Dental

A Maxillary Immediate Tooth Supported Over Denture Opposing A Tooth Supported Straight
Bar Mandibular Over Denture; A Case Report.
1

Anandkumar. G .Patil , P.S .bhusaraddi ,Vinaykumar. Hiremath , satishpatil , Sheetal Kumar . R,

6

Aparna Sheetal Suresh Nagaraj

1

5,6

Professor & Head , Associate professor , Dean. Professor & Head , Professor , Reader. Senior Lecturer
1

7
3

Department of Prosthodontics , Department of anatomy, KIMS,Hubli Karnataka ,,Department of Oral and Maxillofacial Pathology ,
4,5
5
ABSTRACT
Department of oral and maxillofacial surgery , Department of Pedodontics and Preventive Dentistry Mansarovar Dental College
1,3,5,6

Hospital and Research Centre, Bhopal

, H.K.E S.N dental college and research center Gulbarga , Department of Prosthodontics ,
7

ACPM Dental College Kolar Road ,Dhulle ,Maharastra

ABSTRACT

KEY WORDS over denture, immediatedenture, bar

supported over denture,

occlusion and loss of occlusal contacts. Several studies

showed that 20-30% of denture wearers were dissatisfied
and had problems with their dentures. Majority of these
problems are caused by mandibular dentures with poor
stability, retention leading to chewing problems, pain and
discomfort.. In over denture treatment teeth are retained
and this retaining tooth helps not only to reduce bone
resorption, but also improves denture function.
Overdenture with retentive attachments helps in further
2,3
improvement of retention and stability of denture . If
overdenture is inserted immediately after extraction of
hopeless teeth, it gives great psychological comfort to
patient as patient does not have to suffer period of
edentulousness. Vertical dimension of occlusionand
current esthetic scan be maintained if patient desires.To
make a gradual transition from to natural dentition to
complete denture for a patient, an over denture, immediate
denture or immediate over denture is recommended by
3.
prosthodontists

INTRODUCTION
Partial edentulous patients with few teeth remaining in
mouth, especially anterior teeth are very difficult to treat.
Periodontal health of remaining teeth, their strategic
position in the arch to support prosthesis is to be
considered. Extraction of last remaining teeth and
replacement with complete dentures has many
consequences with respect to speech, chewing,
swallowing, esthetics and adapting to a new situation and
many more . The edentulousness may lead to patient's
1
psychological problems and social isolation . Loss of teeth
leads to a reduction of the alveolar ridge, and changes in
denture base adaptation, decrease in vertical dimension of

CASE REPORT
A fifty five years old male patient is reported to the
department and wanted replacement of missing teeth. On
examination teeth remaining in mouth were 11,
12,13,15,21,22, 23,25,33, 34, 35, and 43 of these teeth
34,35 were extremely mobile having grade 3 mobility, 11,
12, 15, 21, 22, 25, were having grade 2 mobility,13,23,33,43
were having grade 1 mobility. Diagnostic x-rays like OPG
and IOPA radiographs were made. On observation of
radiographs13, 23, 33, and 43 were having good alveolar
bone support and planned to retain them as abutments for
overdenture. Immediate over denture for maxillary arch and
bar supported over denture for mandibular arch was

Teeth loss occurs due to caries, periodontal disease,

trauma and other diseases. whenonly few teeth are
remaining in mouth, then patients will develop social and
psychological fear of being edentulousness after the
extraction of remaining teeth.. The position and number of
the remaining posterior or anterior teeth in the arch will
determine the type of treatmentmodalities like extract or
not, or to go for removable and fixed partial denture, or an
over denture or immediate denture treatment.
In line with present day trends immediate dentures,over
dentures ,and immediate over dentures are necessary to
prevent anxiety and distress of patient who must have to
undergo extraction 0f remaining few teeth. These type of
dentures helps in restoring esthetics, phonetics, and
mastication without interrupting normal life style of smiling,
talking, eating, and socializing.

63

Anatomica Karnataka, Vol-7, (1), Page 63-66 (2013)

A Maxillary Immediate Tooth Supported Over Denture Opposing A Tooth Supported Straight Bar Mandibular Over Denture; A Case Report

planned . Oral prophylaxis and intentional endodontic

treatment was advised for 13, 23, 33, and 43. Mean while
extremely mobile teeth 34, 35 were extracted. After healing
and endodontic treatment patient was recalled for abutment
teeth preparation for over denture.13, 23, were prepared for
metal coping 33, and 43 teeth were prepared for coping and
bar attachment .
After the teeth preparation elastomeric impression with
ADDSIL was made and cast was poured in die
stone.Afterwards 15 and 25 teeth of patient were extracted
and recalled after a week for cementation of copings. Mean
while wax pattern for metal coping and metal coping with
retentive bar is prepared on 13,23 and 33,43 respectively.
wax pattern invested and casted. They are retrieved,
finished and polished.
Patient was recalled after a week andhealing was
satisfactory. Copings were cemented onto the 13, and
23.coping with retentive straightbar cemented onto the 33
and 43 with glass inomer luting cement(GC Fuji 1)..
Primary impression of both arches made with alginate
impression material(Algitex) and casts are prepared.
Sectional impression tray made for maxillary without

Dental

covering remaining anterior teeth and full arch impression

tray is made for mandibular arch. Border molding of both
arches is made and secondary impression was made with
medium body addition silicone impression material(Addsil)
for mandibular arch. For maxillary dual impression
5
technique was followed . Border molded Sectional
impression tray with medium body addition silicone is
placed back in mouth and pick up impression made by
heavy body silicone impression in stock tray extending both
anterior teeth and posterior sectional tray.After the material
sets it's removed and examined for details .Its poured in
dental stone and mastercasts prepared. Record bases
were fabricated on master cast and occlusal rims were
made, then they were inserted in patients' mouth and face
bow transfer was made on the articulator and jaw relation
was recorded and casts were mounted in semiadjustable
articulator.Teeth selection was made with the help of natural
anterior teeth present in the mouth .Teeth arrangement is
made and then posterior try in done in patients
mouth.Maxillary anterior trial was not possible and patient
was informed about it. Trial bases were transferred back to
articulator, maxillary anterior teeth are removed from the

Figure1 -before Treatment.

Figure 2 Copings For Overdenture

64

Anatomica Karnataka, Vol-7, (1), Page 63-66 (2013)

A Maxillary Immediate Tooth Supported Over Denture Opposing A Tooth Supported Straight Bar Mandibular Over Denture; A Case Report

Figure 3 After Treatment

Dental

Studies show that anterior teeth exhibit more sensitivity and

discrimination of forces than posterior teeth. By retaining
mandibular canines in overdenture, the resorption of the
alveolar bone surrounding these teeth was reduced by
8
eight times . Considering these factors an immediate over
denture and bar retained over denture is planned for the
patient which provides simplicity of
construction, ease of maintenance, stability, retention,
stabilization of existing structures, less trauma to the
supporting tissues (as a result of distribution of forces),
esthetic excellence, good patient response, and can serve
as a transitional appliance toward a conventional or
2,9
implant-supported denture .
Over dentures are generally indicated for patients when
even single tooth or few healthy teeth are remaining in the
mouth, patients with poor prognosis for complete denture
like severely resorbed residual ridge, high palatal vault,
cleft palate, ectodermal dysplasia and deformities of
9,10,11
maxilla and mandible
over dentures contraindicated in
uncooperative patients ,patients having grade III mobility of
teeth, decreased vertical dimension of occlusion ,severe
hard and soft tissue undercuts and teeth that cannot be
9, 10,11
treated endodontically.
11
Advantages and disadvantages of overdenture
Advantages:
1.
Patient does not have to suffer through edentulous
period
2.
Reduced pain and swelling
3.
Current esthetics retained in dentures
4.
Patient adapts rapidly
5.
Good speech and appearance are retained
6.
Patient does not develop undesirable habits and is
more cooperative emotionally
7.
Acts as a bandage to control hemorrhag
8.
Promotes rapid healing
9.
Provides for minimum social interruptions and
maximum psychological advantages.
Disadvantages: (very few situations contraindicate their
use)
1.
The additional expense of relining immediate
dentures three to six months after insertion creates
problems for some patients.
2.
Additional treatment time is required for the dentist
and patient because of the number of necessary post

cast6 and artificial teeth are arranged in the wax. Proper wax
up and carving is done. Then they are processed by
investing, dewaxing, packing, curing, finishing and
polishing. Once the dentures were ready, patients anterior
teeth were removed and sutures placed and dentures were
inserted into patients mouth.
Occlusion and denture borders were checked and
correction was made. Patient was given instructions not to
remove denture for next two days except for cleaning.
DISCUSSION
Edentulism results in loss of tooth proprioception,
progressive alveolar bone loss, the transfer of all occlusal
forces from the teeth to the oral mucosa, and esthetic
deficiencies.
By retaining natural teeth for an overdenture, we can
preserve some of sensory inputs from the periodontal
receptors which were more precise than that was obtained
from oral mucosa. These periodontal receptors by their
proprioceptive feedback mechanism actively influence
muscles of mastication and thereby the cyclic
7
tempromandibular joint movements of mastication .
65

Anatomica Karnataka, Vol-7, (1), Page 63-66 (2013)

A Maxillary Immediate Tooth Supported Over Denture Opposing A Tooth Supported Straight Bar Mandibular Over Denture; A Case Report

Dental

2.
Dodge, C. Prevention of complete denture
problems by use of overdentures. J Prosthet Dent;1978. 30:
403-41

insertion adjustments
3.
The immediate denture cannot be assessed fully
until it is placed into the mouth
Considering these factors an immediate maxillary
overdenture and bar supported mandibular over denture
was planned.
Copings are made to cover the prepared abutment teeth
and cemented to place. All exposed tooth surfaces should
be covered in an effort to prevent future carious lesions from
developing. The use of the straight bar joint offers
periodontally involved teeth an improved crown/root ratio
and splinting of the teeth. Because the bar is close to the
alveolar bone, forces of mastication exert much less
leverage to the teeth12,. Finally, the bar joint offers slight
vertical and rotational movement of the denture as well as a
stress breaker action. Bar exhibited more cross-arch
involvement than the Zest anchor and allowed occlusal
13,14
forces to be shared between the abutments .
The problems usually associated with immediate over
dentures are post extraction edema, relining, loss of
abutment, associated periodontal disease, caries etc. The
patient should be motivated to properly maintain the
retained teeth with home care and understand the
importance of periodic follow-up care by the dentist2,9,10.

3.
R.E.G, Jonkman, VaanWaas,M.A.J, Satisfaction
with complete immediate dentures and complete
immediate over dentures ;A one year survey ; Journal of
Oral Rehabilitation 1995 22;791-796
4.
Landa LS. Diagnosis and management of partially
edentulous cases with a minimal number of remaining
teeth. Dent Clin North Am. 1985 Jan;29(1):3-16.
5.
203,

Campagna, S. J. . J Prosthet Dent 20: 1968:196-

6.

Jerbi, F. C. . J Prosthet Dent 16: 1966.1047-1053,

7.
Thayer, H. H. Overdentures and the periodontium.
DCNA 24:369-377, 1980
8.
Crum RJ; Rooney GE Jr. Alveolar bone loss in
overdentures: a 5-year study. J Prosthet Dent 1978; 40(6):
610-613,
9.

Morrow, R. M., et al. . J Prosthet Dent1973;30:695,

10.
BrewerA.A. and Morrow R.M. Overdentures.made
easy, 2nd Ed, The C. V. Mosby Co, St. Louis,1980

CONCLUSION
Immediate OVERDENTURE allows patients to continue
their social and business activities without being in
edentulous state, and as a last chance for tooth supported
prosthesis. This advantage can be demanding and
challenging,as the arrangement of artificial teeth cannot be
observedat a try-in appointment. It is important for both
thepatient and the dentist to understand the limitations
ofthe procedure.The prognosis is likely to be influenced by
numerous factors like: Selection of patient, treatment
planning, preparation of the mouth, execution of the basic
prosthodontic principles, and patient motivation.
If we select our patients wisely we can be relatively assured
of successful outcome for many years with over denture
patients.

11.
Heartwell, C. and Salisbury, F. W. . J Prosthet Dent
1965;15: 615-624,
12.
H.H.Thayer and A.A.Caputo. Occlusal force
transmission by overdentureattachments.JProsthet Dent
1979.:41:266-271,

CORRESPONDENCE ADDRESS
Dr Anandkumar. G .Patil
Professor & Head
Department of Prosthodontics
Mansarovar Dental College Hospital and
Research Centre
Kolar Road ,Bhopal-462042
Madyapradesh, India.

REFERENCES
1.
Herman GL. Esthetic and emotional factors in
immediate denture construction.Compendium. 1989
Sep;10(9):486-488.

66

Anatomica Karnataka, Vol-7, (1), Page 63-66 (2013)