Important Concepts

• Mechanical strategies behind the design of the bar and position of attachments on it that brings success of retention and longevity of a prosthesis
• How to restoratively begin any case—each case starts the same way

Denture Therapy

• There should not be unpredictability and frustrations in the end result
• In making dentures, there is more objectivity than subjectivity
• Learn predictable denture techniques and plan for the future
• When in doubt, give a maxillary denture a chance and you can always plan for implant placement in the future
• Designing the best case for your patient

Provisional Restorations

• Provisional restorations and provisional dentures are a must
• Use the term “provisional” for your patients, not “temporary”
• Provisionals are blueprints for the final restoration
• Communication between you, your patient and the laboratory technician to re-establish aesthetics and phonetics, vertical dimension of speech and occlusion, form, function and shape
• Work hard on the front end to make your provisional perfect so the final restoration is easy, predictable and profitable

Denture Retention

• Accuracy of the intaglio
• Border seal with proper height and thickness of flanges
• The proper design and finish of the polished surfaces so that the buccinator muscles help seat the denture
• Balanced occlusion

Practice Everything but Processing on the Next Six Edentulous Patients

• Pour the impressions
• Make the jaw relation records
• Mount the case
• Make the wax rim and the bases
• Set the denture teeth
• Try it in the mouth and evaluate to find any problems now
• Make a new jaw relation record
• Reset the teeth
• Try it in the mouth again; re-evaluate and continue with this process until you try it in the mouth and know it’s right

Dr. LoCascio’s Highlights

• If it looks right, it’s probably right; if it looks wrong, it’s probably wrong.
• Don’t ever put a denture set in a patient’s mouth, feel uncertain and then ask the patient if it’s acceptable. If you’re not happy with it, don’t even give the patient a mirror.
• It’s pretty rare that I try in a denture set and we’re ready to process. We usually do at least two, most of the time three, try-ins after we modify tooth positioning, based on aesthetics and phonetics. Spend the time on the front end—it’s critical.

Tissue Support

• Evaluate if a patient can tolerate tissue support or if they need an implant supported design
• If the patient can tolerate tissue support then they need implant assisted or retained overdenture
• If patient needs implant support then they need an implant supported prosthesis

Minimum Number of Implants—The Numbers:“2,4-4,6”

• Tissue Support: 2 in the mandible / 4 in the maxilla
• Implant Support: 4 in the mandible / 6 in the maxilla

Implant Retained overdenture

• Is there a universal timeframe of how often and how long you should change nylon attachments? And for that matter, at no charge? If you begin to charge a patient when you haven’t before, it becomes a real problem!

Retention

• Stud Attachments
  • Radicular: sits on outer aspect of root or implant (locator)
  • Intra-radicular: sits on the inner aspect of root or implant
• Bar Attachments (Intra-bar Attachment)
  • Can use a locator on a bar, which uses a lot of vertical height
  • Intra-bar Attachments: used when you have limited vertical space
  • Types: Seca M3 attachment, EDS Hader Clip, Locking bar attachments

Attachments

• Resilient: solid, rigid and lockable
• Non-resilient: rotational