Dawson Center for Advanced Dental Study. He enjoys treating senior patients, doing complete makeovers, and most of all, giving his patients their smiles back. In his free time, Dr. Saab enjoys reading and sculpting. Dr. Saab’s practice, Houston Prosthodontic Specialists, is located in the Memorial area of Houston, Texas.

 

Disclosure: Dr. Xavier Saab is a speaker and key opinion leader for Zest Dental Solutions.



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