Tooth-supported telescopic prostheses in compromised dentitions: A clinical report

Yair Langer, DMD,a and Anselm Langer, DMDb The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, and Hebrew University-Hadassah Faculty of Dental Medicine, Jerusalem, Israel

Telescopic crowns were initially introduced as retainers for removable partial dentures (RPDs) at the beginning of the 20th century. They are also known as a double crown, crown and sleeve coping (CSC), or as Konuskrone, a German term that described a coneshaped design. These crowns consist of an inner or primary telescopic coping, permanently cemented to an abutment, and a congruent detachable outer or secondary telescopic crown, rigidly connected to a detachable prosthesis. Copings were designed to protect the abutment from dental caries and thermal irritations and also provided retention and stabilization of the secondary crown. The secondary crown engages the primary coping to form a telescopic unit and serves as an anchor for the remainder of the dentition. The tapered configuration of the contacting walls generates a compressive intersurface tension based on wedging action. This concept has been widely used in engineering for rapid and secure fastening of 2 congruent mechanical parts. Tension should be sufficiently strong to sustain the RPD in place. In restorations involving the entire dental arch, retentive and stabilizing properties of telescopic retainers are directly related to their number, angle of wall taper, and harmonious distribution along the dental arch. The average wall taper commonly has a 6-degree angle.1,2 Tapering of the coping walls reduces retention between the unit elements. The smaller the degree of the taper, the greater the frictional retention of the retainer.2 If the extent of intersurface contact between both components is restricted by limited abutment height, a reduced angulation, between 2 to 5 degrees per side, should be used to improve retention. The splinting action of telescopic restorations occurs when multiple outer and fixed inner telescopic crowns engage each other in situ. Elements of splinting and support are not affected by the degree of wall angulation. Taper of the walls of the primary coping can be adjusted to a predetermined angle, according to special requirements of each patient. They are milled to exact configurations of taper angles of the walls with
Postgraduate Program, Department of Prosthetic Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University. bProfessor Emeritus, Department of Prosthodontics, Hebrew University-Hadassah Faculty of Dental Medicine. J Prosthet Dent 2000;84:129-32. AUGUST 2000
aInstructor,

each other to create a common path of insertion for outer telescopic crowns of a retrievable superstructure. Although an apparently antiquated method of treatment, telescope retained dentures, if appropriately applied, have remained a refined and effective prosthodontic solution for selected complex patient treatments that require unique clinical and technical skills.3-5

CLINICAL CONSIDERATIONS
Telescopic crowns have been used mainly in RPDs to connect dentures to the remaining dentition,1-3 but they may also be designated as retainers in totally abutment-borne detachable prostheses.4 The term detachable was preferred to removable in the context of this article to avoid confusion with RPDs that receive their support partly from abutments and partly from mucoperiosteal structures. Telescopic-anchored prostheses are functionally comparable with conventional fixed partial dentures (FPDs) and are considered to be a most effective replacement for lost teeth and are well tolerated psychologically. The distribution of abutments for detachable prostheses should conform to principles that govern fabrication of FPDs. Accordingly, detachable prostheses are usually indicated only for patients with multiple abutments distributed bilaterally in strategic positions along the dental arch. Telescopic crowns have also been used successfully in RPDs and FPDs supported by endosseous implants in combination with natural teeth,5 including overdentures.6,7 The primary advantage of a telescopic prosthesis is retrievability. If the remaining dentition is in a state of transition, abutments splinted with FPDs can be a problem. A telescopic prosthesis is a more versatile alternative for these patients because the prosthesis can be repaired without reconstruction of the entire superstructure, despite a localized failure. The patient can disengage telescopic restoration with dislodgment of the outer telescopic crowns from their copings. The patient should be instructed on precautions to prevent damage to the denture during cleaning because distortion of an outer telescopic crown can render the prosthesis nonfunctional. There has been ample evidence that telescopic dentures promote oral hygiene and periodontal health because the abutments are more accessible for oral hygiene. In
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Fig. 1. Radiographs for patient 1 before treatment.

Fig. 4. Gingival view of detachable telescopic superstructure.

Fig. 2. Fixed provisional restoration that includes all available maxillary abutments in situ.

Fig. 5. Telescopic prosthesis.

clinical and technical aspects of using telescopic crowns in the restorative treatment of 2 patients.

CLINICAL REPORT Patient 1

The indication for detachable prosthesis is illustrated by a clinical condition of a middle-aged woman (Figs. 1 and 2) who wished to retain her remaining maxillary teeth. The patient was extremely reluctant to have an RPD. Splinting the remaining teeth was indicated to achieve stabilization against occlusal stress. The prognosis of the periodontally compromised abutments remained guarded, making immobilization with a fixed restoration a high risk to the patient. The patient was counseled on the treatment options and chose to receive treatment with a detachable telescopic prosthesis. The hopelessly compromised right second premolar and left central incisor were extracted. The remaining maxillary teeth were prepared. Primary telescopic copings were fabricated and cemented to the remaining teeth from the left second molar to the right first premolar (Fig. 3) after preprosthodontic/periodontic treatments, including provisionalization for the duraVOLUME 84 NUMBER 2

Fig. 3. Primary copings cemented to all abutments.

addition, peripheral gingival margins and the prosthesis can be readily cleaned after removal from the mouth.2,8 The splinting effect of a telescopic superstructure is similar to an FPD and has a favorable influence on stabilization of the remaining dentition and improves periodontal health. This clinical report describes the
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Fig. 6. Panoramic radiograph of patient 2 before treatment.

Fig. 8. All available mandibular abutments provided with primary copings.

Fig. 7. Faulty mandibular FPD and maxillary implant-supported and retained FPD (pretreatment).

Fig. 9. Gingival view of detachable telescopic superstructure.

tion of the follow-up period (Fig. 2). A definitive, removable telescopic prosthesis, which included 8 outer telescopic crowns and 3 pontics (including a left molar, central incisor, and a right cantilever premolar), was then made (Figs. 4 and 5). Oral hygiene regimens were maintained during the course of treatment and the patient received instructions in meticulous home care. A strict 3-month recall regimen was recommended.

Patient 2
A 65-year-old patient was previously treated with a cross-arch FPD that connected the remaining 7 endodontically treated mandibular teeth (Fig. 6). The maxillary arch was restored with a fixed restoration that was supported and retained by 4 endosseous implants (Figs. 6 and 7). Mandibular abutments were judged to be too short to provide sufficient retention for crowns and FPDs (Fig. 7). The endodontically treated roots posed a latent risk for an irretrievable cemented prosthesis, so a detachable telescopic restoration was selected as an alternate solution. The available mandibular abutments were provided with
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Fig. 10. Mandibular telescopic prosthesis in occlusion with implant-bar-splintsupported and retained maxillary overdenture.

primary copings (Fig. 8). A near parallel 2-degree taper was selected to ensure frictional retention between the primary and secondary artificial crowns (Fig. 8). The detachable superstructure was comprised of 7 veneered secondary crowns and 6 pontics that
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included a right premolar-shaped cantilever (Figs. 9 and 10). The maxillary jaw was treated with a barsplintretained and supported overdenture on the 4 dental implants (Fig. 10).

SUMMARY
This article describes indications for treatment with telescopic restorations on patients with periodontally and endodontically compromised dentitions that require splinting, with special emphasis on treatment that restores the entire dental arch. Stabilization of compromised teeth with fixed splinted restorations is usually inadvisable because of the risk factors involved, such as eventual localized abutment failure. Detachable telescopic prostheses may be preferred as a near equivalent or substitute because they can be detached and repaired without reconstruction of the entire restoration. Retentive and splinting properties of detachable telescopic restorations can be as effective as FPDs. Inner telescopic copings can be cemented as individual crowns to facilitate the procedure. Telescopic restorations can be retrieved by the patient for cleaning and easy access to the entire marginal periodontal circumference of the abutments. This promotes effective home care and oral hygiene. In addition, principles of design and indications, as well as technical and clinical factors, were discussed.
REFERENCES
1. Langer A. Telescope retainers for removable partial dentures. J Prosthet Dent 1981;45:37-43. 2. Langer A. Telescope retainers and their clinical application. J Prosthet Dent 1980;44:516-22.

3. Sethi A, Sochor P. Restoration of the maxillary arch using implants, natural teeth and the Konus crown. Dent Update 1994;21:52-5. 4. Langer A. Tooth-supported telescope restorations. J Prosthet Dent 1981;45:515-20. 5. Laufer BZ, Gross M. Splinting osseointegrated implants and natural teeth in rehabilitation of partially edentulous patients. Part II: principles and applications. J Oral Rehabil 1998;25:69-80. 6. Besimo C, Graber G. A new concept of overdentures with telescope crowns on osseointegrated implants. Int J Periodontics Restorative Dent 1994;14:486-95. 7. Besimo C, Graber G, Schaffner T. Hybrid prosthetic implant supported suprastructures in edentulous mandible. Conus crowns and shell-pinsystems on HA-Ti-Implants: part 2. Prosthetic construction principles. ZWR 1991;100:70-6. 8. Hou GL, Tsai CC, Weisgold AS. Periodontal and prosthetic therapy in severely advanced periodontitis by the use of the crown sleeve coping telescope denture. A longitudinal case report. Aust Dent J 1997;42:169-74. Reprint requests to: DR YAIR LANGER DEPARTMENT OF PROSTHETIC DENTISTRY MAURICE AND GABRIELA GOLDSCHLEGER SCHOOL OF DENTAL MEDICINE TEL AVIV UNIVERSITY TEL AVIV 69978 ISRAEL FAX: 972-3-6409250 E-MAIL: edek@inter.net.il Copyright 2000 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/2000/$12.00 + 0. 10/1/108026

doi:10.1067/mpr.2000.108026

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