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Special Issues
July/August 2022
Volume 43, Issue 1

Restoring a Challenging Maxillary Case With a LOCATOR® Bar Overdenture

Michael D. Scherer, DMD, MS

A 72-year-old woman presented with pre-existing dental implants in the approximate positions of Nos. 3, 5, 8, 11, and 14. Because of the patient's age and history of osteoporosis, the surgeon who performed the implant placement had had difficulty locating adequate bone to support the implants. Although the implants were osseointegrated with no clinical signs of mobility, a moderate amount of bone loss around each one was evident. The patient was initially treatment-planned for a crown-and-bridge FP3-style fixed restoration. However, after extensive discussion regarding her concerns, which included a desire for a more esthetically pleasing smile, she opted for a removable RP4-style LOCATOR® bar overdenture restoration (Zest Dental Solutions, zestdent.com), which she would be able to clean and maintain regularly and independently. A vinyl polysiloxane (VPS) impression was made of the implants and a prototype restoration designed. With the prototype used as a guide, a bar framework with four LOCATOR abutments was fabricated. Denture teeth were applied to the framework suprastructure, and the fit of the bar and the tooth arrangement were evaluated intraorally. Upon patient approval, the restoration was finalized and processed using conventional methods. The patient returned for prosthesis placement, and the LOCATOR bar was placed onto the implants. The prosthesis was then placed onto the bar ensuring its stability, and esthetics, phonetics, and occlusion were confirmed.

Key Takeaways

For cases that call for a bar attachment, the LOCATOR bar attachment provides superb retention, long-lasting durability, and a low profile design.

The implant-supported bar attachment system features a self-aligning denture cap for easy and accurate overdenture seating.

The RP4-style LOCATOR bar overdenture restoration used in this case provided the patient the esthetics she desired while giving her the ability to remove, clean, and maintain the prosthesis.

About the Author

Michael D. Scherer, DMD, MS
Assistant Clinical Professor, School of Dentistry, Loma Linda University, Loma Linda, California; Chief Clinical Officer, Zest Dental Solutions; Fellow, American College of Prosthodontists; Private Practice, Sonora, California

Fig 1. The patient presented with a complete denture and a smile that she felt was unesthetic.

Figure 1

Fig 2. Existing dental implants (Astra Tech TX, Dentsply Sirona, dentsplysirona.com) were in prosthetic positions for a crown-and-bridge–style case.

Figure 2

Fig 3. Due to patient factors, there was a moderate amount of radiographic bone loss around the implants, which appeared to be insufficient to support a fixed restoration. Ultimately, the patient opted for a bar overdenture.

Figure 3

Fig 4. An impression of the dental implants was made with VPS (First Half™, Zest Dental Solutions).

Figure 4

Fig 5. Scan bodies for the implants were scanned using an intraoral scanner (Medit i700, Medit, medit.com), and a prototype prosthesis was fabricated in dental laboratory software (DentalCAD, exocad, exocad.com).

Figure 5

Fig 6. The prototype restoration was 3D printed in a provisional crown material (DENTCA Crown and Bridge resin, Dentca, dentca.com) using a laboratory-grade printer (Max UV, Asiga, asiga.com). The prototype restoration was tried in the patient’s mouth to evaluate vertical dimension of occlusion (VDO), centric relation, and tooth contours.

Figure 6

Fig 7. A bar framework was designed and milled using a laboratory-grade milling machine (R5, vhf, vhf.com). LOCATOR bar abutments were placed onto the bar and torqued, and a metal suprastructure was designed and fabricated. Enigma™ denture teeth were placed onto the suprastructure, and the prosthesis was processed using conventional methods.

Figure 7

Fig 8. The patient returned for prosthesis placement. Healing abutments were removed, and the LOCATOR bar was placed onto the implants.

Figure 8

Fig 9. The LOCATOR bar overdenture contours were verified, ensuring the patient would have sufficient ability to clean underneath the prosthesis for the long-term health of the dental implants.

Figure 9

Fig 10. A radiograph was obtained to confirm complete adaptation of the LOCATOR bar framework prior to prosthesis placement.

Figure 10

Fig 11. Light retention LOCATOR inserts were placed into the prosthesis and then onto the bar, providing sufficient retention and stability of the prosthesis.

Figure 11

Fig 12. Esthetics, phonetics, VDO, and occlusion were verified. The patient was highly pleased with the final result.

Figure 12

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