over dentures
RESHMA
I MDS
INTRODUCTION
• Extraction of teeth is followed by continuous
ridge resorption and poor denture foundation.
• Loss of periodontal receptors responsible for
proper masticatory function and accurate jaw
movements.
• Retention of few remaining teeth will preserve
alveolar bone and preserve periodontal
receptors.
DEFINITION
• A removable partial denture or complete denture
that covers & rests on one or more remaining
natural teeth, the roots of natural teeth, &/or
dental implants. GPT 8
• Tooth supported denture
• Overlay denture/ Onlay denture/ Inlay denture
• Superimposed prosthesis
• Hybrid denture
• Biological denture
• Coping prosthesis
• Telescopic
GOALS
• Maintains teeth as part of the residual ridge –
- more support
- withstand more occlusal load
- retention – improved
• Decrease in rate of resorption
alveolar bone exists as a support for teeth
• With the preservation of teeth – also
preservation of periodontal membrane.
Preserves proprioceptive impulses supplied by
periodontal membrane.
Increase in patients manipulative skills in
handling denture.
HISTORY
• 1906–WILLIAM HUNTER put forward his
focal sepsis theory and this dealt a great blow to
the over denture mode of treatment.
• The main point of contention was that the
exposed roots act as foci of infection.
• 1916‐PEESO was employing removable
telescopic crowns. Later on, the bar type of
construction was developed.
• MILLER (1958 ) - published his classic article
where the retention of previously unusable teeth
and their advantageous use in overdenture
treatment was explained as a basic tenet in
management.
• Prieskal(1968) - described various
commercially available over denture
Attachments.
PHYSIOLOGIC BASIS FOR
OVERDENTURES
• Sensory input from periodontal receptors.
• Alveolar bone preservation.
• Occlusal forces substantially increased.
• Masticatory performance.
• Tooth mobility – greatly reduced.
REQUIREMENTS
MAINTENANCE OF HEALTH –
• Evaluation – periodontal condition of abutment
tooth.
• Pocket formation – eliminated.
• Plaque accumulation – prevented.
• Extensive bone loss
Mobility abutment
REDUCTION IN CROWN – ROOT RATIO
• Has immediately favorable effect on tooth
mobility –because of lever arm delivering torque
to mobile tooth.
BASAL SEAT TISSUE -
• Well fitting base essential – to distribute load
over as wide an area as possible.
• Intimate tissue contact – necessary to prevent
food and plaque accumulation under the base.
SIMPLICITY OF CONSTRUCTION -
• Relatively simple to construct and maintain.
EASE OF MANIPULATION
• With the use of retaining devices – over dentures
become struggle for patients to insert and
remove.
ADVANTAGES
• Ridge preservation.
• Proprioception.
• Support, stability and retention are improved.
• Less trauma to supporting tissues.
• Periodontal maintenance.
• Patient acceptance.
• Harmony of arch form.
DISADVANTAGES
• Caries susceptibility.
• Periodontal disease around abutments
• Bony undercuts.
• Encroachment of inter occlusal distance.
• Meticulous oral hygiene is required.
• Time consuming.
• Technique sensitive.
INDICATIONS
• Patient with badly worn teeth.
• Patient with few natural remaining teeth.
• Poor prognosis for routine complete denture.
• Congenital or acquired intra oral defects.
• Mandibular arch where loss of bone is more
rapid.
• Edentulous maxilla opposing intact mandibular
dentition.
• Severe attrition and loss of vertical dimension.
• Young patient.
• Cleft palate causing large free way space.
• Hypodontia.
CONTRAINDICAIONS
• High caries index.
• Poor oral hygiene.
• Poor prognosis of abutment.
• Reduced inter-arch space.
• Undercuts.
• Sufficient attached gingiva not present.
• Where endo and perio treatment can not be
performed satisfactorily.
• Grade III mobility.
CLASSIFICATION
Overdentures
Tooth-supported Implant supported
Non- Attach
Coping
coping ments
Short Long
Magn
Stud Bar ets
BASED ON TYPE
Immediate Transitional Permanent
IMMEDIATE OVER DENTURE
• Constructed prior to preparation & ready for
insertion.
• Enhance patients ability and adaptability to wear
dentures.
INTERIM OVER DENTURE
• Used for patients in transition or preparation
phase until permanent over denture constructed.
DEFINITIVE OVER DENTURE
• Conventional complete over denture constructed
over one or more abutment teeth.
TECHNIQUES INVOLVED IN PREPARATION
OF TEETH TO SERVE AS ABUTMENTS –
I. SIMPLE TOOTH MODIFICATION AND
REDUCTION
• Teeth reshaped to remove undercuts and
reduced in vertical height.
• If teeth are to be reduced to an degree - vital
pulps must be receded sufficiently.
• Used in anodontic patients – or in severe
abrasion of teeth.
• Teeth have minimal preparation prior to final
impression – which makes technique totally
reversible.
• Minimal preparation is possible – because of
presence of great deal of interocclusal distance.
• After final impression –
master cast poured
surveyed
cast duplicated – over denture
processed.
TOOTH REDUCTION AND CAST COPING –
• Teeth reduced and casting is made on teeth in
preparation for overdenture.
• Possible only when teeth have adequate bony
support and good periodontal prognosis.
ENDODONTIC THERAPY AND AMALGAM PLUG-
• INDICATION – Normal coronal height to teeth
and normal inter-occlusal distance with little or
no loss of vertical dimension.
NON COPING ABUTMENTS
• Reduced to a coronal height of 2 - 3 mm and
then contoured to a convex or dome shaped
surface.
• Most teeth require endodontic therapy.
ABUTMENTS WITH COPINGS
• Cover for the exposed tooth surface.
• Cast metal coping with a dome shaped surface
and a chamber finish line at the gingival margin
are fabricated and cemented.
SHORT CAST COPINGS
• 2-3 mm.
• Require endodontic therapy.
LONG CAST COPINGS
• 5-8 mm long
• Long ellipsoidal shaped coronal coping and a
larger crown root ratio.
• Consequently, long cast coping require a greater
level of osseous support.
ABUTMENT WITH ATTACHMENTS
• Small precision devices.
• To improve retention of denture base.
• Secured to abutment by a cast coping.
• Consists – Male
Female
REQUIREMENTS FOR THE
ATTACHMENTS
• Patients should have a low caries index.
• Perform proper home care.
• Sound periodontal health.
• Proper bone support.
DISADVANTAGES OF
ATTACHMENTS
• Added time.
• Expensive.
• Difficult to construct.
• Repair is difficult.
• Not recommended for mentally and physically
handicapped.
RIGID ATTACHMENT
• Doesn’t allow movement of denture base
• Provide adequate retention
• May induce more torque on abutment
RESILIENT ATTACHMENT
• Allows some control of movements.
• Induces less torque on abutments.
STUD ATTACHMENT
• Simplest of all attachments
• Consists of two parts -
• The stud - male component -
usually attached to metal coping
cemented over prepared abutment.
• Housing - female component -
embedded in the fitting surface of
over denture.
EXTRA RADICULAR STUD
ATTACHMENT
• Male element projects from the root surface.
• The stud is attached to the metal coping
cemented over the prepared abutment, while the
housing is embedded in the fitting surface of
denture.
• Gerber
• Ceka
• Rotherman
GERBER ATTACHMENTS
One that allows rigid attachment that
vertical movement doesn't allow for
movement of base.
impart less torque –
rather complex in design popular and widely
and fabrication. Used.
• Consist – male post –threaded onto a screw
attached to a soldering base and female overall
housing containing retention spring and ring.
• Retention – gained by spring clip in female
housing engaging a groove in male section.
ROTHERMANN
Allows more movement less movement
• Short stud – deep groove.
• C- shaped ring.
• Requires less space.
• Excellent for cases with little interocclusal space.
• Need not to be parallel.
CEKA ATTACHMENT
• Male part round with cementable titanium post.
• Female part in titanium alloy with replaceable
plastic part that is flexible and compressible
(split vertically into four sections )
OTHER ATTACHMENTS OF IMPORTANCE
• Introfix attachment.
• Schubiger attachment.
• Quinlivan attachment.
INTRA RADICULAR STUD
ATTACHMENT
• The stud is attached to the fitting surface of the
denture and the housing is incorporated in the
abutment.
ZEST ANCHOR
• Derives retention – within root.
• Female sleeve is cemented in post space made
within the root .
• Male portion consists of nylon post and ball
head attached to over denture.
• Retention by –ball head snapping into undercut
in female sleeve.
BAR ATTACHMENTS
The purpose of using bars -
• Splinting of abutment teeth.
• Retention and support of prosthetic appliance.
BAR •Rigid fixation
•No movement b/w bar and overlying sleeve.
UNITS
BAR •Movement – rotational b/w sleeve
and bar.
JOINTS
BAR ATTACHMENTS OF
IMPORTANCE
• Hader bar
• Dolber bar
• Baker clip
• Ackerman clip and CM clip.
HADER BAR
• Joint / unit.
• Preformed plastic bar and clips – embedded in
denture base.
• Attached to coping wax up and cast with coping.
• Bulk and care must be taken.
DOLDER BAR
• Both unit and joint – egg shaped.
• Preformed bar that is soldered to copings on
abutment teeth.
• Joint – soldered to copings of abutment teeth.
BAKERS CLIP
• Joint attachment consits of small U-shaped clip
to fit over round wire.
• Sizes – 11 & 14.
• Simple , low cost.
ACKERMAN CLIP AND CM CLIP
• Round bar soldered o post copings and a clip
that fits over bar.
MAGNETIC ATTACHMENT
• Detachable keeper element - Made of stainless
steel that is fixed to abutment teeth by
Cementing.
• Retention element – paired – cylindrical –
cobalt samarium magnets –axially magnetised
and arranged with opposite poles adjacent.
• Flat faces – covered on one end b the attached
stainless steel keeper and on other – thin
stainless steel plates.
PATIENT SELECTION
• Possibility of fixed/removable partial dentures.
• Endodontic therapy.
• Periodontal condition of abutment tooth.
• Caries.
• Young patients.
• location of abutment teeth.
• Economics.
PATIENT AGE
• Extractions are to be avoided in a young patient
as far as possible, so over denture do play a
major role in treating young patients with
mutilated dentition.
Factors influencing selection of abutment
teeth -
• Periodontal status
• Mobility
• Location
• Endodontic considerations
• Cost
PERIODONTAL & MOBILITY STATUS
• Minimal mobility, have acceptable bone support
and be responsive to periodontal therapy
• Circumferential band of attached gingiva is an
absolute necessity.
• Compromised teeth with good treatment
prognosis are suitable candidates even when
horizontal bone loss is present.
• Slight tooth mobility with horizontal bone loss is
not contraindicated as decrease in C- R ratio
required for abutment preparation improves
mobility.
ABUTMENT LOCATION
• Ideal - Two teeth per quadrant (stress -
distributed over a rectangular area)
• Tripod - next most favorable form for support
and stability. (maxillary canines and a central
incisor)
• If only 2 abutment teeth - Should be situated
bilaterally for optimum support.
2 canines/ canine, and a premolar, or 2
premolars – desirable to 2 molars.
• Isolated teeth are preferred to several adjacent
teeth as inter dental areas are difficult to clean
and susceptible to gingivitis.
• Anterior mandibular ridge is most vulnerable to
time dependent RRR.
• Canines and premolars are regarded as best over
denture abutments.
• In maxilla central incisors are ideal as over
denture abutments.
• Canines are next (Longest Root).
• Lateral incisors - widely spaced, facilitating
plaque control.
ENDODONTIC STATUS
• Preserve teeth that are already endodontically
treated.
• Usually anterior teeth are preferred as they are
easier to prepare and economical too.
• Whenever pulpal recession to the extent of
calcification has occurred , endodontic treatment
usually can be avoided.
TOOTH PREPARATION
• Remove sufficient tooth structure to provide
favorable root crown ratio.
• Reduce the crown length up to 2 mm above the
gingival crest or extend a chamber type margin
slightly beneath free gingival margin.
• Taper the preparation in occlusogingival
direction.
Consequently optimal abutment preparation is
achieved that has following features:
• Simple
• Short
• Convex
• Dome shaped
• Chamfer finish line
• The finished tooth with cast coping is male
member of denture. The female member is part
of denture base.
COPING FABRICATION
• Make an accurate impression of the abutment
and pour a die.
• Carve the wax pattern.
• Cast the coping
• Cement the polished coping to the tooth.
• Home care of abutment tooth.
IMPRESSION FOR THE
DENTURE
• Follows the same technique that is used in
constructing a conventional complete denture.
• PRELIMINARY IMPRESSION
• BORDER MOLDING
• FINAL IMPRESSION
• RECORD BASES AND OCCLUSAL RIMS
RECORDING MAXILLO MANDIBULAR
RELATIONS
• A face bow transfer is used to relate the
maxillary cast to the articulator.
• Jaw relations and arrangement of teeth for
phonetics are verified at the time of try in.
TRYING THE DENTURE
• Verify jaw relation records
• Make eccentric jaw relation records and adjust
the articulator.
• Assure esthetic acceptability by the patient.
• Verify phonetic acceptability.
LABORATORY PROCEDURES
• Contour The Wax.
• Flask The Denture.
• Eliminate The Wax.
• Prepare Resin.
• Packing.
• Relief For Marginal Gingiva.
DENTURE INSERTION
• Review instruction in denture use and care.
• Use pressure disclosing paste to locate contacts
between female and male members
• Evaluate the tissue side of denture base and
borders for pressure areas and over extensions.
• Perfect the occlusion by remounting and
selective grinding.
• Place patient on recall system.
IMPLANT SUPPORTED OVER DENTURE
INCLUSION CRITERIA –
• Patient desire.
• Health status.
• Sufficient bone quantity.
EXCLUSION CRITERIA –
• Residual ridge dimensions donot accommodate
preferred implant dimensions.
• General health condition preclude a minor
surgical intervention.
• Local aneshesia with vasoconstrictor –
contraindicated.
• Immunosuppressive therapy.
• Prolonged intake of antibiotics/metabolic
disease history.
TYPES OF IMPLANT
OVERDENTURES
TISSUE – IMPLANT FULLY IMPLANT
ATTACHMENTS
• Female portion – prosthesis
• Male portion – implants
• Ball attachments – o-ring system
- locator system
• Bar and clip attachments –
CM Bar and rider
Dolder bar system
Hader bar system
IMPRESSION TECHNIQUES
IMPLANT LEVEL ABUTMENT LEVEL
PICK UP DIRECT
TRANSFER TYPE INDIRECT
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RESTORATIVE SPACE CLASSIFICATIONS
SINGLE IMPLANT RETAINED OVER-
DENTURE
• The single-implant mandibular over denture
(Simo) - recommended for elderly patients
• Due to - decreased functional demands and
common health restrictions, as well as favorable
conditions regarding bone quality and quantity
in the mandibular symphysis region - which
ensures satisfactory primary implant stability.
SUMMARY
