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OVERDENTURE ATTACHMENTS

SHREY SURI
1
ST
YEAR
PROSTHODONTICS
Options for Restoring Totally Edentulous
Jaws
12 Mini-implants per arch with Snap-on Acrylic Bridge
Drill Sequence for 3.0 ScrewIndirect
Implant
Pointed Drill to Initiate Osteotomy
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Compare Imtek Mini-implants to
ScrewDirect
Bar Overdenture on 4 ScrewIndirect 1-
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Bar Overdenture on 4 ScrewIndirect 1-
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Bar Overdenture on 4 ScrewIndirect 1-
Piece Implants
Bar Overdenture on 4 ScrewIndirect 1-
Piece Implants
Bar Overdenture on 4 ScrewIndirect 1-
Piece Implants
Bar Overdenture on 4 ScrewIndirect
Implants
Bar Overdenture on 4 ScrewIndirect 1-
Piece Implants
Restoration of the Totally Edentulous Jaw with an Implant
Supported Bar Overdenture on 5 ScrewInDirect Implants
5 S-InDirect One-piece Implants between Mental Foramen
5 S-InDirect Implants with Snap-on
Comfort Caps
Open Tray Transfer Impression
Bar with Ball Attachments, Attached to Implants within 48 Hours
Bar Attached to Implants 6Mo PO
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Fixed Detachable Bridge on 5
ScrewIndirect Implants
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Implants Dr. Peabody
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Teeth-in-a-Day on 7 ScrewIndirect
Implants
Make Impression to Locate Position
of Holes
Attach Titanium Copings and Seat
Modified Denture
Cold Cure Denture to Titanium
Copings
Screw-in Fixed-Detachable
Restoration
Teeth-in-1Day with 5 ScrewIndirect
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Teeth-in-1Day with 5 ScrewIndirect
Implants
Teeth-in-1Day with 5 ScrewIndirect
Implants
CLASSIFICATION OF OVERDENTURES
(based on method of abutment preparation)
{Heartwell}


Non coping
Coping
Attachments


NONCOPING OVERDENTURES
Selected abutments are reduced to a coronal height of
2 to 3 mm and then contoured to a convex or dome
shaped surface. Most teeth require endodontic
therapy followed by amalgam or composite
restoration.

COPING OVERDENTURES

COPING OVERDENTURE

A coping fitted to a prepared abutment is
called a primary coping. The sleeve or
coping that fits over this primary coping is
referred to as a secondary coping.

There are four basic types of primary
copings


1. Long copings (6-8 mm).
2. Medium copings (4-6mm).
3. Medium-short copings (2-4 mm).
4. Short copings (1-2 mm).

Long copings (6-8 mm)

Medium Copings (4-6 millimeters for
vital and non-vital teeth)

Medium copings
Abutment preparations
for medium copings
Medium short copings (2-4 mm for
nonvital teeth)


Indicated for nonvital teeth; where a
more favorable crown root ratio is
desired than that possible with medium
or long copings
Short Copings (1-2 millimeters for
non-vital teeth)



They are indicated for maximum
favorable crown-root ratio
{CLASSIFICATION BY MENSOR}

Resilient
Non resilient

Coronal
Radicular

Auxiliary

Coronal
Intra coronal attachments
Extra coronal attachments
Radicular
Telescope stud attachments
Bar attachments
Auxiliary attachments
Screw units
Pawl connectors
Bolts
Stabilizers/balancers
Interlocks
Pins/screws
Rests
STUD ATTACHMENTS



They can be resilient or non resilient.

Resilient attachment permits the tissue to compress
slightly before any load is transmitted to the
abutment .

Indicated:


When there are only a few abutments.
When abutments have minimal bone support.
When functioning opposite natural dentition.

A non resilient attachment will not allow
vertical movement (however it may
permit rotational movement). Used :
When no vertical movement is indicated.
When an all-tooth supported prosthesis is desired.
When a tooth-tissue supported appliance is
desired.
With strong abutments having maximum bone
support .

Some Stud Attachments

Gerber attachment
Dalbo attachment
Ceka attachment
Zest anchor
Rothermann attachment
Introfix attachment
Schubiger attachment
Quinlivan attachment


The Gerber stud system is a versatile stud
attachment used routinely.
It consists of a male post soldered to the
coping and a retentive female secured
within the denture base of the overlay
prostheses.
The Gerber attachment is furnished in
two different types - a resilient and non-
resilient form.

Dalbo attachment

Rigid
Resilient
Stress broken

It is composed of the male unit attached
to the tooth & the female housing
embedded in the denture base.
CEKA ATTACHMENT

MALE{affixed to tooth}
has a rounded shape wider
at top & split vertically
into 4 sections.
Over this fits a female housing or ring.

It allows some vertical play & rotational
movement of the base.

Recent advances in CEKA

The Ceka Revax
The new Ceka Revax (M2) is the smallest fully
adjustable and serviceable stud attachment system.
The small size allows for usage
when space is at a premium--
ideal for close bitesituations.
Space requirements for the Revax (M2) are
3.8mm in height
3.4mm in diameter.
Its advised to allow approximately 4.8 mm of
vertical space for the attachment, acrylic resin,
and teeth.
the Ceka requires 0.45 mm more vertical
clearance.
When space is available, select the traditional M3
Ceka as it is stronger and easier to service.


{ Intraradicular}

Post preparation is made in root
& female sleeve is cemented.


The male portion is a nylon
post & a ball head that is
attached to Overdenture as a chair side
procedure.

Advantages:
No space problems
Leverage on abutment tooth negligible
Quick & needs no casting

Advancements allow the male to
freely rotate and move within
the housing or denture cap,
the wide band on the male allows for increased
retention and reduced wear (less bending and
breakage)
the female has a titanium coating for hardness and a
smoother internal surface
New Zest Anchor Advanced
Generation (ZAAG)
The female may be used with a cast coping or
directly placed into a root.

There are two sizes
regular (4.0 mm height, 3.8 mm width)
mini (2.3 mm height, 3.3 mm width)

QUINLIVAN ATTACHMENT

Consists of a prefabricated resin ball -
incorporated with the wax up of post &
coping.

A resin female housing is attached to the
Overdenture with cold cure resin.

Retention is gained by an O rubber ring
inside the female that is secured by a small
lip at the orifice of the female cap.
Advantages:
Free to rotate
in all directions
Easily fabricated & replaceable
Economical

Disadvantages:
Wear & possible fracture of resin housing if
much grinding was originally done to fit the
limited space.

no path of insertion for
patients with limited dexterity
limited servicing requirements
for the operator
up to 24 of rotation per abutment for non-
parallel abutments
prosthesis may engage undercuts for
increased stability
OSO Post

simple techniques
low cost
a pressure relief system for seating
the ability to be used in combination with
splinting bars, processing jigs that allow
dentists to cement the crowns at time of try in
and provide simple repair or replacement of
the removable prosthesis.
The OSO is maintenance free...there is nothing
to repair except the O-ring, which may be
replaced in minutes.

The overdenture system in prefabricated
Vitallium posts are available in 0, 5, 10, 15,
and 20 degrees.

The new Sphero Flex Post system is an
endodontic post rotating ball attachment that
corrects misalignment in any plane up to 15
degrees.
The advantages of this self paralleling system
are -the freedom of movement (resiliency)
that protects weak abutments
-the biocompatibility of titanium
-the small size of the sphere (2.5 mm).
The female may be seated in the prosthesis, or
incorporated in to a cast frame.
The posts are available in three lengths-- 6.75
mm, 8.40 mm, and 9.75 mm.
The 2 degree tapered reamer is used to refine
the canal. This system can also be used with a
cast coping.



The purpose is splinting of the
abutment teeth and retention
& support of the prosthetic
appliance.


Various bar attachments are


Hader bar
Dolder bar
Baker clip
Ackerman clip
CM Clip

Consists of preformed
plastic bars & clips.

The plastic bar is attached to the coping
wax up & is cast with the copings.

The plastic clips can be embedded in
denture base to gain retention

U shaped clip designed to fit over round
wire.
2 sizes of wire are available:
11 gauge
14 gauge

The wire is soldered to post copings. The
clip is attached to denture base.
TREATMENT PLANNING

This includes

Periodontal considerations
Endodontic treatment
Caries Management
Location and Distribution of forces
Economics


PERIODONTAL CONSIDERATION

Periodontal inflammation

Pocket formation

Bony defects and poor zone of attached gingiva
must all be eliminated before commencement of the
treatment

A common periodontal requisite with over denture
abutment teeth is that an adequate zone of attached
gingiva is mandatory
ENDODONTIC
CONSIDERATION
Advantages
The crown root ratio can be made more favorable.


Reduction of the clinical crown provides an
interocclusal distance more favorable for the placement of
the artificial tooth in an esthetically acceptable position
and in more favorable relation to the opposing teeth.

Contra indications for endodontic
treatment
Vertical fracture of the root or roots.
Mechanical perforation of the root canal.
Broken instrument in the root canal.
Horizontal fracture of the root below the
bony crest.
Posterior teeth that are tilted more than 25
degrees.

LOCATION AND DISTRIBUTION OF
ABUTMENT

Two canines & two premolars abutments are
the most common pattern for four abutments.
Three abutments, two canines & a second
premolar can be used where fourth
abutment is unavailable
CARIES MANAGEMENT

The presence of high caries index
and the situation that will create a
carious environment are the
devastating sequelae to improper
over denture patient selection.


Choice of abutment is a tooth
that have a healthy clinical crown.


Frequent recall check up and treatment of the
abutment with periodic fluoride application to
ensure against any further break down.



Endodontic treatment,
cast copings, attachments and
Overdenture itself may workout
expensive so economics of the patient
should be considered.

Implant-Supported

Overdenture


A Solution For all
Missing Teeth
Dental implants can be used to support a
specially designed denture, known as an
Overdenture.
minimum bone loss
improved stability
improved occlusion
improved speech, retention, support

THESE ARE ESPECIALLY
ADVANTAGEOUS FOR THE LOWER
ARCH, WHERE RETENTION OF
DENTURES IS OFTEN A PROBLEM
Implant-supported Overdenture may be
supported by two to six implants.
There are two types of implant-supported
dentures:
bar-retained

ball-retained
Bar-retained dentures
A thin metal bar that follows
the curve of jaw , is attached
to two to five implants.

Clips or other types of
attachments are fitted to the
bar ,the denture, or to both.
The denture fits over the bar
and is securely clipped into
place by the attachments.

Ball-retained dentures
(stud-attachment dentures)
Each implant that has been
placed in the jawbone
holds a metal attachment
that fits into another
attachment on the
denture.
In most cases, the
attachments on the
implants are ball-shaped
("male" attachments), and
they fit into sockets
("female" attachments) on
the denture
Impression making for Overdenture

CUSTOM TRAY FABRICATION
TISSUE BORNE SIDE OF TRAY
SCREW FINAL TITANIUM ABUTMENTS INTO
PLACE IN ROOT FORM IMPLANTS
TRANSFER COPINGS
SCREW EACH TRANSFER COPING TIGHTLY
INTO ITS MATCHING ABUTMENTS
BORDER MOULDING IN MOUTH
FINAL IMPRESSION RECORDS ALL TISSUES &
TRANSFER COPINGS
EACH TRANSFER COPING IS REMOVED
FROM ABUTMENT & SCREWED INTO A
PROSTHETIC IMPLANT ANALOGUE
PLACE ABUTMENT
ANALOGS INTO THEIR
IMPLANT MATES ON
WORKING CAST
PROCESS BASE PLATE ON
CAST
WAX RIM BUILT ON
BASE PLATE FOR CR
& VD
SET TEETH IN WAX ON IDEAL PLANE
VIEW ABUTMENT FROM ABOVE IN THEIR
ACCURATE RELATION TO DENTURE BASE
FOLLOW UP CARE

Brushing with soft bristle
Bubble gum physiotherapy
Daily application of 0.4% SnF2 gel using
Overdenture as a carrier.

Floss
Perio aids
Rubber tips should be
used which guarantee that all plaque
accumulation is removed from tooth
surface & sulcus.
0.12% chlorhexidine gluconate mouth
wash
The dentist should recall regularly.
Initial 2 minute treatment with 1.23% APF gel
followed by 0.4% stannous fluoride gel for 2
minute.


Failures of Overdenture

ABUTMENT FAILURE
Abutment caries is a problem , the effects
can be managed by restoration &
improved oral hygiene efforts.
Abutment failures -an exacerbation of
periodontal disease ( more
common cause)
OVERDENTURE BREAKAGE

Fracture characteristically were through or
immediately adjacent to abutment teeth
& often occurred 6-8 weeks postinsertion
just before relining.
Contributing factors:
Residual ridge changes secondary to healing
Additional load transference to abutments
Changes:
Use of resin denture teeth.
Grooves placed in ridge laps of resin
teeth - provide additional bonding area
for denture base resin & to increase the
strength & rigidity of Overdenture
High impact denture base resins were
used for immediate Overdentures

OVERDENTURE is a preventive dentistry concept which
has been brought into prosthodontics. Even though the
technique resembles that of complete denture there are
important differences. The prognosis of the restoration is
likely to be influenced by numerous factors like :
Selection of patient
Treatment planning
Preparation of mouth
Patient home care
references
-Sheldon Winkler-Essentials of complete denture
prosthodontics, second edition
-Zarb-Bolender-Prosthodontic treatment for
edentulous patients, twelfth edition
-Charles M. Heartwell Jr, Arthur O.Rahn- Syllabus
of complete dentures, fifth edition
The dental clinics of north America- complete
dentures Vol. 40, No. 1, Jan 1996. Pg 169-194.
An attachment of overlay denture. JPD 1974 ;32:
3, 256-261.

Alveolar bone loss in Overdenture: a 5 year
study. JPD 1978;40:6, 610-613.
Effect of 0.4% stannous fluoride gel on the
gingival health of overdenture abutments
JPD 1982; 48:23-26.
Classification & selection of attachments. JPD
1973: 20; 494.
Attachment fixation of the Overdenture. JPD
1978;39: 1, 16-19.

DCNA 2004: removable prosthodontics;586-
613
Atlas of oral Implantology A. Norman Cranin
Contemporary Implant Dentistry Carl E. Misch