|Allan S. Deutsch, D.M.D., F.A.C.D.
The New EZ-Change Overdenture
Maximum Retention with Minimum
most articles that appear in Endo-Mail, this article does not have anything
to do with endodontics directly. However, when we developed the Flexi-Post,
we also made an overdenture attachment to go along with it. That overdenture
attachment is affixed to an endodontically treated tooth. Voila!
Thatís the connection between this article and endodontics.
††††This simple ball-and-nylon-socket attachment has been successfully
used around the world for the past fifteen years. Many articles about the
attachment and the technique have been published in international dental
journals. The EZ-Change Overdenture Attachment has been found to have the
highest retention among all overdenture attachments being sold. Yet
installing it is a very simple and direct technique to do. So why
am I talking about it here? Recently, we have improved it and now offer
it as an implant attachment.
Advantages of the EZ-Change Overdenture
Unfortunately, not every root canal is a success, and many patients
come to us with only a few teeth left in the arch. In addition, there
are implant cases that start out with many implants placed and end up with
only a few that have integrated.
††††Also, many patients would like the convenience and esthetics of
fixed restorations, but can only afford removable restorations for their
implants. The restoration of implants with fixed cases is a time-consuming
procedure that is difficult for the dentist to master. The operatory and
laboratory aspects of these cases are quite complicated, and the majority
of dentists in the United States donít perform restorations of implant
The placement of the EZ-Change Implant Overdenture Abutment Attachment
(from Essential Dental Systems)
truly is ďeasy.Ē Itís a simple technique even if you have not restored
implant cases before. It gives your patient a restoration that looks
great and works even better.
FIGURE 1: A healing screw
allows the gingiva to heal in the desired shape.
|The Placement Technique
O.K., so what do you need to perform this technique? Well, you
donít need teeth. If your patient has an existing denture, even better.
If not, hold on to the bridgework that the patient currently has as a temporary
restoration until the implants have integrated and are ready to be loaded
(usually approximately six to nine months). Talk to your oral surgeon
or periodontist to determine which implant type they are most comfortable
in placing. Generally, they will be placing either a; Branemark ,
3i, SteriOss, Calcitek, IMZ, or Paragon implant.
††††We have overdenture attachments that are compatible with these
††††Once the implant has integrated, whoever placed it will now surgically
uncover it. A healing screw can now be placed to allow the gingiva
around the implant to heal in the desired shape. The shape that we
want is just a parallel cylinder from the top of the implant to the top
of the gingiva (see Figure 1). Once the gingiva has healed, you will
need to know the height (thickness) of this gingiva to determine the gingival
cuff height of the implant overdenture attachment (labeled H in Figure
2). When you know the implant type (Branemark, 3i, Paragon etc.), and the
gingival cuff height of the attachment , you will be able to pick out the
exact implant OVD attachment from the catalog for your case.
††††Before placing the attachment, the denture is constructed.
You can let the patient wear it for several weeks until all the soft tissue
is compressed and any wear spots are relieved. You can now remove
the healing screw from the implant and, using the appropriate wrench, screw
in the E-Z Implant Overdenture Attachment into the implant (Figures 3 and
4). Then the rubber band is placed over the ball attachment to block
out the height of contour of the ball and prevent the acrylic from locking
under the ball. Once the rubber band is in place the EZ-Change nylon
cap and keeper are placed onto the ball (Figures 5 and 6).
FIGURE 2: H indicates the
gingival cuff height.
FIGURE 3: Removing the healing
screw from the implant.
FIGURE 4: Screwing the E-Z
Implant Overdenture Attachment into the implant.
FIGURE 5: The EZ-Change nylon
cap and keeper.
FIGURE 6: The cap and keeper
in place on the ball.
||††††Some marking paste or Occlude marking spray is placed on top of
the keeper. The denture is seated and then removed. The marking paste
indicates the area in the denture that must be relieved to make room for
the female nylon cap and keeper part of the attachment. The denture
is then relieved. The denture is placed over the attachments and
checked to make sure that it seats passively in place (Figure 7).
Pink cold-cure acrylic is mixed and poured into the relieved areas in the
††††The denture is seated while the cold-cure acrylic sets. After eight
to ten minutes, the denture is removed. The metal keeper that holds
the nylon cap is now incorporated into the denture permanently. The
excess flash is removed, and the denture smoothed and polished. You
can now remove the rubber band that is still under the ball and dismiss
††††The nylon caps last about eighteen months to two years before they
wear out and lose their retention. At that time, a special wrench
is used to unscrew the nylon cap from the keeper and a new nylon cap can
be threaded in its place. This takes about thirty seconds to do and
is a really simple and easy technique to start you off with implants. The
attachments have a fifteen-year clinical history of happy patients and,
consequently, happy dentists.
FIGURE 7: The denture is placed
over the attachments and checked to make sure that it seats passively in
We welcome your responses and questions.
Please feel free to visit the Endo Forum
and add your comments about any of the articles in Endo-Mail.