FENTON THE JOURNAL OF PROSTHETIC DENTISTRY

The decade of overdentures: 1970-1980

Aaron H. Fenton, DDS, MSa
Faculty of Dentistry, University of Toronto, Toronto, Ontario

Jaw bones resorb when teeth are lost. People cannot function as well with complete dentures
compared with their natural teeth. As more people are living longer and these cumulative effects
become increasingly documented, dentists in the 1970s attached more importance to keeping teeth.
The concept of overdentures developed as a simple and economic alternative to prolong the reten-
tion and function of the last few teeth in a compromised dentition. The previous option was
extensive fixed prosthodontics. An overdenture is a complete or removable partial denture that has
one or more tooth roots to provide support. Rather than extracting all compromised teeth, the
crowns, and pulpal tissue of selected teeth (usually two anterior teeth) are removed. The remaining
root projecting through the mucosa is restored and/or contoured. With the crown removed, there
is space to cover the area with a denture. The root has less mobility, and its retention retards bone
resorption. Overdentures with roots are more stable, and patients can chew better than with
dentures supported on residual alveolar bone and mucosal tissue alone. Keeping even a few teeth
has a strong psychological value for some patients. Patients who have lost teeth, adjacent tissue,
and bone need replacement of more oral structures than tooth crowns alone can provide. A com-
plete denture with flange contours can restore tissue and appearance. The conventional tooth-
supported overdenture concept continues to be an accepted treatment modality and has now been
adapted to implants. (J Prosthet Dent 1998;79:31-36.)

D entistry through the centuries has been prima-

rily concerned with removing disease. From the barbers
and surgeons of Paul Revere’s time, dentists have been
successful at giving patients relief from pain. The pro-
fession gained an increased acceptance with the intro-
duction of reliable anesthesia. With the discovery of ni-
trous oxide by Horace Wells and ether by William
Morton, extractions became painless.1
Hunter2 advocated dental extraction to cure a vari-
ety of medical ailments and indicted restorative den-
tistry as “mausoleums of gold over a mass of sepsis.”
Despite the efforts of John Greenwood who carved
dentures for George Washington, dentistry has had lim-
ited success at replacing teeth until reliable denture
materials were developed. In the 1850s, Claudius Ash
and Seymour White1 developed porcelain teeth, and
Nelson Goodyear1 patented a process for vulcanizing
rubber to create a serviceable denture base. Thus the
first part of the twentieth century was characterized by
a strong focus of dental extractions to cure disease,
along with methods of complete denture fabrication
to replace teeth for edentulous patients. In the 1950s,
health sciences began to apply more of the scientific
method in clinical medicine and dentistry. What be-
came evident was that tooth loss started a cascade of
alveolar bone loss, irrespective of the health of the over-
all skeleton.
Cross-sectional and longitudinal studies displayed
Presented at the annual meeting of the Academy of Prosthodontics,
Halifax, Nova Scotia, Canada, May 1997.
a
Associate Professor, Department of Prosthodontics.
the destructive results of dental extractions.3-5 More
bone loss occurs in the anterior areas than the poste-
rior areas of the jaws, and more bone loss occurs in
the mandible when compared with the maxilla. Thus
the area that is most critical for maintaining teeth to
retain alveolar bone is the anterior region of the man-
dible.
Dentists became more aware that tooth retention in
association with complete dentures was valuable and
various authors described the effect of maintaining teeth,
or tooth roots, under complete dentures.6-10
THE OVERDENTURE CONCEPT
By the 1960s, there was sufficient information to
launch the concept of overdentures as a viable treatment
modality.3-5,8-10 Dentists were already successful at mak-
ing complete dentures and providing periodontal and
endodontic treatment for single rooted anterior teeth.
They were also aware of the alveolar bone loss that fol-
lowed tooth loss. The possibility of intentionally leaving
roots under dentures began to receive consideration. The
landmark articles that described simplified overdenture
treatments were published in 1969 by Morrow et al.11
and Lord and Teel.12 Later textbooks described the vari-
ous principles, concepts, and practices specific to
overdenture therapy.13-17
The key to this procedure is elective endodontics. This
allowed for a shortened dental crown, which created ad-
equate space for the overlying artificial denture tooth
and denture base. The shortened crown also improved
the crown to root ratio, which reduced the mobility of
roots with limited bone support (Fig. 1).
A second important planning factor was the selection

JANUARY 1998 THE JOURNAL OF PROSTHETIC DENTISTRY 31

THE JOURNAL OF PROSTHETIC DENTISTRY FENTON

A B

C D
Fig. 1. Classic mandibular overdenture. A, Clinical view, and B, radiographs of compromised
anterior teeth. C, Two canines are shortened, treated endodontically, and restored with silver
amalgam. Hopeless teeth have been removed. D, Overdenture intaglio shows root surfaces
within denture contours.

A B
Fig. 2. A, Edentulous maxillae are traumatized by denture opposing complete intact mandibu-
lar dentition. B, Retention of even one root preserves ridge contour, denture position, and
function.

of strategic roots for retention. Preservation of at least
two roots in the anterior mandible to avoid the advanced
resorption of the anterior edentulous mandible has been
the primary application of the overdenture. Another cri-
terion was maintenance of equivalent dental support in
opposing arches. When an almost complete mandibular
dentition remains, the retention of some maxillary an-
terior tooth roots enhanced the stability and acceptance
of a maxillary overdenture (Fig. 2, A and B).
OVERDENTURE FABRICATION
Two of the most common methods of making
overdentures are by making an interim denture, or an
immediate overdenture. An interim denture provides an
ideal method when an adequate existing removable par-
tial denture can be modified to become a complete pros-
thesis. Denture teeth and associated flanges are added
to the existing partial denture, selected abutments are
endodontically treated, and the remaining teeth are ex-

32 VOLUME 79 NUMBER 1
FENTON
Fig. 3. A, Without root support, mandibular denture has
“settled” and occlusion has shifted. B, For another patient,
lateral skull radiograph illustrates how overlaid roots preserve
facial height and contour.
tracted. The interim overdenture is inserted and relined
with a tissue-conditioning material. When healing is
complete, a definitive overdenture can be made. One
disadvantage of this method is that patients are often
satisfied with the interim prosthesis, and it may be many
years before the patient returns for the definitive pros-
thesis.
To fabricate immediate overdentures, the master cast
is trimmed to simulate the retained roots, endodontic
therapy is performed, and the tooth roots are prepared
to the estimated contour on the trimmed master cast
before removal of the remaining hopeless teeth. The
immediate denture is inserted and the local area relined
with a tissue-conditioning material maintains the stabil-
ity and security of the immediate overdenture. At subse-
JANUARY 1998
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 4. Overlaid root functions in confined space and is vul-
nerable to decalcification.
quent appointments, the roots are restored and protected
with fluoride. A disadvantage to this procedure is that it
is not possible to have a complete wax try-in to fully
assess the appearance and tooth position and obtain the
patient’s consent before processing the denture.
RESULTS
The concept of overdentures was presented at the
World Dental Congress in 1861 by Butler, Roberts, and
Hays who presented case histories of 12 years.11 The
current concepts of overdentures were presented to the
American Dental Association at the 1970 annual meet-
ing in Las Vegas, Nev. Dr. Charles Bolender and his study
club presented a step-by-step outline of overdenture
treatment modalities. Since that time, longitudinal stud-
ies have documented this concept of making complete
dentures that intentionally retained roots. The 12-year
data18-20 from these and other studies provide the fol-
lowing evidence-based information:
Overdentures provide better function than complete
dentures through a variety of parameters, such as im-
proved biting force and chewing efficiency and increased
speed of controlled mandibular movement.21 The im-
pairment of these parameters created by an edentulous
condition is partially maintained by the mere retention
of two tooth roots.
The retained roots that support overdentures preserve
bone and minimizes the downward and forward settling
of a denture, which otherwise occurs with alveolar bone
resorption.22 The overdenture occlusion is maintained
rather than shifting forward to simulate the appearance
of an Angle Class III malocclusion (Fig. 3, A and B).
Because of the close proximity of the prosthesis, gin-
givitis around the retained tooth root is more prevalent,
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Fig. 5. A, View after polishing and prophylaxis. Amalgam (am) and dentin (d) covered by
“smear layer” of plaque, prophylaxis paste, and oral fluids. (Original magnification ´100.) B,
View after 10 seconds acid wash and rinse; (am), amalgam sealing pulp chamber in upper right
corner of view; (2d), secondary dentin deposited on pulpal surface is poorly calcified, porous,
and caries is almost inevitable; (1d), primary dentin of root more calcified but still porous. Acid
exposure opens dentinal tubules to leave porous, caries susceptible surface. (Original magni-
fication, ´100.) C, View of acid washed primary dentin of prepared overlaid mandibular ca-
nine with porous tubule openings. (Original magnification, ´2000.)

but manageable.23,24 With excellent home care and pro-

Fig. 6. Two coverings to protect overlaid roots. Root on left has
dentin bonded unfilled light-cured resin covering all dentin for 2
years; root on right overlaid with gold casting since 1971 (26 years).
fessional assistance, overlaid roots can be maintained at
the level of health similar to untreated controls.
Decay can be problem with overlaid roots,25 as they
are more vulnerable to caries for two reasons. First, the
teeth are in an enclosed environment as they are cov-
ered by the overdenture. The potential for salivary buff-
ering is reduced and the risk of acid attack is increased.
Overlaid maxillary tooth roots and all roots in patients
with reduced salivary flow are at increased risk of caries
(Fig. 4). Secondly, it is known that the calcification of
dentine varies with location.26 The dentin close to the
pulp is less calcified than dentin near the root surface.27,28
When a tooth is reduced to create an overlaid root un-
der a denture, the deeper, more porous dentin is left
exposed. The problem with overlaid root caries is that it
appears to occur in the deeper dentin around the mar-

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FENTON THE JOURNAL OF PROSTHETIC DENTISTRY

Fig. 7. Scanning electron microscopy views of coverings of roots from patient in Figure 6.
(Original magnification, ´20.) A, Left root with dentin bonding sealing all porous root dentin to
create caries resistant acrylic resin surface. B, Right root covered with cast gold crown exhibits
worn and irregular but still functioning margins. This dentin-cementum surface is caries resis-
tant.

gin of the restoration, which seals the pulp chamber,
rather than at the root surface. Caries control has been
attempted by covering the root with a metal casting for
protection or by topical fluoride application. Gold cast-
ings increase the costs to the patient, and topical agents
depend on daily patient compliance. Chlorhexidine has
also been advocated for caries control.29
A fourth method to protect overlaid root dentin from
caries is to use dentin bonding agents. After tooth prepa-
ration, a smear layer is left on the tooth and dentinal
tubules are open. These tubules should be sealed and
covered to arrest decay (Fig. 5). When sufficient low
viscosity unfilled resin is applied liberally, and light po-
lymerized, the dentinal tubules are plugged, and the
surface should be protected. 30 After polishing, the
smooth convex surfaces should have less caries suscepti-
bility. This surface may wear, but it can be resurfaced at
any time (Figs. 6, and 7, A and B).
SUMMARY
Overdentures supported by natural teeth generated a
decade of excitement and interest in prosthodontic
circles. They were the last line of defense that success-
fully kept patients from becoming edentulous. Patients
could chew better, their ridges did not resorb as quickly,
and they had dentures that were more stable and reten-
tive. There is little similarity between a complete den-
ture on resilient mucosa and an overdenture. From 1970
to 1980, this treatment modality was popular and the
concept experienced widespread use in dentistry. By the
end of that decade, P. I. Brånemark had provided the
evidence to promote titanium implants as successful
tooth replacements.31 The concept of overdentures is
even more popular when applied to titanium “roots.”
Titanium is not vulnerable to the perils of periodontal
disease and caries, and implants have a better prognosis
than compromised teeth or tooth roots.19,20,31 The de-
cade of dental overdentures was being succeeded by
implant overdentures.
WHAT IS THE FUTURE?
There seems to be an understanding in the dental com-
munity that complete denture prosthodontics will de-
cline. With the availability of implant-supported den-
tures, that understanding seems to be that dentists will
no longer have to obsessively use the most meticulous
edentulous impression and articulation techniques to
help patients manage complete dentures on resilient
mucosa. If more security is desired, just turn to tita-
nium. This approach makes it easy to ignore classic qual-
ity denture delivery and service. Dental overdentures are
still an excellent therapeutic concept, but they will be
used less frequently because implants are available. Den-
tists will be able to maintain a few mobile teeth and a
removable partial denture, rather than intervene with
endodontics and overlaid roots to keep the patient’s
natural teeth. The longevity of mobile teeth can be sur-
prising, and some patients may appreciate this service.
If and when the last few teeth are lost, many patients
will function to their satisfaction with complete den-

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THE JOURNAL OF PROSTHETIC DENTISTRY FENTON

tures. If not, dentistry can offer patients the choice of a
fixed or detachable implant prosthesis. Patients are cer-
tainly better off with the range of options than can now
be offered by the dental profession.
My appreciation to R. Chernecky, M. L. Josey, and the Photogra-
phy Department, Faculty of Dentistry, University of Toronto, for as-
sistance in the preparation of this manuscript. All scanning electron
microscopic views were made by Mr. R. Chernecky.
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Reprint requests to:
DR. AARON FENTON
DEPARTMENT OF PROSTHODONTICS
FACULTY OF DENTISTRY
UNIVERSITY OF TORONTO
124 EDWARD ST.
TORONTO, ONTARIO
M5G 1G6
CANADA
Copyright © 1998 by The Editorial Council of The Journal of Prosthetic Den-
tistry.
0022-3913/98/$5.00 + 0. 10/1/87064

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36 VOLUME 79 NUMBER 1