Use of Implant-Supported Overdentures for Edentulous Patients

Edentulous patients—those who have lost part or all of their dentition—often face significant challenges related to the retention, stability, and comfort of conventional complete dentures. Post-extraction alveolar bone resorption progressively reduces the supporting tissue foundation, frequently resulting in inadequate denture retention. One solution that has evolved in modern prosthodontics is the use of implant-supported overdentures, which are removable prostheses assisted by implants that provide additional retention and stability.

Implants function as artificial roots anchored to the alveolar bone, while the overdenture is designed to attach to these implants using various attachment systems, such as ball, locator, bar, magnet, coping, or combination systems. This approach enhances the functional and biomechanical performance of the denture while preserving its removable nature, facilitating oral hygiene and maintenance.

Clinical studies and case reports conducted by Faculty of Dentistry UGM students and published in Majalah Kedokteran Gigi Klinis—including work by Gene Rizky Natalia Gunawan under the supervision of Prof. drg. Titik Ismiyati, MS, Sp.Pros.(K); Prof. Dr. drg. Haryo Mustiko Dipoyono, MS., Sp.Pros(K); and drg. Herijanti Amalia Kusuma, S.U., Sp.Pros(K)—have evaluated various overdenture retention systems. One case study demonstrated that combining magnet, coping, and bare root retention successfully improved mandibular complete denture retention. 

This article discusses implant-supported overdentures, their benefits and challenges, attachment options, and clinical recommendations.

Implants as Overdenture Supports

Function of Implants in Overdentures

Implants act as fixed anchoring structures that provide greater stability than retained natural roots. By establishing stable retention points in edentulous areas, implants help prevent translational and rotational denture movements during mastication and lateral occlusal loading.

Key advantages include

1. improved retention and stability
2. reduced alveolar bone resorption through physiological load transfer
3. enhanced masticatory efficiency
4. ease of removal for hygiene maintenance.

However, the practicalities of implant and overdenture fabrication require careful planning—including evaluation of bone anatomy, implant position, attachment type, motion tolerance, and patient hygiene.

Types of Overdenture Attachments

Common implant-supported overdenture attachment systems include:

1. Locator / ball attachment
2. Bar and clip / bar‐bar
3. Telescopic / coping
4. Magnet
5. Combination systems (e.g., bar plus magnet)

Each system has specific advantages and limitations depending on bone condition, vertical space, occlusal force direction, and patient hygiene capability.

Integration of Implant Systems with Combination Retention Concepts

Although the cited case study was not implant-based, the successful combination of bare root, coping, and magnet retention provides a conceptual analogy for implant-supported overdenture design.

For example, when strategically positioning implants, one implant might use a magnetic system (or locator), while the other implant might use a coping or friction-generating system. This combination can distribute the load more evenly and flexibly, and provide a retentive backup should one system weaken.

Strategic use of multiple attachment systems can distribute loads more evenly

• enhance retention redundancy
• offer flexibility in clinical adaptation.
• The distribution of retention forces and occlusal forces can be adjusted so that pressure concentration does not occur.

However, the combination design must take into account movement tolerances, installation precision, and cleaning.

Clinical Stages of Implant-Supported Overdenture Fabrication

The general clinical workflow includes

1. Evaluasi diagnostik:
   • Pemeriksaan radiografi (CBCT) untuk menilai volume dan kualitas tulang.
   • Cetakan diagnostik dan analisis hubungan maksilo‐mandibula.
   • Perencanaan posisi implan agar selaras dengan rangka gigi tiruan.
2. Pemasangan implan:
   • Prosedur bedah (tahap 1 dan bila perlu tahap 2), penyembuhan tulang (osseointegration).
   • Pemantauan penyembuhan jaringan lunak.
3. Penempatan abutment dan pemasangan attachment:
   • Pasang attachment (locator, ball, bar, magnet, coping) sesuai desain.
   • Uji kesesuaian dan toleransi gerak.
4. Pencetakan overdenture:
   • Cetakan presisi dengan abutment/attachment terpasang.
   • Proses laboratorium: pembuatan bar, koping, basis akrilik, atau elemen magnetik.
5. Inseri dan penyesuaian:
   • Cek retensi, stabilitas, oklusi, kenyamanan.
   • Edukasi pasien dalam penggunaan dan perawatan.
6. Kontrol jangka panjang:
   • Pemeliharaan kebersihan (implan dan jaringan sekitarnya).
   • Penggantian elemen attachment (misalnya insert locator, magnet) bila aus.
   • Pemeriksaan radiografi berkala untuk mengevaluasi stabilitas tulang.

Benefits, Risks, and Challenges

Benefits

• significantly improved retention and stability
• reduced prosthesis displacement
• preservation of alveolar bone
• enhanced patient comfort and confidence

Risks and challenges

• implant osseointegration failure
• technical complications
• inappropriate attachment selection
• ongoing maintenance needs
• potential peri-implant inflammation due to poor hygiene.

Clinical Recommendations

To optimize the use of overdenture-supported implants:

• Perform CBCT-based planning and digital protocols when appropriate.
• Select attachment systems compatible with available vertical space (locator systems are often preferred).
• Consider combination retention designs to provide backup stability.
• Educate patients on hygiene and maintenance
• Conduct regular clinical and radiographic follow-up.

Overall, implant-supported overdentures offer substantial functional and comfort improvements for edentulous patients. The concept of combining retention systems—such as magnet, coping, and bare root approaches—may serve as technical inspiration when designing multi-retention implant-based overdentures.

References
MKGK, Gene Rizky Natalia Gunawan, Prof. drg. Titik Ismiyati, MS, Sp.Pros.(K), Prof. Dr. drg. Haryo Mustiko Dipoyono, MS., Sp.Pros(K), drg. Herijanti Amalia Kusuma, S.U., Sp.Pros(K), Perawatan gigi tiruan lengkap menggunakan overdenture magnet, coping dan bare root sebagai retensi, https://journal.ugm.ac.id/mkgk/article/download/65735/31234

Author: Rizky B. Hendrawan | Photo: Freepik