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Download Secrets_of_Dentures_files/Successful Dentures Part 2
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Topics Conventional Denture Treatment: Secrets to Successful Dentures Trends in removable prosthodontics. Anatomy Maxillo-Mandibular Relationship Vertical Dimension Tooth Selection, Arrangement, and Occlusion Part II Implant Supported Overdentures: Dalhousie Continuing Education Dr. Mark Vallee BSc MS DDS DP FRCDC Overdenture abutments Implant Placement Locator Abutments Converting a denture into an overdenture. Direct Pickup Trends in Removable Prosthodontics Patient Demographics Conventional Denture Treatment Esthetic Awareness Implant treatment Patient Demographics Patient Demographics Average lifespan of patients: 14 Percent 13 60 Percent Edentulous 18+ yrs old 50 Percent Edentulous 65+ yrs old 12 40 11 10 1960 1970 Trends in tooth loss 1980 1990 30 1960 1970 1980 1990 Patient Demographics Esthetic Awareness Will there be a need for complete dentures in 2020? Complete dentures patients will increase from 33.6 million adults in 1991 to 37.9 million adults in 2020. The 10% decline in edentulism experienced each decade for the past 30 years will be more than offset by the 71% increase in the adult population older than 55 years. Esthetic Awareness Implant Treatment An increase in esthetic awareness has prompted Out of 33 million edentulous patients only 2-4% have received an increase in patient demand for quality removable prosthodontic restorative treatment. implant treatment Estimated 60% of patients are NOT given implants as a treatment option Implant supported overdentures are now the standard of care for the edentulous mandible Anatomy in Relation to Complete Dentures Edentulous Maxilla Anatomy a c k d d j b i l e m g f h a. Labial frenum b. Buccal frenum c. Labial vestibule d. Anterior buccal vestibule e. Posterior buccal vestibule •Retrozygomatic space •Coronoid bulge f. Hamular notch •Pterygomaxillary notch g. Fovea palatini h. Vibrating line i. Residual alveolar ridge j. Palatal rugae k. Incisive papilla l. Median palatine raphe m. Maxillary tuberosity Anatomy in Relation to Complete Dentures Edentulous Maxilla a c k d d j b i l e a. Labial frenum •Fold of mucous membrane •Does not contain muscle •Labial notch in denture is narrow b. Buccal frenum •Overlies levator anguli oris •May be moved in an A-P direction by the actions of the orbicularis oris and buccinator Anatomy in Relation to Complete Dentures Edentulous Maxilla a c k d d j b i l e m g m h g f Anatomy in Relation to Complete Dentures Edentulous Maxilla a c k d d j b i l e m g h f f. Hamular notch •Pterygomaxillary notch •Does not contain any muscles or ligaments to interfere with the addition of pressure with a postdam g. Fovea palatini •2 small pits representing mucous gland openings •Usually located just posterior to the vibrating line Anatomy in Relation to Complete Dentures Edentulous Maxilla a d b l e m g h Edentulous Maxilla a i. Residual alveolar ridge •Crest is primary stress bearing area •Fibrous CT least displaceable and best able to carry the stress of mastication j. Palatal rugae •Secondary stress bearing area h. Vibrating line •Imaginary line across palate •Connects the pterygomaxillary notches c k d d j b i l e m g h f Posterior Palatal Seal •Area not a line •Functions: border seal, prevent food impaction beneath, improve retention, compensate for shrinkage of denture resin •Pressure on displaceable mucosa that covers palatal glands •Anterior border – junction between hard and soft palate; ‘blow’ line •Posterior border (vibrating line) – junction between movable and immovable soft palate; ‘ah’ line Anatomy in Relation to Complete Dentures Edentulous Maxilla Denture bearing areas d j i Anatomy in Relation to Complete Dentures a c k f h f c. Labial vestibule •Reflection contains no muscle d. Anterior buccal vestibule •Overlies buccinator muscle whose fibers are downward and forward and limit the height and thickness of the buccal flange e. Posterior buccal vestibule •Thickness determined by the masseter muscle •Coronoid process of the mandible encroaches on the space during lateral excursions •Labial and buccal flanges of the denture must contact movable tissues in order to make a seal c k d d j b i l e m g f h k. Incisive papilla •Guards the incisive canal •Pressure will interfere with the blood and nerve supply causing a burning sensation •Provide relief l. Median palatine raphe Anatomy in Relation to Complete Dentures Edentulous Mandible i h l j g f k c e b a d a. Labial frenum b. Buccal frenum c. Lingual frenum d. Labial vestibule e. Buccal vestibule f. Residual alveolar ridge g. Buccal shelf h. Retromolar pad i. Pterygomandibular raphe j. Mylohyoid ridge k. Alveololingual sulcus l. Retromylohyoid space Anatomy in Relation to Complete Dentures Edentulous Mandible Anatomy in Relation to Complete Dentures Edentulous Mandible i h l j g f k c e b a d a. Labial frenum •Fold of mucous membrane •Does not contain muscle b. Buccal frenum •Overlies depressor anguli oris (VII) •Movable by the buccinator and orbicularis oris (VII) resulting in a wide notch in the denture c. Lingual frenum •Overlies genioglossus muscle (XII) Anatomy in Relation to Complete Dentures Edentulous Mandible Denture bearing areas i h l j g f k c e b a d. Labial vestibule e. Buccal vestibule •Entire periphery of denture must end in soft tissues •Stability of denture must come from the maximum use of all bony foundations where tissues are firmly and closely attached to bone i h l j f c e b a j g f k d c h. Retromolar pad •Contains: •Retromolar gland •Pterygomandibular raphe •Buccinator muscle •Temporal tendon •Underlying basal bone is resistant to resorption •Coverage will provide some border seal i. Pterygomandibular raphe •Extends from the pterygoid hamulus superiorly to the alveolar ridge inferiorly under the retromolar gland e b a Edentulous Mandible k l d Anatomy in Relation to Complete Dentures g i h d f. Residual alveolar ridge g. Buccal shelf •Bounded laterally by the external oblique ridge and medially by the crest of the ridge •Attachment of buccinator muscle (VII) •Buccal flange rests upon buccinator and should extend as far as the tissues permit •Masseter muscle (V3) may crowd buccinator forward against the denture causing an indentation at the DB angle Anatomy in Relation to Complete Dentures Edentulous Mandible i h l j g f k c e b a d j. Mylohyoid ridge •Attachment of mylohyoid muscle (V3) which forms the muscular floor of the mouth •Fibers are almost horizontal in front of the hyoid where they join those of the opposite side to form a raphe •At the level of the hyoid they pass almost vertically downward to insert into the hyoid k. Alveololingual sulcus •Slopes toward the tongue to permit action of the mylohyoid •Length of flange distally compared to anteriorly is greater owing to the changed length and direction of the mylohyoid fibers Anatomy in Relation to Complete Dentures Panoramic Radiograph Edentulous Mandible i h l l. Retromylohyoid space •DL extension determined by styloglossus (XII) •Posterolateral extension determined by superior pharyngeal constrictor (X) and palatoglossus (X) •Overextension may cause pain on swallowing j g f k c e b a Coronoid Process of mandible Mandibular Condyle Glenoid Fossa EAM d Maxillary Tuberosity Articular Eminence Nasal Septum Anterior Nasal Spine Hard Palate Pterygomaxillary Fissure Orbit Zygomatic Arch Maxillo-Mandibular Relationship Pharynx Earlobe Mandibular Foramen Mental Foramen Lip Lines Symphysis Mandibular Canal Maxillary Relations External Oblique Ridge Cervical Vertebrae Shadow of tongue Styloid Process Incisal Display Dental Midline Occlusal Plane Orientation Facebow Hyoid Bone Facial Artery Notch Maxillary Relations Natural Dentition Incisal Display at Rest Incisal edge of central incisor in relation to the lip line at rest Young woman – 3 mm below lip line at rest Young man – 2 mm below lip line at rest Middle age – 1.5 mm below lip line at rest Elderly (>80) – 0 mm below to 2 mm above lip line at rest Rest After Wax Adjustment Maximum Smile After Wax Adjustment Maxillary Relations Maxillary Relations Dental Midline Dental Midline Rest After Smile After Maxillary Relations Dental Midline Maxillary Relations Occlusal Plane Orientation Frontal Plane Parallel to interpupillary line Fox Plane Maxillary Relations Occlusal Plane Orientation Maxillary Relations Occlusal Plane Orientation Sagittal Plane Parallel to Camper’s Line Inferior border of the ala of the nose to the superior border of the tragus of the ear Frankfort horizontal plane Orientation to the external auditory meatus and orbitale Cephalometric landmark FHP CL OP Mandibular Relations Vertical Dimension Centric Relation Vertical Dimension Anatomic Landmarks 2/3 up the height of the retromolar pad Vertical Dimension Esthetics Vertical Dimension Adjust occlusal plane Parallel to maxillary rim Clinical assessment of vertical dimension Anatomic landmarks Physiologic rest position Pre-extraction records Existing prosthesis Esthetics Phonetics Swallowing Average occlusal rim dimensions Vertical Dimension Anatomic Landmarks Level with the lower lip at rest Vertical Dimension Phonetics ‘S’ ‘F’ ‘Ch’ ‘M’ Vertical Dimension Vertical Dimension Swallowing Average Occlusal Rim Dimensions Maxillary – 22 mm During swallowing Mandibular – 18 mm After swallowing Anterior Tooth Selection Tooth Selection Anterior Tooth Selection Anterior teeth are primarily selected to satisfy esthetic requirements Posterior teeth are primarily selected to satisfy masticatory requirements/ occlusion Anterior Tooth Selection Anterior Tooth Selection Guides Shape Pre-extraction records Photos, diagnostic casts, old radiographs Existing dentures Patient’s facial characteristics Patient’s gender, personality, age Arch size and shape Patient’s preferences Square, tapering, ovoid Size Length, width, circumference Shade Anterior Tooth Selection Shape Anterior Tooth Selection Dentogenics concept Rounded contours which taper towards the cervical ridge Moderate gingivo-incisal curvature Square moderate Offers maximum light deflection and creates a bold effect 50 Size Anterior Tooth Selection Size Wax rim & ruler Width of 6 anteriors •Commissure of lips represents distal surface of canine on a curve Average 46-56 mm Major rugae of palate points to canine position Tapering Central incisor is dominant and gingivo-incisal curvature is Age Young – tapered, ovoid, rounded teeth Middle – somewhere between young/old Old – square, sharp corners Anterior Tooth Selection curvature which tends to disperse light and create a softened appearance Personality Vigorous or delicate – maxillary lateral varies more in size, form, and position Anterior Tooth Selection Ovoid Pronounced gingivo-incisal Gender Male – rugged with square teeth and bold central incisors Female – pronounced curvatures, rounded point angles Shape Size Anterior Tooth Selection Exaggerated Smile Size Length High smile – 11% Reveals total length of maxillary anterior teeth and a continuous band of gingiva Average smile – 69% Reveals 75-100% of maxillary anterior teeth and interproximal gingiva only Low smile – 20% Displays less than 75% of maxillary anterior teeth Anterior Tooth Selection Size & Shape Anterior Tooth Selection Size & Shape Determine the facial Commercial Products outline Compare form of face to vertical lines Width Square tapering Determine the size of the maxillary central Indicator is proportioned in a ratio of 16:1 Width – 9.25 mm Length – 11 mm Length 56 Anterior Tooth Selection Take a picture Size & Shape Insert it into a program Anterior Tooth Selection Shade Portrait shade guide 57 Anterior Tooth Selection Aim to harmonize between color of the skin, hair, & eyes Guides Complexion Hair color Eye color Age Personality & activity Patient desires Need to educate patients Shade Anterior Tooth Arrangement Position has been tentatively established during the clinical refinement of the maxillary occlusal rim Adequate lip support Proper phonetics Maxillary Anterior Tooth Arrangement Anterior Tooth Arrangement Central General Arrangement Considerations Labial surfaces flush with wax rim contour Long axis slightly distal to Anterior teeth are set primarily perpendicular for esthetics not function Considering creating asymmetry after discussion with patient Each tooth should appear as an individual tooth Gingival 1/3 of maxillary incisors provide lip support Incisal 1/3 of maxillary incisors provides esthetics Maxillary anterior teeth are set on the smile line Incisal edge is at occlusal plane Lateral Long axis at an angle more distal than central Incisal edge is slightly above occlusal plane Canine Long axis at a more distal angle than lateral Cervical is prominent, incisal edge looks tucked-in Incisal edge is at occlusal plane 61 Maxillary Anterior Tooth Arrangement 62 Maxillary Anterior Tooth Arrangement • Labial surface of the centrals usually 5-7mm anterior to incisal papilla Maxillary Anterior Tooth Arrangement Maxillary Anterior Tooth Arrangement Esthetics of natural teeth Golden Proportion Avoid lampshade convergence of roots! Ratio of 1.618:1 Proportion between a larger part and a smaller part Width of the central incisor is in the golden proportion to the width of the lateral incisor 65 66 Mandibular Anterior Tooth Arrangement Mandibular Anterior Tooth Arrangement • Teeth are set over bone Anterior Tooth Arrangement Anterior Tooth Arrangement • 2-3 mm Overjet • 0 mm Overbite Goals of Complete Denture Occlusion Right Working Tooth Selection Posterior Tooth Selection Minimize trauma to the supporting structures Preserve remaining structures Enhance stability of the dentures Facilitate esthetics and speech Restore mastication efficiency to a reasonable level Decrease lateral forces to the residual ridges Left Working General Concepts of Denture Occlusion Occlusal Spectrum Anatomic Common Features Balanced occlusion Functional anatomy is the main determinant of denture tooth position Lingualized Balanced occlusion Non-balanced occlusion Simultaneous, bilateral posterior contact in centric relation Centralization of centric occlusal Non-anatomic (Monoplane) Balanced occlusion Non-balanced occlusion Neutrocentric Centric Relation forces over the mandibular residual ridges Buccal-lingually Anterior-posteriorly Occlusal Spectrum Posterior Tooth Selection Lingualized (lingual contact) Criteria Resorbed or flabby ridges Physical condition of the patient nonanatomic (balancing ramp) semianatomic Patients who clench or brux Previous denture occlusion Ridge relationship Immediate dentures Opposing arch anatomic nonanatomic Posterior Tooth Selection Indications Indications Anatomic Non-anatomic Good residual ridges Poor residual ridges Well coordinated patient Poor neuromuscular control Previously successful with (Bruxers, CP, etc.) Previously successful with monoplane dentures or severely worn occlusion on previous denture anatomic dentures Class I ridge relationship Denture opposes natural dentition When “Lingualized” occlusion is desired Posterior Tooth Selection Arch discrepancies Class II or III or cross-bite Immediate dentures Except when opposing natural dentition Potential poor follow-up Anatomic Good residual ridges Non-anatomic Poor residual ridges Posterior Tooth Selection Indications Indications Non-anatomic Anatomic Well coordinated patient Posterior Tooth Selection Poor neuromuscular control (Bruxers, CP, etc.) Posterior Tooth Selection Indications Anatomic Class I ridge relationship Anatomic Previously successful with anatomic dentures Non-anatomic Previously successful with monoplane dentures or severely worn occlusion on previous denture Posterior Tooth Selection Indications Non-anatomic Arch discrepancies › Class II or III or cross-bite Anatomic Occlusion Anatomic Denture opposes natural dentition Non-anatomic Immediate dentures › Except when opposing natural dentition Lingualized Occlusion Disadvantages Definite point of positive Difficult to set High esthetic demands Good esthetics Less adaptable to arch Severe mandibular ridge Freedom of non-anatomic intercuspation may be developed Esthetically similar to natural dentition Tooth-to-tooth and cusp-to- cusp balanced occlusion can be achieved Maintains some shearing ability after moderate wear relation discrepancies Horizontal force development due to cusp inclinations Harmonious balanced occlusion is lost with denture base settling Requires frequent follow-up and may require more frequent relines to maintain proper occlusion Indications Advantages Advantages atrophy Displaceable supporting tissues Malocclusion Previous successful denture with lingualized occlusion teeth Potential for bilateral balance Centralizes vertical forces Minimizes tipping forces Facilitates bolus penetration (mortar and pestle effect) Non-Anatomic Occlusion Advantages Disadvantages Reduction of horizontal No vertical component to aid forces CR can be developed as an area instead of a point Freedom of movement Can develop solid occlusion despite arch alignment discrepancies Easily adapted to situations prone to denture base shifting Easy to set and adjust teeth Is ‘Balance’ Necessary? in shearing during mastication Occlusal adjustment impairs “Bolus in” in” efficiency unless spillways and cutting edges restored Patients may complain of lack of positive intercuspation position “Balance out” out” Somewhat esthetically limited (don’t look like natural teeth) Complete Denture Occlusion Posterior Landmarks Landmarks for the Arrangement of Posterior Denture Teeth Investigators have not shown one type of denture occlusion to be: Superior in function Safer to oral structures More acceptable to patients Neuromuscular control may be the single most significant factor in the successful manipulation of complete dentures under function Tongue function and denture wearing experience Crest of the ridge Mandibular posterior teeth are centered over the ridge Medial/lateral Retromolar pad Medial/lateral Superior/inferior 2/3 height retromolar pad 88 Posterior Landmarks Mandibular Posterior Tooth Arrangement Three landmarks used to determine the plane of occlusion: Retromolar pad 2/3 height retromolar pad Incisal edge of the mandibular central incisor 90 Mandibular Posterior Tooth Arrangement Mandibular Posterior Tooth Arrangement Horizontal Plane Pound’s triangle Horizontal Plane Central groove of denture teeth centered over the crest of the ridge Lingual aspect of mandibular teeth should be positioned within a triangle created by drawing 2 lines from the mesial aspect of the canine to each side of the retromolar pad 91 Mandibular Posterior Tooth Arrangement 92 Mandibular Posterior Tooth Arrangement Sagittal Plane Boucher Occlusal plane of mandibular arch should be established at ⅔ Sagittal Plane Long axes of the teeth are perpendicular to the occlusal plane height of the retromolar pad Marginal ridges of adjacent teeth should be at the same level Teeth are not set on the ascending area of the mandibular ridge or the retromolar pad Otherwise the mandibular denture tends to shift forward 93 Mandibular Posterior Tooth Arrangement 94 Mandibular Posterior Tooth Arrangement Frontal Plane Frontal Plane Lingual view Facial view Buccal and lingual cusps should contact the occlusal plane Buccal and lingual cusps should contact the occlusal plane analyzer analyzer 95 96 Maxillary Posterior Tooth Arrangement Maxillary Posterior Tooth Arrangement Lingual cusps should be set over central fossa of mandibular teeth Teeth should be set up to, but not on top of, the tuberosity Teeth should not extend beyond the denture base periphery on the facial 97 98 Conventional Dentures Tooth loss increases with age the number of edentulous people will continue to increase for Implant Supported Overdentures several decades because of the increase in mean age. Complete dentures have been the traditional standard of care for edentulous patients for more than a century. Complete denture wearers are usually able to wear an upper denture without problems, but many struggle with the complete lower denture because they are loose. Conventional dentures have a bite force of 25% and 20% chewing efficiency of natural teeth. Patient Demographics Implant Supported Overdentures Dissatisfied 7.7 % Patients are significantly more satisfied with 2-implant overdentures than with new conventional dentures regardless of the type of attachment system used bar, ball, magnet, locator. Moderately Satisfied 25.6 % Fully Satisfied 66.7 % Patient satisfaction also depends upon expectations and some patients may have very unrealistic expectations. For this reason it is important to guide and educate the patient. Implant overdentures increase the bite force to 60% of natural teeth. Patients find implant overdentures significantly more stable, their ability to chew various foods are significantly easier, they are more comfortable and speak more easily. Implant Supported Overdentures Overdenture Attachments Studies of several populations have shown that ratings of quality of life are significantly higher for patients who receive 2-implant mandibular overdentures opposing complete maxillary conventional dentures than for those with conventional dentures. People who receive mandibular 2-implant overdentures modify their diets which improves their nutritional state. Such improvements may have a strong positive impact on general health, particularly for senior adults who are vulnerable to malnutrition. 2-implant overdenture are becoming the first choice of treatment for the edentulous mandible. Ball attachments Ball and rubber o-rings and/or metal housings Used to be the attachment of choice Wear quickly, not as retentive Overdenture Attachments Overdenture Attachments Bar Attachments Locator™ 1-3 bars with 1-3 clips Lowest vertical height of 3.17mm. Retentive at first, get loose or break over time. Self aligning Hard to adjust and fix Durable Not as popular anymore Up to 40° angle correction Retention flexibility Overdenture Attachments Can also have a bar with locators cast or tapped into the framework. Usually have 3 - 4 locators incorporated. Framework can be gold (cast) or titanium (milled). Framework must be passively attached to the implants. Returns the bite-force of the edentulous to approximately 80% of natural teeth. Implant supported and retained. Fixed Full-arch Restorations Returns the bite-force of the edentulous pt close to natural teeth Must have enough space for restoration, minimum of 10mm. Framework can be gold (cast), titanium or zirconia (milled). Prosthesis can be metal-ceramic, or metal-acrylic. Framework must be passive. Patient must be able to clean underneath framework Implant supported and retained. External-hex and Internal-hex Overdenture Attachments External-hex Implants More common in the past Good for multiple unit restorations Rely more on the screw for retention of single unit restorations. Internal-hex Implants More common now Md Implants usually placed in position of: 2 implants - 33, 43 4 implants - 32, 34, 42, 44 Good for single tooth restorations Can use for multiple unit restorations - cement retained or need specific abutments. Rely more on the connection for retention of single unit restorations. Mx Implants usually placed in position of: 4 implants - 13, 23, 16, 26 6 implants - 13, 23, 15, 25, 17, 27 Tissue supported, implant retained. Implant Placement Parallel to each other Perpendicular to the occlusal plane Same occlusal height Equal distance from the midline Center of the ridge Bu-‐Li Too far apart: Increased ant-‐post rocking Surgical Guides A necessity. Allows the clinician to have control over the prosthetic outcome. Should be made/designed by the DDS not the lab. Duplicate the denture or wax set-up in orthodontic resin Drill holes for placement Slot from foramen to foramen, end at the incisal edge Implant Placement 22 mm One implant is more distal Primary rotation point or fulcrum when the patient occludes posteriorly Increase complications Wear of the attachment Abutment loosening Crestal bone loss Implant failure Prosthesis fracture 17 mm Panoramic Radiograph Panoramic Radiograph Panoramic Radiograph Panoramic Radiograph Panoramic Radiograph Panoramic Radiograph Locator Abutments Diameter of Locator retention top – 3.85 mm. Available in a variety of cuff heights and for most implant types and sizes. 1.5 mm of the top should be supragingival to be able to retain the Height mm 1 2 overdenture. Recommended torque is 20-25 Ncm. Ø mm height mm 3 4 5 Locator Selection Locator Abutment Delivery Select the correct Locator Abutment based on the Seat the Locator Abutment using the Locator level of tissue indicated when using the Abutment Depth Gauge. Appropriate abutment height keeps the top 1.5 mm extended above the soft tissue. Abutment Driver, part of the Core Tool. For final tightening, use the Torque Wrench Bit together with a Torque Wrench, or insert a driver into the Abutment Driver. The recommended seating torque is 20-25 Ncm. Next steps Implant Impressions Make a new denture start to finish Open Tray Impression Coping Initial impression Final impression with your choice of implant impression Wax Rim adjustment Wax try-in Delivery Convert an existing denture into an overdenture Closed Tray Impression Coping Locator Pickup Impression Coping With a reline impression (indirect approach) Direct pickup of Locator housings with a chairside reline. Fixture Level Impression Abutment Level impression Firmly attach the Locator Abutment Pick-ups to the Locator Abutments. Verify to ensure a perfect fit. The copings should have stable friction retention. Converting a denture into an overdenture. Converting a denture into an overdenture. Identify the positions of the Locator Abutments in the denture base. Relieve the denture base to obtain adequate space for the impression material and the Locator Abutment Pick-up. Make an impression Converting a denture into an overdenture. Converting a denture into an overdenture. Firmly place the Fabricate a working Locator Abutment Replica in the impression copings, which, if indicated, are then repositioned in the impression using an elastic impression material Make a reline if needed. model with the Locator Abutment Replica and high-quality stone material. Complete the relining and convert the existing denture into a Locator attachment retained overdenture Converting a denture into an overdenture. Converting a denture into an overdenture. Five types of Locator Replace the processing insert with the required retentive insert. Remove the Locator Insert by using the Insert Removal Tool portion of the Locator Core Tool. Press a new Locator Insert over the Insert Seating Tool, and press the Locator Insert into the housing Inserts are available to obtain the required retention for the prosthesis. The inserts come with different retentive holding force levels: Clear 5 Pounds Pink 3 Pounds Blue 1.5 Pounds Green 3-4 Pounds* Red 1.5 Pounds* (*for angled implants) Direct Pickup Direct Pickup Choose, insert, and tighten correct Locator abutments Place processing ring and locator housing with black processing insert on the abutments. Identify position and relieve denture base, create vent for excess acrylic. Apply acrylic and seat denture, allow for adequate curing. Trim and polish, remove processing ring, and replace insert with appropriate retentive insert. Locator Core Tool Locator Core Tool Use Gap Loosen the Insert Removal Tool a full 3 turns counter clockwise. You will see a visible gap. Insert Removal Tool Insert Seating Tool To remove an insert from the titanium metal housing; simply insert the tip into the insert assembly and push straight in to the bottom of the nylon insert. Then tilt the tool so that the sharp edge of the tip will grab hold of the insert and pull it out of the cap. Abutment Driver To discard the insert from the new tip on the Locator™ Core Tool; point the tool down and away from you and tighten the Insert Removal Tool clockwise back onto the Locator Core Tool. This will activate the removal pin and dislodge the insert from the tip end of the Insert Removal Tool. 1. Loosen Insert Removal Tool Gap Separate the Insert Removal Tool section from the Locator Core Tool and use the Insert Seating Tool end of the remaining two sections to place a new insert into the empty titanium metal housing. 2. Remove the Insert 3. Discard the Insert 4. Remove the Insert Removal Tool 5. Place a New Insert Questions? Insert Seating Tool end
