Nesbits and Implant Supported Unilaterals
Posted on 02/12/2014
Treating the unilateral edentulous space, for example where #3 and 4 are missing, poses certain challenges if the patient has limited funds for a fixed bridge or for implant supported fixed prostheses.
In a recent article in Denstistry Today*, Dr. John F. Carpenter discusses the implant supported nesbit. He notes the inherent problems with standard nesbits - risk of swallowing - and the deficiencies associated with instability of the cast nesbit and tissue pressure with a flexi nesbit.
His alternative is an attachment or implant supported nesbit - or a combination. For example, a single implant between #3,4 with a locator abutment. For three unit bridges, he offers the option of a mini era attachment on the most mesial tooth, and an implant in the far distal area. He argues that implant and attachment supported nesbits have a much lower risk of patient swallowing.
From a cost perspective, the option of an implant supported nesbit is a great option. But we do recommend that doctors planning a case should make sure they feel comfortable with chairside placement of the male attachments using self curing acrylic. A common issue that arises in the lab is where a doctor not familiar with chairside placement of male parts asks for an implant supported denture, without providing an impression using an impression coping and analog. It’s important to note that lab techs cannot process male attachments on a stone model replica of the locator abutment or era attachment. The lab needs to work on the metal analog.
One easy and effective solution is for the lab to make the partial with space left for the attachment. This requires that the doctor purchase the parts and tools needed for chairside placement. It is the most cost effective approach as there is no implant labor charge by the lab, and no markup of the implant parts.
Thanks for reading and have a great day!
*Dentistry Today January 2014 Pg. 106. Implant-Assisted Unilateral Removable Partial Dentures by Dr. John F. Carpenter
In a recent article in Denstistry Today*, Dr. John F. Carpenter discusses the implant supported nesbit. He notes the inherent problems with standard nesbits - risk of swallowing - and the deficiencies associated with instability of the cast nesbit and tissue pressure with a flexi nesbit.
His alternative is an attachment or implant supported nesbit - or a combination. For example, a single implant between #3,4 with a locator abutment. For three unit bridges, he offers the option of a mini era attachment on the most mesial tooth, and an implant in the far distal area. He argues that implant and attachment supported nesbits have a much lower risk of patient swallowing.
From a cost perspective, the option of an implant supported nesbit is a great option. But we do recommend that doctors planning a case should make sure they feel comfortable with chairside placement of the male attachments using self curing acrylic. A common issue that arises in the lab is where a doctor not familiar with chairside placement of male parts asks for an implant supported denture, without providing an impression using an impression coping and analog. It’s important to note that lab techs cannot process male attachments on a stone model replica of the locator abutment or era attachment. The lab needs to work on the metal analog.
One easy and effective solution is for the lab to make the partial with space left for the attachment. This requires that the doctor purchase the parts and tools needed for chairside placement. It is the most cost effective approach as there is no implant labor charge by the lab, and no markup of the implant parts.
Thanks for reading and have a great day!
*Dentistry Today January 2014 Pg. 106. Implant-Assisted Unilateral Removable Partial Dentures by Dr. John F. Carpenter
