Attachments on 4 Straumann® RN/NNC implants for retention of full upper denture with palatal reduction
A clinical case report by Michael Kristensen, Denmark
In the present case, four Straumann® RN/NNC implants with Straumann® Novaloc® attachments added high retention to a full upper denture. The four implants were placed almost parallel, making it an easy case for the dental technician as well. Sometimes the anatomy of the residual upper ridge gives the implants in the front an anterior inclination. In such cases, angulated Novaloc® abutments can be beneficial in reducing “shine through” of the attachment housing through the acrylic.
2 private practices in Aarhus, Denmark with focus on implantology, prosthetics, ortodontics and endodontics. Postgraduate education curriculum in Implantology at the Goethe University Frankfurt, Germany. Speaker for Straumann on national level.
The patient, a diabetic, non-smoking 75 year old male, was referred to the clinic complaining of a lack of retention of full upper denture due to severe resorption of the alveolar ridges.
The patient wanted to restore his chewing capacity and the security of knowing that his denture would not come loose under function. Orthopantomography showed enough bone under the sinuses for the placement of 10 mm implants (Fig 1). But intraorally the width of the bone was reduced in the frontal area. We planned 4 tissue level implants: 2 RN distally in the region 14, 24, and 2 NNC in the region 12, 22, with the new Novaloc® attachments and new upper denture with palatal reduction. 1 mm Novaloc® abutments were used on the 2 RN implants and 3 mm Novaloc® on the 2 NNC implants. This case report focuses mainly on the prosthetic procedure and the use of Straumann® Novaloc® abutments.
A crestal incision was made from 15 to 25, and a full periosteal flap was reflected. In the region 14 and 24 the implant bed was prepared just to the sinus floor. Next, two Straumann® RN 4.1 mm x 10 mm were inserted. Since the bone width was reduced in the region 12 and 22, Straumann® NNC 3.3 mm x 10 mm were placed. All implants showed good primary stability with an insertion torque of 25 Ncm, and healing caps (2 mm RN, 3 mm NNC) were mounted for transgingival healing. The upper denture was adapted and relined following suture removal after 1 week.
After 4 months of healing time (Figs. 2-3) (patient was hospitalized meantime), the black Novaloc® attachments (Figs. 4-5) were placed using the SCS screwdriver with an insertion torque of 35 Ncm (Fig. 6). An impression was taken to fabricate the new upper denture. The matrix housing is available in two materials, titanium and PEEK. For this case we chose the two PEEK matrix housings, which were relined in the denture according to standard procedures. Note: In contrast with other well-known systems, the retention inserts are made of PEEK instead of nylon. The final result for the upper overdenture, adapted to the Straumann® Novaloc® technology, is presented in Figs. 7-9
A full upper denture with Novaloc® attachments and palatal reduction resulted in better patient comfort and quality of life. The patient was very happy with the esthetics and the function. The dentist and the laboratory were also pleased with this new product: The handling was very convenient, in addition the familiar SCS screwdriver could be used, making an additional tool unnecessary. Lab work by Michael Wiernek, Aarhus, Denmark.