OVERDENTURES

Presentedby DepartmentofProsthodontics&Implantology, SRMKattankulathurDentalCollege&Hospital

INTRODUCTION

Withincreasingstressonpreventive prosthodontics,theuseofoverdentureshas reachedapointwhereitisnowafeasible alternativetomosttreatmentplanoutlinesin theconstructionofaprosthesisforpatients withremainingteeth.

INTRODUCTIONContd..

Theoverdenture,acompleteorpartial dentureprosthesisconstructedoverexisting teethorrootstructure,isnotanewconcept inatechnicalapproachtoaprosthodontic problem.Indeeditsusedatesbackto100 years.

DEFINITION

Definition:Aremovablepartialorcomplete denturethatcoversandrestsononeormore remainingnaturalteeth,roots,andor/dental implants.{GPT6}

Analternativewaytodefinean overdenture

Adentalprosthesisthatreplacesthelostor missingnaturaldentitionandassociated structuresofmaxillaandormandibleand receivespartialsupportandstabilityfromone ormoremodifiednaturalteeth.

Synonyms
Overlaydentures Onlaydentures Hybriddentures Superimposeddentures Telescopeddentures Biologicdentures Copingprosthesis

HISTORY
1856 LEDGER prescribed a prosthesis resembling an overdenture. His restorations were referred to as plates covering fangs, but the principle was similar. 1888 EVANS described a method for using roots to retain restorations 1896 ESSIG described a telescopiclike coping. 1870 there is also evidence to suggest that overdentures were being made in the UK.

HISTORY
1906 HUNTER said whatever the reasons for retaining roots, they were normally devitalized. This type of construction therefore lost favor when the focal sepsis scare was at its peak. 1916 PEESO was employing removable telescopic crowns at this time. Later on, the bar type of construction was developed.

GOALS Thereare3importantgoalsofoverdentures:
Maintains teeth as part of the residual ridge
1. 2.

3.

More support Withstands more occlusal load Retention improve

Decrease in the rate of resorption Retaining the proprioception

Alveolar bone exists as a support for teeth An increase in the patients manipulative skills in handling the denture

Overdentures

Tooth supported

implant supported

non Coping

coping

attachments

stud

bar

magnets

CLASSIFICATION

BASEDONTYPEOFOVERDENTURE
1.Immediateoverdenture 2.Transitionaloverdenture

ADVANTAGES,DISADVANTAGES, INDICATIONSANDCONTRAINDIATIONS

ADVANTAGES

Preservationofalveolarbone. Preservationofproprioceptiveresponse. Asimpleapproachtoaproblempatient.

ADVANTAGES

Simplicityofconstruction easeofobtaining accuraterecordsandsuperiordenture stability Support Periodontalmaintainence.

ADVANTAGES

Retention Openpalatepossible Costeffective

ADVANTAGES

Idealocclusion Superiorpatientacceptance Lesstraumatosupportingtissues

ADVANTAGES

Convertibility Conversiontocompletedenture

DISADVANTAGES Cariessusceptibility. Bonyundercuts: overcontouredandundercontoured flanges. Encroachmentofinterocclusaldistance. Demandformeticulousoralhygiene Esthetics

INDICATIONS

ALLENA.BREWER Althoughthepresenceoffewremaining teethoneofthemajorindicationsfor overdenture,asmanyabutmentsaspossible areretainedinthearch

INDICATIONS

Patientswithpoorprognosisforcomplete dentures Inmaxilla incaseswithexcessivevertical overlapofanteriorteeth Unilateraloverdenturewithbonelossis excessiveononesideofthearch

CONTRAINDICATIONS Lackofpatientacceptance Lackofproperoralhygieneandperiodontaltissue maintenance Whenothertreatmentmodalitiespromisesuperior results Costconsiderations

EXAMINATION,DIAGNOSIS,TREATMENT PLANNINGANDPROGNOSIS

EXAMINATIONOFTHE OVERDENTUREPATIENT

Historyandrecords Visualanddigitalexamination pathology, healthofthesupportingtissues Radiographicexamination

TREATMENTPLANNING

Whenindicatedfixedpartialdenturesarethe treatmentofchoice,howevertheprospective overdenturepatientusuallydoesnothave properlydistributed,healthyteethwith suitablecrownrootratios.

ABUTMENTSELECTION

Chronologyoftoothloss Maxilla>Mandible Maxilla posterior>anterior Mandible posterior>anterior

ABUTMENTSELECTION Chronologyoftooth loss

Initialstagesoftoothloss Maxillaryoverdentureversusthecomplete componentofmandibularnaturalteeth Laterstages mandibularoverdentureversus maxillarycompleteedentulousarch Maxillaryandmandibularcompletedenture

Evaluatefor

1. 2. 3. 4.

Periodontalstatus Cariessusceptibility Potentialforendodontictreatment Positionalconsiderations

PERIODONTALCONSIDERATIONS Mandibularcanine,Firstpremolarversus Secondpremolar Numberofroots,presenceandconditionof thefurcation,quantityanduniformityofthe investingalveolarbone.

Roleofendodontictreatment inthepreparationofabutment

Estheticresult ImprovementofCrownrootratios Permitsuseoftiltedandmalposedteethand hemisectionedorrootamputatedmolar teethasabutmentsforoverdentures.

LOCATIONOFABUTMENTTOOTH Positional considerations

Positionoftoothinthearchanditsposition betweenthebuccalandlingualcorticalplates Inareasofmaximumforceandridgeresorption potential Bestchoiceofabutmentiscaninesand premolars

LOCATIONOFABUTMENTTOOTH Positional considerations

Inmaxillaryarch,incisorsareused Atleastonetoothperquadrantshouldbepresent Idealis2teethperquadrant.thestressis distributedoverarectangulararea Atripodapproachcanalsobeused

 Mostcommonlyusedteethinthemandiblefor abutment Canine Reasons Position,Largesurfacearea,TheCanineresponse, Timeperiodofretentionofthetooth,less susceptibilitytoperiodontalbreakdown,fewer anatomicalandpositionaldifficulties.

QuadretandTripod configurations

Maxillaryarch ThetwoCentralsandthe canines/premolars. Idealwhenopposingmandibularanteriors exist Whenonlysingleincisorremains Tripod lessmechanicaladvantage.

OVERDENTUREABUTMENTMANAGEMENT 1. Noncopingpreparation 2. Copingpreparation 3. Attachments

NONCOPINGABUTMENTS Thetoothisreducedtoacoronalheightof2to3 mm Thecrowniscontouredtoaconvexordomeshape Thetoothisendodonticallytreatedandfilledwith amalgamorcompositerestoration

COPINGPREPARATION
Acopingisacoverfortheexposedtoothsurface. Castmetalcopingswithadomeshapedsurfaceandachamfer finishlineatthegingivalmargin Shortcopings Longcopings

23mmlong.58mmlong RCTdone. RCTisnotamust Copingsarewithapost.Copingsarelong CanalsfilledwithGP

CASTCROWNCOPINGS

ATTACHMENTSFOROVERDENTURES

ATTACHMENTSINOVERDENTURES
Attachmentsaresmallprecisiondevices Theyareincorporatedtoprovidesomeadditional benefitslikeretentionandsupport Moreretentioncanbegainedbylengtheningthe postandtheuseofpins Itconsistsoftwounits: Male female

REQUIREMENTSFORTHEATTACHMENTS
Thepatientsshouldhavealowcariesindex Performproperhomecare Soundperiodontalhealth Abutmentteethwithproperbonesupport

DISADVANTAGESOFATTACHMENTS
Addedtime Maycauseincreasedstressonthetooth Moredifficulttoconstruct Requirescarefulmanipulationbythe patients.Thereforeisnotofuseforthe mentallyandphysicallyhandicapped

DISADVANTAGESOF ATTACHMENTS

Moreexpensive Reconstructioninthecaseofdamageis difficult Addedrisktotheabutmentduetocariesand periodontaldiseaseifpoororalhygieneis performedbythepatient

STUDATTACHMENTS Malestud solderedtothe basewhichisacopingcovering thepreparedtoothstump Femalehousing thisis embeddedintheacrylicofthe ODoritissolderedto substructureintheOD Maleandfemaleattachments maybeeitherresilientornon resilient

GERBERATTACHMENT Rigid Resilient

Expensivelesstorque,complexinits Torqueonthetoothifthedesignandconstruction basemovesduetoimproper impressionorreducedadaptability Advantages: Easilyreplaceable Maleunitscanberemovedbyunscrewing thethreadsand otherattachmentcanbefixed

RIGIDTYPEGERBERATTACHMENT
Mostpopularandwidelyused Malepostthreadedontoascrew attachedtoasolderingbase Female:overallhousingcontaininga retentionspring Retentionisbymeansofaspringclipin thefemaleengagingagrooveinthemale section

RESILIENTFORMGERBERATTACHMENT
Malestud:hasasolderingbasewithadifferent retentionpost Femalehousing:containsamountingring, bushing,andaretentionringwithaspring Morebulky adequateinterocclusalspacemust bepresent Complicatedtouseandfrequentreplacementof theringisessential Torquecanoccurifdenturebasesupportis inadequate

DALBOATTACHMENT
Rigid,resilientorthestressbreakertype Malepartissolderedtothetoothandthe housingtothebase Therigidtypehasacylindricalmaleunitwith aroundedhead Theresilientisthesmallestandthemost commonlyused. Rotationalandverticalmovementpossible becauseofreliefspacersbetweentheunits Retentioninthisisbytheflexiblearmsofthe femaleunitfittingovertheundercutheadof themaleunit

CEKA ATTACHMENT
Malepartaffixedtothetoothandhas aroundedshapewideratthetopand splitverticallyinto4sections.They areflexibleandcanbecompressed Femalehousingfitsoverthis Theattachmentcanalsobe constructedwithadifferenttypeof retentionmalethathasaspace betweenthepartstoallowboth rotationalandverticalmovements

ZESTANCHOR
Idealforinterimoverdenture Derivesitsretentionfromwithintheroot Apostprepismadewithintherootandthe femalesleeveiscementedintoplace Maleportionconsistsofanylonpostanda ballheadattachmenttotheoverdentureasa chairsideprocedure. Thepostisplacedinthesleeveandthe overdentureisplacedoveritwithaselfcure resin

ADVANTAGES
Overcomes any space problem Leverage to the abutment tooth is reduced Attachment procedure is simple Parallelism is not necessary if more than one tooth is used due to the flexibility of the nylon

DISADVANTAGES
Caries susceptibility as no coping placed Nylon stud can bend preventing seating To correct this frequent recall visits are necessary When eating foods without the OD can cause food to stagnate in the female part

ROTHERMANATTACHMENT
Types:resilientandnonresilient Resilientallowsbothverticalandrotational movement Themalepartconsistsofagroovedeeperat oneendthantheother ThehousingcontainsaCshapedringthe endsofwhichfitinthedeepestpartofthe retaininggroove Adv : noneedforparallelismwhen>1copings areused Attachmentiseasy Disadv: Duetolingualbulk,thedentureisthin andthisleadstodenturefracture

INTROFIXATTACHMENT
Tallstudattachmentcomposedofasolder baseanadjustablesplitmalepostanda femalehousing Designissimpleandprovidesfrictional attachmentbetweenthetwoparts Malestudhasalongitudinalsplitthatcanbe attachedtoprovidemoreorlessretention Thisisreplaceableasitisscrewedtothesolder base Thelengthystudcanproduceatorque potential Sousedinonlyatotallytoothsupported systemorODwithexcellentsupport

OTHERATTACHMENTS

Theotherattachmentsofimportance:
Schubigerattachment Ancrofixattachment Quinlivanattachment

BARATTACHMENTS Thepurposesofusingbarsare: Splintingofabutmentteeth Retentionandsupportoftheprosthetic appliance Thereare2types: Barunits whicharetherigidtype Barjoints whichallowsomemovementofthe rotationaltype.utilizestheresidualridgefor support

BARATTACHMENTS

HADERBAR Canserveasstudorabar Itcanserveasbothbarjointsandunits Preformedplasticbarwhichisattachedtothe copingwaxupandcast Preformedplasticclipswhichareembeddedin thedenturebase Sincethebarandcliparebulky,enoughspaceis required

DOLDERBAR
Barunit:
preformedbarwithparallelsidesand roundedtopsolderedtothecoping Sleeveispresentinthedenturebases Retentionisduetofriction Ifthepostofthecopingscannotbemade paralleltoseatthesolderedbarthena schubigerunitisused Becauseoftheparallelwallsandclose adaptation,rotationisnotpossible

Barjoint:
Eggshapedbarwithaspacer.Thisallows somemovement Difficulttoadapttotissuecontourand bulky

BAKERCLIP AsmallUshapedclipof11and14gaugetofitover thewireofthesamegauge Wireissolderedovertothepostcoping Theclipisplacedonthewire Itisthenpickedintothedentureusingaselfcure resin

ACKERMANCLIPANDCMCLIP
Itconsistsofaroundbarsolderedtothepost copings Theclipfitsoverthebar Itinadditionhasretentionwingsfor engagementoftheclipintotheresinifthe overdenture Spacerissupplied,sobothrotationaland verticalmovementsareallowed Itisanexcellentchoicebecauseoftheease offixationandthesmallsize

Advantageanddisadvantageofrigidandresilient typeofattachment

MAGNETS
Detachablekeeperelement:

madeofstainlesssteelthatisfixedtothe abutmentteeth Thiscanbedoneby:

Cementinginapreformedkeeperafterpreparation ofthetooth Screwinginapreformedkeeper Castingarootcapanddowelkeeperandcementing thattoplace Dentureretentionelement hasapaired,cylindricalCoSm magnetsaxiallymagnetizedandarrangedwiththeir oppositepolesadjacent

MAGNETICRETENTION

IMPLANTSUPPORTED OVERDENTURES

INTRODUCTION Animplantretainedoverdentureisanalternative formoftreatmenttothefixedimplantprosthesis. Thedenturemayattachonacastbarfixedto abutments,oritmayattachtoindividual abutments. Pt.canremovetheoverdentureforcleaning Duetoanincreasedawarenessofthevarietyof clinicalsituations,bonedensity,biomechanics,and patientsdesires,andanevergrowingnumberof patientsbenefitfromadditionalretentionand supportthroughthehelpofimplantsupported overdentures.

PROSTHETICOPTIONSIN IMPLANTDENTISTRY
FP1 Fixed,replacesonlythecrown;Lookslikea naturaltooth. FP2 Fixed,ReplacestheCrownandaPortionof theRoot. FP3 Fixed,ReplacesMissingCrownsandGivngival ColorandPortionoftheEdentulousSite RP4Removable,overdentureSupported CompletelyByimplants. RP5Removable,overdenturesupportedbyboth softtissueandimplant.

INDICATIONS Implantsupportedoverden
Atrophicridge,thereforeobjectiveimprovement cannotbeexpectedbyfabricationofnew conventionaldentures Edentulouspatientswhoarenolongerableto wearcompletedentures. Thepatientisbasicallysatisfiedwithcomplete denturesbutwantsthesecurityofincreased retention. Thepatientsgeneralhealthallowsonlyashort surgicalprocedure.

 Residualridgewillpermittheinsertionofat leasttwoimplants Patienthasnoexaggerated,unrealistic expectationsforsuccess. Patienthaswornremovabledentures previously Economics:thepatientiseitherunwillingor unabletobeartheexpenseofafixed reconstruction.

CONTRAINDICATIONS
Patient selection for implantsupported overdentures is best established on the basis of the following exclusion criteria;

Reduced intellectual capacity to the point that communication is difficult or impossible Mental disorders or unresolved emotional problems. Abuse of medications and drugs Inadequate bone substance for placement of at least two implants Systemic conditions that are absolute

 ABSOLUTE:
Chemotherapy Uncontrolledmetabolicdisorders Longtermantibioticandsteroidtherapy Immunosuppression IntoleranceofadrenalineinLA.
RELATIVE

Diabetes Priorradiationtherapy Anticoagulationtherapy

 Thepresurgicalevaluationofan overdenturepatienthasthefollowing goals:

Toavoidinterferencebetweenthe prospectivepositionsoftheimplants,the attachments,andthedenturebase. Tooptimizeplacementoftheimplantsin relationtobonemassandanatomical structures Todistributetheimplantssothatthe attachmentdevicesarereasonably arranged

IMPLANTPLACEMENT
Thegreatestavailableheight ofboneislocatedinthe anteriormandible,between thementalforaminaor anteriorloopsofthe mandibularcanalwhen present Theavailableboneofthe anteriormandibleisdivided intofiveequalcolumnsof boneservingaspotential implantsiteslabeledA,B,C,D, andE,startingfrompatients rightside.

NUMBEROFIMPLANTS Twoorfourimplantsareusuallyusedtoanchoran overdenture.Thereisaincreasingtendencyto placeonlytwoimplants,especiallyinthe mandible, Economicconsiderations Generalconditionsofthepatient. Simplificationofthesurgicalproceduretothe necessaryminimum Clinicalexperienceindicatingthattwoimplants provideenoughretention.

REQUIREMENTS Distancebetweenbarconnectedimplantsmust benolessthan8to10mm,sothatthelengthsof thebarsegmentsbetweenimplantsaresufficient forproperplacementoftheretentionclips. Arrangementoftheimplantsshouldbeas symmetricalaspossible. Pointsofemergenceofallimplantsshouldlieat thesameheight Inmandible,twoimplantsmaybesufficient Inmaxilla,morethantwoimplantsrecommended

OVERDENTUREMOVEMENT
Prosthesismovementmayoccurinoneto sixdirections:occlusal,gingival,facial, lingual,mesialand/ordistal. TheactualODmovementmaybe completelydifferentfromtheoneprovided byindependentattachments Prosthesismovementisevaluatedwhilein placebutcanberemoved.

PM - 0

IF PROSTHESIS IS RIGID WHILE IN PLACE BUT CAN BE REMOVED

PM - 2 PM 3 PM - 4

HINGELIKE PROSTHESIS MOVEMENT PERMITS ACTION IN TWO PLANES SYSTEM THAT PERMITS APICAL MOVEMENT AND A HINGE MOTION SYSTEM ALLOWS A RANGE OF MOTION IN A MESIAL, DISTAL, FACIAL AND LINGUAL DIRECTION. PERMITS ALL RANGES OF PROSTHESIS MOVEMENT

PM - 6

Mandibular overdenture treatment option

MaxillaryTreatmentOptions

Option1 edentulousmaxilla with46implantsof3are positionedinpremaxilla Option2 edentulousmaxilla with710implantsforsupport

ATTACHMENTS

FEMALEPORTION PROSTHESIS MALEPORTION IMPLANTS BARATTACHMENTSYSTEMS

MECHANICAL
CLIPS STUD ORINGS

MAGNETIC

UNCONNECTEDFIXTUREOPTIONS
MECHANICAL
MAGNETIC

BALL(ORING)ATTACHMENT
COMPONENTS
ORING(ODPART)
SILICONE,NITRILE, FLUOROCARBON, ETHYLENEPROPYLENE

METALENCAPSULATOR
STAINLESSSTEEL

ORINGPOST(IMPLANT PART)
MACHINEDTITANIUM ALLOYORACAST PRECIOUSMETAL

MAGNETATTACHMENTS

Rareearthelementmagnets(denture part) Neodymiumironboronalloyor samariumcobaltalloy Corrodequicklyinoralfluids Soencasedinprotectivecoating Protectedduringprocessing Ferromagnetickeepermadeof ferromagneticalloy(implantpart)

BARATTACHMENTS

Purposeofbaristoanchorthe prosthesis Movableretentionmechanism round barandtheeggshapedbarbydolder (barjoint) RigidbarsareUshaped(sliding attachmentbar)

 MOVABLERETENTION
Allowthedenturetorotatearoundthebarsaxis Posteriorridgesegmentsbecomeloadedbythe denture Ifroundbarisbentbetweentwoimplantsormultiple implantsareconnectedwithroundbarsegmentstwo ormoreaxisorrotationresult,preventrotation

RIGIDBARS
Rigidregardlessof numberofimplants Posteriorridgeremain virtuallyunloaded Moreloadtobeborne byimplants

MAINTENANCECARE

HYGIENECHECKLIST:
Evaluatehygiene Identifyandchartproblemareas Placebarandscrewsinultrasoniccleaner Removeplaquewithrubbercup

Removecalculuswithspecial scalersofhardplastic Reinforceoralhygieneinstructions Practicewiththepatient Evaluatecleanlinessoftheprosthesis Cleanthedentureinanultrasoniccleaner

PROSTHETICFOLLOWUPCARE
Occlusion(remountingrecords) Base(relining) Pressurespots Bar(loosescrews) Barclips(broken,loose) Femaleretainersandclipsremounted withacrylicresin Signsofwear

ADVANTAGES 1. 2. 3. 4. 5. 6. 7. 8. 9. prevent bone loss. maintain facial esthetics, reduce or eliminate prosthesis movement create reproducible centric relation occlusion. eliminate soft tissue abrasions. improve prosthesis retention. increase occlusal force improve prosthesis retention improve chewing efficiency.

10. improve speech compared with dentures.

DISADVANTAGES 1. Eliminate bone grafting or implants with poor prognosis for fixed restorations. 2. some patients want implants primarily because they do not want to be able to remove the prosthesis. This would not satisfy the psychologic need of these patients to feel that the prosthesis is part of their body. 3. lack of sufficient inter-arch space makes an overdenture system more difficult to fabricate than a porcelain fused to metal fixed prosthesis and more prone to component fatigue and failure.

CONCLUSION
Theoverdenturedescribedarea deviationfromthenormaldental treatmentmethods. These,aredefinitivelyadvantageousto thepatientandthereforeshouldbe undertakenwhenevertheclinical situationsprovideaopportunity.

REFERENCES
Essentials of complete denture prosthodontics Sheldon Winkler 2nd edition Prosthodontic treatment for edentulous patients ZarbBolender 12th edition Complete denture prosthodontics John J. Sharry Syllabus of complete dentures Charles M. Heartwell & Arthur O. Rahn 4th edition Dental Implant Prosthetics Carl E . Misch JPD.,44:247,1980 JPD.,30:703,1973 JPD.,11:689,1961 JPD.,26:251,1971 JPD.,35:228,1976

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