There are usually two emotional reactions when treatment involves the removal of all remaining natural teeth and creating a removable prosthesis to replace them. First, the patient becomes emotional when they finally realize they are getting all their remaining teeth removed, and secondly, the restorative dentist becomes emotional when realizing they need to find all the correct components for a specific implant system.

Straumann Novaloc abutments
Figure 1: Straumann Novaloc abutments and attachments are available for bone level (BL), bone level X (BLX), and tissue level (TL & TLX).

One reason I enjoy dentistry is because I help edentulous patients with an area on their face that is visible, personal, and important for function, speech articulation, and expression.

Recently, I worked with a great patient who presented with a fractured lower overdenture. One can only imagine the thoughts moving through her mind as she took the leap of faith required to move forward with treatment, which included a dental implant-supported overdenture that fractured soon after insertion.

initial presentation compared to restorative outcome with novaloc attachment system
Figure 2: Initial presentation (L) compared to the definitive restorative outcome (R) with the Novaloc attachment system for the lower overdenture.

The treatment for this patient included an upper and lower overdenture, each supported by four dental implants using the Novaloc attachment system. My goal was to quickly create a long-term, low-maintenance result for a patient forced into treatment for a new overdenture.

While creating a new upper and lower overdenture definitive restoration, I identified many scenarios where a Straumann Novaloc attachment system could solve most restorative challenges for edentulous patients.

The design features of the Novaloc attachment components caught my attention, and while working with the system, I now understand how this could be the first-choice system for overdenture patients in our practice.

The design features of Straumann's Novaloc attachment system include:

  • The PEEK attachment demonstrates a longer life span at 0 degrees, 7 degrees, and 12 degrees, representing an improvement over nylon attachments at 10,000 cycles.
  • The retention insert is designed to work around the external surfaces of the abutment – most likely to maintain a clean surface creating the retention as intended.
  • A 15-degree angle correction is available with the Novaloc abutments accommodating anatomic variations minimizing the accommodation required of the attachment.
  • The design of the PEEK retention insert helps absorb lateral pressure that occurs on insertion and removal, as well as during function.
  • The Novaloc housing is available in traditional titanium or a white PEEK version that improves the ability to mask color differences within the denture base.

Here's how the Novaloc attachment system helped create a successful outcome for my patient.

Identifying ideal tooth position

initial presentation of patients teeth
Figure 3: Initial presentation and treatment plan focused on identifying the desired tooth position in a 2-dimensional plane.
initial presentation with 2d overlay
Figure 4: Initial presentation and treatment plan focused on identifying the desired tooth position in a 2-dimensional plane.

The patient was concerned about the prominent appearance of her teeth. She felt she didn't look right when she saw herself in a mirror. The initial plan was to shorten the incisal edges of her teeth and alter the occlusal plane to achieve the desired appearance.

The next step was to verify the restorative treatment plan intraorally with a trial prosthesis.

patient side profile evaluation
Figure 5: The patient was concerned about their teeth being too prominent, so we evaluated tooth position to determine the desired outcome.

As we worked through finding the desired tooth position, it became clear that the incisal edges, the occlusal plane, and the anterior to posterior position of the maxillary teeth required modifications.

The patient felt more comfortable with her tooth display once the upper teeth were set back toward the alveolar ridge.

But, when working with any dental implant attachment system, when the upper teeth are moved back toward the residual alveolar ridge, restorative space becomes a concern. I needed to determine if there was enough space to embed the attachment components within the acrylic base of the overdenture.

maxillary impression
Figure 6: The maxillary impression picked up components for the Novaloc system and the PEEK housings positioned on the Novaloc abutments intraorally.

I positioned the Novaloc abutments to account for the thickness of the residual alveolar ridge soft tissues, as well as the path of insertion and removal. At this point, the goal is to construct the definitive prosthesis working with the foundation of the edentulous arch.

The restorative design for the patient's overdenture included an intaglio framework that supports the individual attachments. The patient's priority was for a durable overdenture due to the experience with the fracture of the initial overdenture. I designed the maxillary framework to accommodate an open palate should the patient ever want a change for some reason.

maxillary overdenture prosthesis with PEEK housings
Figure 7: The maxillary overdenture prosthesis incorporates a metal intaglio framework, PEEK Novaloc attachment housings, and white PEEK Optiloc retention inserts.

The PEEK attachment housings available in the Novaloc system provide a few unique advantages over the traditional metal housing. The white color is much easier to hide where the acrylic denture base is thin and potentially visible. The surface can be treated and bonded to the acrylic denture base instead of relying exclusively on retentive features incorporated into the surface of a metal housing.

restorative outcome patient results novaloc attachment
Figure 8: The restorative outcome for upper and lower dental implant-supported overdentures using the Novaloc attachment system.
changing optiloc PEEK retention insert
Figure 9: Changing the Optiloc PEEK retention insert was efficient and intuitive working with the Novaloc toolset.

When thinking about restorative options for edentulous patients, the Novaloc low-profile attachment system can be incorporated into the restorative design for almost any scenario. The Optiloc PEEK retention insert is durable over time, and the research rings true when I watched the patient work with the attachments and changing the insert.

Novaloc designed the housing to allow expansion of the slotted retentive insert, which is likely most critical on insertion and removal of the overdenture and serves well during chewing function. The availability of PEEK housing in the Novaloc system provides advantages in the ability to bond the housing while hiding it within the denture base. The 15-degree angle correction available in stock abutments helps minimize the need for the attachment insert to accommodate for divergence between multiple implants.

Please use the comment section below to leave your thoughts about this system.

Douglas G. Benting, D.D.S., M.S., F.A.C.P. is a member of Spear Resident Faculty.