Indian J Dent Adv 2012; 4(2) 863

Overdenture: A Way of Preventi ve

Prosthodonti cs
Gorakhnath B Shi nde
1
and Wadkar AP
2
ABSTRACT:
When si tuati on ar i ses wi th few r emai ni ng natur al teeth,
Prosthodonti st are posed wi th di l emma for treatment opti ons.
I n such cases, over dentur e ther apy has been pr oven to be
advantageous. Beari ng i n mi nd the phi l osophy of Preventi ve
Prosthodonti cs, overdenture therapy has l ong term advantage,
by preservi ng the propri ocepti on and thereby resi dual al veol ar
r i dge. Thi s cl i ni cal r epor t descr i bes the Pr osthodonti c
rehabi l i tati on a pati ent wi th few remai ni ng natural teeth by
usi ng stud attachment r etai ned maxi l l ar y over dentur e and
tel escopi c mandi bul ar overdenture for added advantages l i ke
better retenti on, stabi l i ty, support and psychol ogi cal benefi ts.
Key words: Over dentur e, Pr eventi ve Pr osthodonti cs, Stud
attachment, Tel escopi c overdenture
CAS E RE PORT
doi: ...........................
1
Post Graduate Student
2
Professor and PG Gui de
Department of Prosthodonti cs
Nai r Hospi tal Dental Col l ege
Mumbai
Article Info:
Recei ved: Apri l 16, 2012;
Revi ew Compl eted: May, 16, 2012;
Accepted: June 12, 2012
Publ i shed Onl i ne: August, 2012 (www. nacd. i n)
NAD, 2012 - Al l ri ghts reserved
Email for correspondence:
shi ndegor akhnath@gmai l .com
Quick Response Code
INTRODUCTION:
Preventi ve prosthodonti cs emphasi zes the i mportance of any procedure that can del ay or el i mi nate
future probl ems. Retenti on of teeth, roots of one or more teeth for overdenture offers the pati ent a l ot of
advantages l i ke better r etenti on, stabi l i ty, pr opr i ocepti on, suppor t, mai ntenance of al veol ar bone and
psychol ogi cal aspect of retai ni ng teeth. The use of tooth-supported overdenture i s a common form of treatment.
There are two physi ol ogi c tenets rel ated to overdenture therapy: the fi rst concerns the conti nued preservati on
of al veol ar bone around the retai ned teeth
1
whi l e the second rel ates to the conti nui ng presence of peri odontal
sensory mechani sms
2
that gui de and moni tor gnathodynami c functi ons.
Removabl e dentures attached by means of tel escopi c anchors are regarded to be a good cl i ni cal sol uti on
whi ch gi ves an opportuni ty to decrease destructi ve rotati onal and hori zontal occl usal forces by di recti ng
them more axi al l y.
3
I t can al so i ncrease the stabi l i ty of abutment teeth wi th peri odontal di sorders and protect
them from pathol ogi c mi grati on, and thus, may enhance the functi onal effect of the prostheti c treatment.
Di fferent attachment systems are used to retai n overdenture: bars wi th cl i ps, studs and magnets has
been reported as vi abl e treatment opti ons. Studs due to thei r si mpl e appl i cati on have gai ned a wi de popul ari ty
i n cl i ni cal practi ce. I t has been shown that sol i tary non spl i nted attachments are l ess techni que sensi ti ve,
and easi er to cl ean than bars.
4
The pati ent sati sfacti on wi th overdentures depends on mul ti pl e factors l i ke
pati ent preferences, chewi ng comfort, phoneti cs and estheti cs.
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Indian J Dent Adv 2012; 4(2) 864
Thi s cl i ni cal report descri bes the prosthodonti c
management of a pati ent wi th few r emai ni ng
natur al teeth by usi ng stud attachment r etai ned
maxi l l ar y over dentur e and tel escopi c mandi bul ar
overdenture.
Case report:
Fi fty fi ve years ol d femal e pati ent reported to
Department of Prosthodonti cs Nai r Hospi tal Dental
Col l ege wi th compl ai n of di ffi cul ty i n chewi ng.
Extraoral exami nati on showed squari sh face form
and strai ght profi l e and there were no pathol ogi c
fi ndi ngs seen.
Intraoral examination showed:
- Teeth remai ni ng 13, 23, 33, 34, 35, 43, 44 and 45
- Abr asi on wi th 13, 23, 34, 44 and 45 wi th
moderate attri ti on
- Gr ade I mobi l e 34, 44 wi th gr ade I gi ngi val
recessi on
- Grade I I mobi l e 33 and 43 wi th grade I I gi ngi val
recessi on
- Grade I gi ngi val recessi on wi th 13 and 23
The edentul ous span had favourabl e ri dge wi th
fi r ml y attached ker ati ni zed mucosa. Cl i ni cal and
Radi ographi c exami nati on reveal ed abutment teeth
33 and 43 were peri odontal l y week. [Fi g.2] Pati ent
wanted restorati on of hi s denti ti on wi th mi ni mal
i nterventi on. Di agnosti c casts were prepared usi ng
i r r ever si bl e hydr ocol l oi d i mpr essi ons. Casts wer e
mounted on arti cul ator usi ng centri c rel ati on record
and i nter ri dge di stance was assessed.
Provisional Treatment options:
1. Fi xed restorati on i n anteri or regi on and di stal
extensi on cast parti al denture
2. I mpl ant supported prosthesi s
3. Overdenture wi th or wi thout attachment
Dur i ng the fol l owi ng vi si t, tr eatment opti ons
were di scussed wi th the pati ent, i ncl udi ng extracti on
of 33 and 43; endodonti c therapy of remai ni ng teeth
and fi xed restorati on i n maxi l l ary anteri or; ei ther
cast parti al or i mpl ant supported prosthesi s wi th
r espect to both ar ches; an over dentur e wi th or
wi thout attachments. To retai n a bri dge or crown
and a par ti al dentur e woul d pl ace unfavour abl e
str esses that may l ead to thei r ear l y l oss. After
consi der i ng i nvasi veness, amount of ti me and
fi nanci al aspect, i t was deci ded to have, stud
retai ned prosthesi s i n maxi l l ary arch and tel escopi c
overdenture i n mandi bul ar arch.
Treatment Plan:
Teeth ar r angement was done on di agnosti c
mounti ng to assess amount of space avai l abl e for
attachment.
1. Preprostheti c phase-
- Extracti on of 33, 43
- Oral prophyl axi s.
- Endodonti c treatment of 13, 23, 34, 35, 44, 45.
2. Prostheti c phase-
Maxillary arch: Abutment teeth 13 and 23
were prepared to recei ve stud attachment- bal l and
socket type (Access post- EDS system). Teeth were
r educed at the gi ngi val l evel and post space was
prepared usi ng dri l l s provi ded by the manufacturer.
Then posts wer e tr i ed. [Fi g.5] After cl i ni cal and
radi ographi c eval uati on for correct posi ti oni ng, posts
were cemented usi ng resi n cement. [Fi g.6]
Mandibular arch: Abutment teeth 34, 35, 44,
and 45 were prepared to recei ve pri mary copi ngs
and i mpr essi on was made usi ng putty and l i ght
bodi ed addi ti on si l i con. Then cast was fabri cated and
wax patterns for pri mary copi ngs were fabri cated
keepi ng i n mi nd that they are paral l el to each other.
Wax patter ns wer e i nvested, cast wi th cobal t-
chr omi um al l oy, fi ni shed and modi fi ed usi ng a
paral l el i ng cutti ng devi ce; casti ngs were pol i shed,
tri ed i n pati ent mouth and cemented [Fi g.8]
A putty and l i ght bodi ed addi ti on si l i con
i mpressi on wi th the pri mary copi ng i n pl ace was made
for the fabrication of secondary copings and framework.
Stone models were poured and the cast duplicated with
Agar. Secondary copi ngs and framework were waxed
up on the refractory cast and casted in cobalt chromium
al l oy. Secondary copi ng wi th framework was tri ed i n
pati ents mouth for fi t, retenti on and stabi l i ty. [Fi g.9]
Retenti on of the denture was fi nal l y provi ded by the
fri cti on between the paral l el surfaces of the pri mary
and secondary copi ngs.
After cementati on of over dentur e post i n
maxi l l ary arch and checki ng for fi t of mandi bul ar
framework, the pri mary i mpressi on of the maxi l l ary
and mandi bul ar arches were made and overdenture
was fabri cated fol l owi ng steps of the conventi onal
compl ete den tu r e. Den tu r es wer e ev al u ated
i ntraoral l y for retenti on, stabi l i ty, support, occl usi on
and estheti c. [Fi g.14] The femal e attachments of
maxi l l ary denture were cured at the chai rsi de usi ng
autopol ymeri si ng acryl i c resi n. Due to l ack of space
sl i ght metal component of mandi bul ar denture was
Overdenture: A Way of Preventi ve Prosthodonti cs Gorakhnath & Wadkar
Indian J Dent Adv 2012; 4(2) 865
di spl ayi ng through acryl i c denture base materi al ,
[Fi g.14] whi ch was mask by Cer amage (SHOFU
I NC.) for better char acter i zati on and eval uated
i ntraoral l y. [Fi g.15]
Postoperati ve i nstructi ons on how to i nsert the
pr os th es es an d on adequ ate or al h y gi en e
mai ntenance were provi ded. Pati ent was schedul ed
on peri odi c recal l .
Discussion:
The phenomenon of resi dual ri dge resorpti on
(RRR) fol l owi ng removal of teeth been wel l observed
and documented i n l i terature.
5
Whi l e the bone l oss
fol l owi ng the removal of teeth i s stated to be rapi d,
progressi ve, i rreversi bl e and i nevi tabl e, i t i s equal l y
wel l obser ved that bone i s mai ntai ned ar ound
standi ng teeth and i mpl ants.
6
The teeth whi ch are
too weak to suppor t a fi xed par ti al dentur e and
whi ch ar e consi der ed unsui tabl e to suppor t a
r emovabl e par ti al dentur e can often at ti mes be
useful l y conserved and sui tabl y modi fi ed to act as
abutments for over dentures.
The tel escopi c overdenture system used i n thi s
case i n mandi bul ar ar ch r eveal ed a l ong l asti ng
useful ness i n the prostheti c treatment of the pati ent
wi th reduced denti ti on. Si mi l ar cl i ni cal observati ons
were al so descri bed i n reports made by other authors.
7
I t has been observed by many authors that posi ti ve
r esul ts of pr ostheti c tr eatment wi th tel escopi c
dentures i n pati ents wi th reduced denti ti on.
8
There
are many advantages of tel escopi c crowns l i ke axi al
l oad of the tooth and ful l coveri ng of the abutment
(on the contrary to cl asps), whi ch may reduce ti l ti ng
for ces wi th thei r negati ve i nfl uence on abutment
suppor ti ng ti ssues. The axi al for ces sti mul ate
per i odontal ti ssues and al veol ar bone. They al so
provi de i ndi rect spl i nti ng i nfl uence, easy oral hygi ene
mai ntenance and easy ways of repai r.
9
Si nce ther e was metal di spl ay of fr amewor k
through mandi bul ar denture base materi al , denture
characteri zi ng materi al Ceramage (SHOFU I NC.)
was used to mask the effect of metal framework.
The stud attachments used i n maxi l l ary arch
wer e bal l and sock et type. They pr ovi de good
retenti on as wel l as support. I t has been observed
by many author s that pati ent wi th bal l -socket
attachments were more sati sfi ed than pati ent wi th
magnet attachment and bal l -socket systems bor e
hi gher axi al l oads than bar and cl i p system.
10,11,12
Pati ent was schedul ed on a r egul ar r ecal l
program- 3 months and 6 months.
As the status of overdenture prosthesi s and i ts
ben efi ts to th e pati en t depen d s ol el y on th e
conti nued retenti on of the underl yi ng abutments,
i t becomes obl i gatory to peri odi cal l y moni tor thei r
heal th and i nsti tute necessary steps to prol ong thei r
useful span. Here i n l i es the i mportance of peri odi cal
r ecal l and r evi ew and pati ent moti vati on whi ch
makes over denture therapy a conti nued servi ce.
Summary:
Retai ni ng teeth permi t the stresses of occl usi on
to be borne parti al l y by the teeth, thus reduci ng the
abu s e, wh i ch th e al v eol ar pr oces s an d th e
mucoperi osteum undergo when dentures are worn.
By reduci ng the trauma to the mucosal ti ssues, i t i s
reasonabl e to expect that resorpti on of the al veol ar
process wi l l be l essened.
References:
1. Pri nce I B. Conservati on of the supporti ng mechani sm. J
Prosthet Dent 1965; 15:327.
2. Yal i sove I L. Cr own and sl eeve copi ng r etai ner s for
r emovabl e par ti al pr osthesi s. J Pr osthet Dent 1966;
16:1069-1085.
3. M. Sai to, Y. Mi ur a, K. Notani , and T. Kawasaki . Str ess
di str i buti on of abutments and base di spl acement wi th
pr eci si on attachment- and tel escopi c cr own-r etai ned
removabl e parti al dentures. Journal of Oral Rehabi l i tati on
2003; 30: 482487.
4. Cune MS, de Putter C, Hoogstraten J. Treatment outcome
wi th i mpl ant-r etai ned over dentur es: Par t I I Pati ent
sati sfacti on and pr edi ctabi l i ty of subjecti ve tr eatment
outcome. J Prosthet Dent 1994; 72: 152-8.
5. Tool son LB, Smi th DE. A two year l ongi tudi nal study of
overdenture pati ents, Part 1: I nci dence and control of cari es
on overdenture abutments. J Prosthet Dent 1978; 40:486-91.
6. Tal l gr en A. The conti nui ng r educti on of the r esi dual
al veol ar r i des i n compl ete dentur e wear er s: a mi xed
l ongi tudnal study coveri ng 25 years. J Prosthet Dent 1972;
27:120-32.
7. John J. Sharry: Compl ete Denture Prosthodonti cs. Thi rd
edi ti on,1974.
8. Hou G.L., TsaI C.C., Wei sgol d A.S. Per i odontal and
prostheti c therapy i n severel y advanced peri odonti ti s by
use of the cr own and sl eeve copi ng tel escope dentur e. A
l ongi tudi nal case report. Aust Dent J. 1997; 42:169-74.
9. Langer Y, Langer A. Tooth supported tel escopi c prostheses
i n compromi sed denti ti ons: A cl i ni cal report. J. Prosthet
Dent. 2000;84:129-32.
10. Duyck J, Van Oosterwyck H, Vander Sl oten J, De Cooman
M, Puer s R, Naer t I . I n vi vo for ces on or al i mpl ants
suppor ti ng a mandi bul ar over dentur e: the i nfl uence of
attachment system. Cl i n Oral I nvesti g 1999; 3: 201-207.
11. Gi ul i o Meni cucci , Massi mo Lor enzetti , Paol o Per a and
Gi ul i o Preti . Mandi bul ar I mpl ant-Retai ned Overdenture:
A Cl i ni cal Tri al of Two Anchorage Systems I nter J of Oral
Maxi l l ofaci al I mpl ants, 1998; 13: 851-856.
12. Dav i s D M, Pack er M E. Man di bu l ar ov er den tu r es
s tabi l i zed by As tr a Tech i mpl an ts wi th ei th er bal l
attachments or magnets: 5- year resul ts. I nt J Prosthodont
1999; 12: 222-229.
Overdenture: A Way of Preventi ve Prosthodonti cs Gorakhnath & Wadkar
Indian J Dent Adv 2012; 4(2) 866
Figure1(a) and (b): Preoperati ve Extraoral photograph Figure2(a) and (b): Preoperati ve OPG
Figure3(a), (b) and (c): I ntraoral photograph after extracti on of 33 and 43
Figure4: OPG after endodonti c Figure5(a) and (b): Teeth prepared to recei ve pri mary copi ngs i n
mandi bul ar arch
Figure6(a) and (b): Pri mary copi ngs on cast and i ntraoral l y
Figure7(a), (b) and (c): Mandi bul ar i mpressi on for secondary copi ngs and framework, framework on cast and i ntraoral l y
Overdenture: A Way of Preventi ve Prosthodonti cs Gorakhnath & Wadkar
Indian J Dent Adv 2012; 4(2) 867
Figure16(a): Post operati ve extraoral photographs
Figure8(a) and (b): Abutment preparati on to recei ve stud
attachment i n maxi l l ary arch
Figure9(a) and (b): I ntraoral peri api cal
radi ograph to assess post posi ti oni ng
Figure10(a) and (b): Maxi l l ary and mandi bul ar defi ni ti ve i mpressi on Figure11(a) and (b): Face bow record and centri c rel ati on
Figure12(a) and (b): Mounti ng and teeth arrangement on
semi -adjustabl e ar ti cul ator
Figure14(a), (b) and (c): Fi nal denture i n si tu
Figure15(a): Fi nal denture i n si tu after characteri zati on usi ng Ceramage
Figure13(a), (b) and (c): Wax denture try i n
Overdenture: A Way of Preventi ve Prosthodonti cs Gorakhnath & Wadkar